461-160-0030 Effective 07/01/19
Overview of Costs
- Costs incurred by the filing group that the filing group has a legal responsibility to pay are deductible from income in accordance with the rules in this division of rules.
- The following costs are not deductible:
- A cost paid by someone outside the filing group through a reimbursement, vendor payment, or in-kind benefit.
- A cost that is paid by a person or company outside the filing group or that is written off by a medical facility. These are referred to as third-party payments.
- The cost for a service provided by someone in the filing group, such as child care provided by the father while the mother works.
- A cost used as an income deduction in one budget month or averaged over several months cannot be used again.
- In the OSIPM program, a cost that the client incurred while the client was serving a disqualification from Medicaid under OAR 461-140-0210 to 461-140-0300 for a transfer of assets for less than fair market value.
- In the OSIP and OSIPM programs, the medical deduction allowed under OAR 461-160-0620 is determined as follows:
- In order to be allowed as a deduction, a cost or portion of a cost that has already been paid must be reported in the month it is paid or within 10 days of the date it is paid.
- For one-time costs that have been incurred but not paid in full:
- Any amount already paid when reported is allowed if it was reported in the month that it was paid or within 10 days of the date it was paid.
- For amounts not already paid, the amount allowed as a deduction is the amount the individual expects to pay each month, not to exceed the total amount due at the time the cost is reported.
- Deductions for one-time medical expenses that have been paid with a credit card are allowed as follows:
- The amount allowed as a deduction is the amount the individual expects to pay or is currently paying each month on the card until the outstanding balance of the medical cost would be paid in full.
- For costs charged prior to the month reported, the outstanding balance is the amount of the original cost charged to the card less any subsequent payments to the card.
- Count all payments made to the credit card toward the principal balance of the medical cost.
- Additional deductions are not allowed if the individual incurs interest or fees.
- Recurring costs, such as those for ongoing prescription medications, may be anticipated and allowed until the total amount of the cost has been allowed or through the next annual redetermination (see OAR 461-115-0430), whichever occurs first.
- The amount anticipated should reflect actual and verified costs.
- Recurring costs may not be averaged.
- The effective date for an allowable cost is determined in accordance with OAR 461-180-0020.
- Additional deductions are not allowed if the individual fails to pay the cost.
Statutory/Other Authority: ORS 409.050, 411.060, 411.400, 411.404, 411.816, 412.014, 412.049, 413.085, 414.685
Statutes/Other Implemented: ORS 409.010, 411.060, 411.400, 411.404, 411.816, 412.014, 412.049