Actuarially sound. A commercial annuity which pays principal and interest out in equal monthly installments over the actuarial life expectancy of the annuitant. For purposes of this policy, the actuarial life expectancy is established by the life expectancy table in SPD WG E.1. For transactions (including the purchase of an annuity) occurring:
461-145-0020 and 461-145-0022
Adjusted income. Adjusted income is countable income minus deductions.
Adult Basic Education (ABE).
Adult Foster Care (AFC). See Chapter 411, Division 050 of the Oregon Administrative Rules for more information.
Aid to the Blind (AB).
Annuitized annuity. A contract or an agreement under which one or more persons receive annuities in return for prior set payments made by themselves or another. The annuities are payable yearly or at other regular intervals for a certain or uncertain period (e.g., for years or for life).
Approved account. A segregated account in a financial institution, the purpose of which is to save to use for future disability-related expenses that would increase the individual’s independence and employment potential. Also included in this definition are accounts regulated by the Internal Revenue Code and used for retirement planning, such as IRAs, 401(k)s, TSAs, and KEOGHs. 461-001-0035
Assets. Income and resources. 461-001-0000.
Assisted living facility (ALF). See Chapter 411, Division 056 for more information.
Assumed eligible newborn (AEN). A child born to a mother who is receiving OHP (except OHP-CHP) is assumed eligible for medical benefits until the end of the month in which the child becomes one year old, as long as the child lives with the mother. The mother does not have to be currently eligible for benefits in order for the child to receive benefits.
Basic decision notice. A decision notice mailed no later than the date of action given in the notice.
BEIN. Screen that identifies SSA benefits
Beneficiary Data Exchange System (BENDEX).
Benefit group. The individuals who receive benefits. 461-110-0750
Blind work expenses (BWE). Those costs defined by the Social Security Administration (SSA) that can be used as reductions to earned income as defined in 20 CFR 416.1112(c)(8). 461-001-0035
Cafeteria plan. A written benefit plan offered by an employer in which:
(a) All participants are employees; and
(b) Participants can choose, cafeteria-style, from a menu of two or more cash or qualified benefits. In this context, qualified benefits are benefits other than cash that the Internal Revenue Services does not consider part of an employee's gross income. Qualified benefits include, but are not limited to:
(A) Accident and health plans (including medical plans, vision plans, dental plans, accident and disability insurance);
(B) Group term life insurance plans (up to $50,000);
(C) Dependent care assistance plans; and
(D) Certain stock bonus plans under section 401(k)(2) of the Internal Revenue Code (but not 401(k)(1) plans). 461-001-0000
Capital asset. Property that contributes toward earning self-employment income, including self-employment income from a microenterprise, either directly or indirectly. A capital asset generally has a useful life of over one year and a value, alone or in combination, of $100 or more. 461-001-0000
Certification period. The period for which a client is certified eligible for a program.
Citizen/Alien-Waived Emergent Medical (CAWEM). Medicaid coverage of emergent medical needs for clients who are not eligible for ADCM, OHP or OSIPM solely because they do not meet citizen/alien status requirements. 461-101-0010
Child. Child includes natural, step, and adoptive children. The term child does not include an unborn.
Children's Health Insurance Program (CHIP). Provision of the 1997 Balanced Budget Act. OHP coverage for persons under age 19 who qualify under the 185 percent income standard for medical assistance. Also known as OHP-CHP.
CIIS. Children's Intensive In-Home Services. 411-300-0100 to 411-300-0220.
Client contribution. The amount that must be paid monthly as a condition of eligibility for the EPD program. This contribution is the combination of the Cost Share and the Premium. 461-110-0115
Client Maintenance System (CMS). CMS stores case data. The information provided to CMS:
Commercial annuity. A contract or agreement (not related to employment) by which an individual receives annuitized payments on an investment for a lifetime or specified number of years. 461-145-0020 and 461-145-0022
Community based care. Any of the following:
Community based facility. A client is considered living in community based facility if the client resides at one of the following care settings licensed by the Department:
Community spouse. A person who is legally married to an institutionalized spouse and is not in a medical institution or nursing facility. OAR 461-160-0560
Continuing benefit decision notice. A decision notice that informs the client of the right to continued benefits and is mailed in time to be received by the date benefits are, or would be, received.461-001-0000
OHP-CHP. When a pregnant child is eligible for and receiving OHP-CHP program benefits loses this eligibility, her medical assistance continues through the last day of the month in which the pregnancy ends as long as she is not a recipient of private major medical health insurance. Code this case a P2 with CEC.
