Generic Program Elements N. Miscellaneous

DHS home | SPD Staff Tools | Generic Program Elements | N. Miscellaneous

Generic Program Elements

N. Miscellaneous

Effective 9/1/11

1. Eligibility for Inmates

For information on case susmention for inmates, see the HB 3536 website.

An inmate is an individual living in a public institution who is:

Confined involuntarily in a local, state or federal prison, jail, detention facility, or other penal facility, including a person being held involuntarily in a detention center awaiting trial or a person serving a sentence for a criminal offense;
Residing involuntarily in a facility under a contract between the facility and a public institution where, under the terms of the contract, the facility is a public institution;
Residing involuntarily in a facility that is under governmental control; or
Receiving care as an outpatient while residing involuntarily in a public institution.

An individual is no longer an inmate when:

The person is released on parole, probation, or post-prison supervision;
The person is on home- or work-release, unless the person is required to report to a public institution for an overnight stay; or
The person is staying voluntarily in a detention center, jail, or county penal facility after his or her case has been adjudicated and while other living arrangements are being made for the individual.

A public institution is any of the following:

A state hospital (as defined by ORS 162.135) such as the Oregon State Hospital, Eastern Oregon Psychiatric Center, and any other hospital established by law for similar purposes, including the "SAIP" means Secure Adolescent Inpatient Program (SAIP), and the Secure Children’s Inpatient Program (SCIP).
A local correctional facility (as defined in ORS 169.005): a jail or prison for the reception and confinement of prisoners that is provided, maintained and operated by a county or city and holds persons for more than 36 hours.
A Department of Corrections institution (as defined in ORS 421.005): a facility used for the incarceration of persons sentenced to the custody of the Department of Corrections, including a satellite, camp, or branch of a facility.
A youth correction facility (as defined in ORS 162.135):
- A facility used for the confinement of youth offenders and other persons placed in the legal or physical custody of the youth authority, including a secure regional youth facility, a regional accountability camp, a residential academy and satellite, and camps and branches of those facilities; or
- A facility established under ORS 419A.010 to 419A.020 and 419A.050 to 419A.063 for the detention of children, wards, youth, or youth offenders pursuant to a judicial commitment or order.

As used in this rule, the term public institution does not include:

A medical institution as defined in 42 C.F.R. 435.1009;
An intermediate care facility as defined in 42 C.F.R. 440.140 and 440.150;
A publicly operated community residence that serves no more than 16 residents, as defined in 42 C.F.R. 435.1009; or
A child-care institution as defined in 42 C.F.R. 435.1009 with respect to:
- Children for whom foster care maintenance payments are made under title IV-E of the Social Security Act; and
- Children receiving TANF-related foster care under title IV-A of the Social Security Act.

If this policy indicates that the medical benefits of a client are suspended, a client meeting the eligibility requirements of a program covered under chapter 461 of the Oregon Administrative Rules is not required to submit a new application for the benefits to be reinstated.

For all programs:

Except as covered in 461-135-0750, an inmate of a public institution is not eligible for benefits.
If a pregnant woman receiving medical assistance through the GAM, OHP, or OSIPM program is an inmate of a public institution, her medical benefits are suspended. When the Department is informed the woman is no longer an inmate, her medical benefits are reinstated—effective on the first day she is no longer an inmate—if she is still in her protected period of eligibility under 461-135-0010(2).
In all other Medical programs OPAR will 'susmend' the medical benefits unless the case is coded APD,ICP,NFC, DAN or DDS. These cases will be sent to the local office for processing.

Not all SPD clients will be eligible for benefit reinstatement upon release. If the case has been in susmend status for more than 12 months, the client will need to reapply for Medicaid. Please follow the following case-specific actions for clients released within 12 months of incarceration who contact the local office upon release. Susmended SPD cases will have a 913 case descriptor except OHP cases, which will have a DOC case descriptor. Please do not remove the case descriptor:

SSI recipient: Restore the case. Inform the client that they need to contact SSA and request that their SSI be reinstated.

Protected Eligibility Groups: Restore the case. Inform the client that they need to contact SSA and request that their SSD benefits be reinstated.
PMDDT clients: If the client is released prior to a medical review due date, reopen the case. If the client was incarcerated when the medical review came due, they will need to reapply for PMDDT and be redetermined to meet the disability criteria.

QMB/SMB/SMF: SSA does not maintain Medicare eligibility for inmates. Do not reopen the case until you can determine that Medicare has been reinstated.

Service Cases: If the client is incarcerated for fewer than 30 days, the incarceration is not considered a break in services and Medicaid can be restored without a new assessment. If the client is incarcerated for over 30 days, a new period of care begins and the client will need a new assessment. 461-001-0030.

EPD Cases: If the client is incarcerated fewer than 30 days and can verify continuing employment upon release, restore EPD case. If client is incarcerated fewer than 30 days and can not verify employment or is incarcerated over 30 days, they would no longer qualify for the EPD program.

OHP Cases: If the client is released before their redetermination comes due, reopen the case and process the redetermination at the regular review period. If the client was incarcerated when their redetermination came due, redetermine their eligibility for OHP. If they continue to be eligible, restore the case and update the redetermination date.

In the Food Stamp and GA programs, in addition to the other provisions of this rule, an inmate released from a public institution on home arrest, and required to wear an electronic device to monitor his or her activity, is ineligible for benefits if the correctional agency provides room and board to the person.

461-135-0950

2. Plan for Self-Support Rules

461-140-0410 Criteria for Developing a Plan for Self-Support
461-140-0420 Treatment of Assets Under a Plan for Self-Support
461-140-0430 Cooperation with a Plan for Self-Support
461-140-0440 Establishing New or Revised Plans for Self-Support

3. Sponsored Noncitizens

For information on sponsored noncitizen see Family Services Manual section 9.C.5 & C.6, Noncitizens.

If you have a disability and need a document on this Web site to be provided to you in another format, please contact Donna Zeit at (503) 945-7021. If you know of others who need this accommodation, please let them know it is available.