OHP E. Financial Requirements (2024)

OHP program manual

E. Financial requirements

Effective 10/1/13

1. Overview of Assets

An asset is counted as income, counted as a resource, or excluded in any given month. When an asset is excluded, it is not counted as either income or a resource. An asset that is counted as income is excluded as a resource in that month. When determining financial eligibility, count all assets that are not specifically excluded. For more information on whether to count types of income or a resource, refer to Counting Client Assets (see also for information on the availability of assets) or the OHP Asset Quick Reference Chart at the end of this chapter.

461-140-0010

2. Countable Resources

When determining OHP eligibility, calculate the amount of the eligibility group’s countable resources by counting only cash and types of resources that can be readily converted to cash; i.e., bank accounts, stocks and bonds. Money in a bank account is excluded if it is from an excluded payment and is kept separate from other resources. Resources that cannot be readily converted to cash, such as a home, motor vehicles and retirement accounts, are also excluded (if monthly income form these items is received, may be considered income).

3. Resource Limits

When a financial group has countable resources that exceed the allowable limit for a program, some or all members of the group may be ineligible for medical assistance.

For OHP, there is no resource limit for persons under age 19 whose eligibility is determined under the OHP-CHP, OHP-OPC, OHP-OP6 or OHP-OPP categories.

The resource limit for non-pregnant adults whose eligibility is determined under the OHP-OPU category is $2,000.

• Note: The OHP financial group may include some people who are subject to a resource limit and others who are not, depending on which category they are in.

Resource transfers are excluded for OHP. See rule 461-140-0210.

Availability of resources: 461-140-0020
Resource limit: 461-160-0015

4. Income Deductions

Income deductions are specified amounts that are subtracted from the eligibility group’s countable income.

Unless a person is self-employed, do not allow any income deductions from earned or unearned income. If a financial group contains a person with significant authority in a business, the group must not have gross income over $20,000 in the budget month. If gross income exceeds $20,000, they are not eligible for OHP. If gross income is less than $20,000, they are allowed a minimum deduction of 50% of their gross sales and receipts and a maximum of the total excludable costs, when determining their countable earned income. This is intended to allow for their costs of producing the income.

Use of Income: 461-160-0700
Self-employment: 461-145-0930Income Standard OHP: 461-155-0225

5. Eligibility and Budgeting

A change in income or resources during a certification period does not affect the eligibility of the benefit group for that certification period.

Click here for definitions used in eligibility and budgeting.

Click here if the financial group includes a person with significant authority in a business entity ("principal").

Do not annualize, convert or prorate the financial group's income. Use the gross countable income available for each month of the budgeting process. For self-employment income, see CCA C.

Budget month. When determining financial eligibility for OHP programs, first determine the budget month. The budget month is one of the following:

• For a new applicant, the month of application.
• For a client reapplying at the end of an OHP certification period, and for clients moving from Plus to OHP-standard, the last month of the current eligibility period.
• When the Department initiates a redetermination of eligibility, the month the Department initiates a date of request.
• For an individual joining a filing group, the month in which the individual requests medical benefits.
• For a late reapplication, the month the application is received.
• For individuals who are not eligible using the budget month described above, float to the month following the initial budget month to determine eligibility, but no further.

The budget month is the calendar month from which nonfinancial and financial information is used to determine eligibility and benefit level.

Budgeting: 461-150-0055
When an Application Must be Filed: 461-115-0050

Calculate the amount of the financial group's countable income using the following steps:

For each member of the need group, the countable income of the financial group from the budget month is used to determine eligibility as follows:

• Compare the countable income to the OHP Countable Income Standards of 100%. If the countable income is below the 100% standard and the group meets all other eligibility requirements, the group is eligible for OHP. There is no need to evaluate eligibility using income received in the budget month. Use the OHP case descriptors for each eligible person as follows:
  • OPU - Nonpregnant adults
• OPC - Children
• OPP - Pregnant persons, regardless of age

• If the countable income equals or exceeds the 100% income standard, nonpregnant adults (except DV) are not eligible. Determine eligibility for the remaining members of the need group as follows:
  • Compare the countable income to the OHP Countable Income Standards as appropriate. If the countable income is below an income standard for all remaining members of the need group, and all of these members of the need group meet all other eligibility requirements, these members of the need group are eligible for OHP. Use the OHP case descriptors for each eligible person as follows:
    • OP6 - Children under 6 (income below 133% FPL)
    • CHP- Children (income below 301% FPL)
    • OPP - Pregnant persons, regardless of age (income below 185% FPL

• If the need group includes children or a pregnant person who were not eligible using the countable income, determine eligibility for all children and pregnant persons in the need group using the amount of countable income received and anticipated to be received in the budget month.

• If the need group includes a victim of domestic violence, and any of the need group members are not eligible using the financial group’s countable income, determine eligibility for everyone in the need group using the amount of countable income received and anticipated to be received in the budget month.

Use the following process to determine eligibility using budget month income:

Compare that single month’s income to the OHP Countable Income Standards. If the single month’s income is below an income standard and the group meets all other eligibility requirements, each child, nonpregnant adult (DV), and pregnant person whose eligibility is determined utilizing the income standard is eligible. Use the OHP case descriptors for each eligible person as follows:

• OPC - Children (income below 100% FPL)
• OP6 - Children under 6 (income below 133% FPL)
• CHP- Children - DV only (incomebelow 301% FPL)
• OPP - Pregnant persons, regardless of age (income below 185% FPL)
• OPU- Nonpregnant adult - DV only (income below 100% FPL)

An assumed eligible newborn is coded as OHP-OPC, OHP-OP6 or OHP-OPP, depending on income level. An assumed eligible newborn at or above the OHP-OP6 (133%) Income Standard is not to be coded OHP-CHP.

Eligibility and Budgeting: 461-150-0055
Use of income: 461-160-0700

If a group contains a person with significant authority in a business entity—a “principal” as defined in 461-140-0088 or a person who is self-employed - the group is ineligible for the OHP program if the gross income (in the budget month) of the business entity is $20,000 or more. If the group is not ineligible under this section, its eligibility is evaluated using the standards below.

Oregon Health Plan for Adults (OPU) & Children (OPC)
OHP 100% Countable Income Standard

Effective 1-30-13

Oregon Health Plan for Children Under Age 6 (OP6)
OHP 133% Countable Income Standard
Effective 1-30-13

Oregon Health Plan for Pregnant Females and their Assumed Eligible Newborn Children under Age One (OPP)

Effective 1-30-13

Oregon Health Plan for Children (CHP)
OHP 300% Countable Income Standard
Effective 8-23-13

461-155-0225

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