To be eligible for the continuous eligibility in CHP, a client must meet all of the following requirements:
Continuous eligibility ends:
All other OHP programs (Medicaid). When a non-CAWEM child who is eligible for and receiving OHP (except OHP-CHP) loses eligibility with time remaining in the 12-month continuous eligibility period, the child’s medical assistance continues for the remainder of the 12-month eligibility period. Code this case a P2 with CEM.
The continuous eligibility period is based on the most recent OHP program approval date. A child losing eligibility less than 12 months after having been approved for benefits qualifies for continuous program benefits for the balance of the 12 month period following that approval.
To be eligible for continous eligibility in Medicaid programs, a client must meet all of the following requirements:
Continopus eligibility for medicaid ends when the client --
Continuous period of care. Reside for a period of at least 30 consecutive days or until death in a long-term care facility, waiverable care setting, or an acute care hospital. If a client is receiving care at home, through natural supports or paid care, it must be verified that the individual would have met SPL at that time.
There must be sufficient evidence to show there is a reasonable expectation that the client will remain in care for at least 30 consecutive days. For the purposes of this policy, an interruption in care (for example, leaving and then returning to a nursing home, or switching from one type of care to another) that lasts less than 30 days is not considered a break in the 30 consecutive days of care. A new period of care begins if care is interrupted for 30 or more days. 461-001-0030
Cost share (EPD) . The amount of unearned income in excess of the OSIP income and payment standard that is given to the state as a condition of eligibility for EPD. 461-001-0035
Countable. An available asset (either income or a resource) is not excluded and may be considered by some programs to determine eligibility.
Countable income. The amount of available income remaining after exclusions.
Decision notice. A written notice of a decision by the Department regarding an individual's eligibility for benefits in a program. 461-001-0000
Disability Determination Services (DDS). Employees of DHS/SPD who make disability determination for federal Social Security benefits (SSI/SSDI).
Disabled. For SNAP, means a person who meets any of the following:
Disabled or has a disability (EPD). Having a physical or mental impairment, or a combination of these impairments, that meets the definition of disability used by the Social Security Administration when determining eligibility for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) as defined in 20 CFR Part 404. 461-001-0035
Disability determination (EPD). The process used to establish whether the individual’s disability meets the definitions used by the Social Security Administration (SSA) SSA in determining eligibility for Supplemental Security Income (SSI) SSI and Social Security Disability Insurance (SSDI) SSDI. 461-001-0035
Domestic violence. The occurrence of one or more of the following acts between family members, intimate partners, or household members:
Elderly. For SNAP, means a person age 60 or older. 461-110-0110
Express Lane Agency (ELA). A public agency identified in the State Medicaid Plan as an agency capable of making determinations regarding eligibility in the OHP-OPC, OH-CHP or HKC programs.
Express Lane Eligibility (ELE).The Department's option to rely on a determination made by an ELA. ELE qualifies a child for medical assistance benefits based on a finding from another public agency.
Employment (EPD). Employment refers to an ongoing work activity for which a client provides the Department with one of the following:
Employment and independence expense (EIE). The cost of any expense that can be reasonably expected to enhance the individual's independence and employment potential. 461-110-0115
English as a second language (ESL).
Equity value. Fair market value minus encumbrances. 461-001-0000
Fair market value. The amount an item is worth on the open market. 461-001-0000
Family Health Insurance Assistance Program (FHIAP). Program subsidizes the purchase of health insurance for qualified, uninsured Oregonians by paying a large part of their health insurance premiums. Link to FHIAP. Link to more information on applying for Medicaid and FHIAP.
Financial institution. A bank, credit union, savings and loan association, investment trust, or other organization held out to the public as a place receiving funds for deposit, savings, checking, or investment. 461-001-0000
SNAP cash out. Some SSI recipients and the elderly living in Clackamas, Columbia, Multnomah and Washington counties may qualify to get their SNAP via checks or direct deposit into a bank account.
Food Stamp Management Information System (FSMIS). Computer system used to calculate and issue SNAP benefits, and track SNAP clients from application through benefit issuance.
General Assistance (GA). Cash assistance to low-income individuals with disabilities who do not have dependent children.
General Equivalency Degree (GED).
Homeless. In the SNAP program, a person is homeless if the person does not have a fixed or regular nighttime residence or has a primary residence that is one of the following:
Impairment Related Work Expense (IRWE). Those costs defined by the Social Security Administration (SSA) that can be used as reductions to earned income. To be allowed, the item/service must be related to the impairment and necessary to enable the person to perform their job as defined in 20 CFR 416.976. 461-110-0115
Initial month. Initial month of eligibility means the following:
Institutionalized spouse. A person who is in long-term care or receiving waiverable home or community-based services for a continuous period and is married to a community spouse. 461-160-0560
Income-producing property. Any real or personal property that generates income for the financial group. Examples of income-producing property are:
Inmate. A person living in a public institution who is:
Intentional Program Violation (IPV).
Job Opportunities and Basic Skills (JOBS). An employment program for REF, REFM and TANF clients. JOBS helps these clients attain self-sufficiency through training and employment. The program is part of Welfare Reform. OAR 461-101-0010
JOBS Plus. Provides subsidized jobs rather than SNAP or TANF benefits. For TANF clients, JOBS Plus is a component of the JOBS Program; for SNAP clients and noncustodial parents of children receiving TANF, it is a separate employment program. Eligibility for TANF clients, SNAP clients and noncustodial parents of children receiving TANF is determined by AFS. Eligibility for UI recipients is determined by the Oregon State Employment Department. When used alone, JOBS Plus includes only clients whose JOBS Plus program participation is through the Department of Human Services. JOBS Plus administered through the Oregon State Employment Department is known in chapter 461 of the Oregon Administrative Rules as Oregon Employment Department UI JOBS Plus. The following acronyms are used for specific categories:
Landlord/tenant relationship. For all programs except SNAP, a landlord/tenant relationship exists when:
Legally married. A marriage uniting a man and a woman according to the provisions of either:
Long-term care. The system through which the Department provides a broad range of social and health services to eligible adults who are aged, blind, or have disabilities for extended periods of time. This includes nursing homes and state hospitals (Eastern Oregon and Oregon State Hospitals). 461-001-0000
Low Income Subsidy Program (LIS). A federal assistance program for Medicare clients who are eligible for extra help meeting their Medicare Part D prescription drug costs. LIS helps Medicare clients pay their monthly premium, deductible, and co-insurance costs under Part D. LIS is a means-tested program. All clients must qualify on the basis of household income, resources, and size as defined by the Social Security Administration.
Medical Assistance Assumed (MAA). The Medical Assistance Assumed program provides medical assistance to people who are eligible for the Assessment Program or ongoing TANF benefits. OAR 461-101-0010
Medical Assistance to Families (MAF). The Medical Assistance to Families program provides medical assistance to people who are ineligible for MAA but are eligible for Medicaid using ADC program standards and methodologies that were in effect as of July 16, 1996. OAR 461-101-0010
Mental health residential treatment facility. One of the following:
Monthly reporting system (MRS).
NED. SNAP - No earnings, elderly or disabled.
Nonstandard living arrangement. In the OSIP(M), and QMB programs, each of the following locations:
In all programs except OSIP(M), and QMB, a nonstandard living arrangement means each of the following locations:
Oregon Health Plan (OHP). The Oregon Health Plan Program provides medical assistance to many low-income individuals and families. The program includes five categories of people who may qualify for benefits. The acronyms for these categories are:
Oregon Supplemental Income Program (OSIP). Cash supplements and special need payments to persons who are blind, disabled or 65 years of age or older. When used alone, OSIP refers to all OSIP programs. The following acronyms are used for OSIP subprograms:
Oregon Supplemental Income Program Medical (OSIPM). Medical coverage for elderly and disabled individuals. When used alone, OSIPM refers to all OSIP-related medical programs. The following codes are used for OSIPM subprograms:
See the OSIP program manual
Parent. Parent means the biological or legal (step or adoptive) mother or father of a person or unborn child.
Past relevant work (PRW). Work done within the past 15 years, that was substantial gainful activity, and that lasted long enough for the worker to learn to how do it. 461-110-0115
Premium (EPD). The payment given to the state that is based on a graduated percentage of the individual’s total income of the individual.
Presumptive Medicaid (PM). Presumptive OSIPM.
Presumptive Medicaid Disability Determination Team (PMDDT).
Primary person. For SNAP, primary person means:
Private major medical health insurance For purposes of 461-135-1100, this term refers to a comprehensive major medical insurance plan that at a minimum provides physician services; hospitalization; outpatient lab, x-ray, immunizations and prescritpion drug coverage. This term does not include coverage under the Kaiser Child Health Program or Kaiser Transition Program but does include policies that ae purchased privately or are employer-sponsored.
Qualified Individual 1 (QI 1). Refers to the QMB-SMF program. This is the federal terminology for the program.
Qualified Medicare Beneficiaries (QMB). Programs providing payment of Medicare premiums and one program also providing additional medical coverage for Medicare recipients. Each of these programs also is considered to be a Medicare Savings Program (MSP). When used alone in a rule, QMB refers to all MSP. The following codes are used for QMB subprograms:
See the QMB program manual
Qualified Partnership Policy. A long term care insurance policy meeting the requirements of OAR 836-052-0531 that was either:
Real property. Land, buildings, and whatever is erected on or affixed to the land and taxed as real property.
Reimbursement. Money or in-kind compensation provided specifically for an identified expense. 461-001-0000
Residential Care Facility (RCF). See Chapter 411, Division 055 for more information.
Senior Farm Direct Nutrition Program (SFDNP). Food vouchers for low income seniors. Funded by a grant from the US Department of Agriculture. 461-101-0010
SFMU. System used to add a case or record changes in service levels or client payment liability.
SMUX. A screen used to access the child support master record.
Supplemental Nutrition Assistance Program (SNAP).
Social Security Administration (SSA).
Social Security Benefits (SSB).
Social Security Disability Income (SSDI).
Specialized Living Facility (SLF).
Spouse. Means an individual who is legally married to another individual. In the SNAP program, spouse includes an individual who is not legally married to another, but is presenting themselves to the community as the husband or wife by:
Shelter costs. In all programs except SNAP, housing costs (rent or mortgage payments, property taxes) and utility costs, not including cable TV or non-basic telephone charges 461-000-0001. For SNAP, see 461-160-0420.
Shelter-in-kind. An agency or person outside the financial group provides the shelter of the financial group , or makes a payment to a third party for some or all of the shelter costs of the financial group.
Shelter-in-kind does not include temporary shelter provided by a domestic violence shelter, homeless shelter, residential alcohol and drug treatment facilities or situations where no shelter is being provided, such as sleeping in a doorway, park or bus station.
Standard living arrangement. A location that does not qualify as a nonstandard living arrangement. 461-001-0000
Substantial gainful activity (SGA). The term used by SSA to describe a level of work activity and earnings. In the EPD program, an individual is engaging in SGA if their earnings are at or above the EPD income standard.
Supplemental Security Income (SSI).
Supplemental Income Payment (SIP). Typically a payment or need amount of $1.70. This payment brings an SSI client, with other unearned income less than $20, up to the OSIP payment standard. The payment/need is more for clients that are blind. SIP payments are made to SSI couple only when they both reside in the same facility and the payment is needed for room and board. The SIP is added to special or service needs to determine the actual payment.
Temporary Assistance to Needy Families (TANF). Temporary Assistance for Needy Families. Cash assistance for families when children in those families are deprived of parental support because of continued absence, death, incapacity or unemployment. Cash assistance used to be known as ADC. OAR 461-101-0010
Timely continuing benefit decision notice. A decision notice that informs the client of the right to continued benefits and is mailed no later than the time requirements in 461-175-0050. 461-001-0000
TPQY. Access through BEIN or WQY1,SSN. Request update information from SSA.
UCMS. CMS Case Update screen.
WAGE. Screen which displays the Employment Department wage records.
Waivered services. Services needed to keep a person out of a long-term care facility. Waivered services are:
Waivered client. A client receiving Title XIX waivered services for a continuous period.
Eligibility is the decision as to whether a person qualifies, under financial and nonfinancial requirements, to receive program benefits. This decision must be made before budgeting is done.
Budgeting is the process of calculating the benefit level after eligibility has been determined.
The initial month of eligibility is one of the following:
The ongoing month is one of the following:
The payment month is the calendar month for which benefits are issued.
The budget month is the calendar month from which nonfinancial and financial information is used to determine eligibility and benefit level for the payment month.