Chapter 515 Oregon Laws 1999
Session Law
AN ACT
SB 1156
Relating to eligibility for
medical assistance; amending ORS 414.025.
Be It Enacted by the People of the State of Oregon:
SECTION 1.
ORS 414.025 is amended to read:
414.025. As used in this chapter, unless the context or a
specially applicable statutory definition requires otherwise:
(1) "Category of aid" means old-age assistance, aid
to the blind, aid to the disabled, temporary assistance for needy families or
Supplemental Security Income payment of the Federal Government.
(2) "Categorically needy" means, insofar as funds are
available for the category, a person who is a resident of this state and who:
(a) Is receiving a category of aid.
(b) Would be eligible for, but is not receiving a category of
aid.
(c) Is in a medical facility and, if the person left such
facility, would be eligible for a category of aid.
(d) Is under the age of 21 years and would be a dependent child
under the program for temporary assistance for needy families except for age
and regular attendance in school or in a course of professional or technical
training.
(e) Is a caretaker relative named in ORS 418.035 (1)(c) who
cares for a dependent child who would be a dependent child under the program
for temporary assistance for needy families except for age and regular
attendance in school or in a course of professional or technical training; or
is the spouse of such caretaker relative and fulfills the requirements of ORS
418.035 (2).
(f) Is under the age of 21 years, is in a foster family home or
licensed child-caring agency or institution under a purchase of care agreement
and is one for whom a public agency of this state is assuming financial
responsibility, in whole or in part.
(g) Is a spouse of an individual receiving a category of aid
and who is living with the recipient of a category of aid, whose needs and
income are taken into account in determining the cash needs of the recipient of
a category of aid, and who is determined by the Department of Human Resources to
be essential to the well-being of the recipient of a category of aid.
(h) Is a caretaker relative named in ORS 418.035 (1)(c) who
cares for a dependent child receiving temporary assistance for needy families
or is the spouse of such caretaker relative and fulfills the requirements of
ORS 418.035 (2).
(i) Is under the age of 21 years, is in a youth care center and
is one for whom a public agency of this state is assuming financial
responsibility, in whole or in part.
(j) Is under the age of 21 years and is in an intermediate care
facility which includes institutions for the mentally retarded; or is under the
age of 22 years and is in a psychiatric hospital.
(k) Is under the age of 21 years and is in an independent
living situation with all or part of the maintenance cost paid by the State
Office for Services to Children and Families.
(L) Is a member of a family that received temporary assistance
for needy families in at least three of the six months immediately preceding
the month in which such family became ineligible for such assistance because of
increased hours of or increased income from employment. As long as the member
of the family is employed, such families will continue to be eligible for
medical assistance for a period of at least six calendar months beginning with
the month in which such family became ineligible for assistance because of
increased hours of employment or increased earnings.
(m) Is an adopted person under 21 years of age for whom a
public agency is assuming financial responsibility in whole or in part.
(n) Is an individual or is a member of a group who is required
by federal law to be included in the state's medical assistance program in
order for that program to qualify for federal funds.
(o) Is an individual or member of a group who, subject to the
rules of the office and within available funds, may optionally be included in
the state's medical assistance program under federal law and regulations
concerning the availability of federal funds for the expenses of that individual
or group.
(p) Is a pregnant woman who would be eligible for temporary
assistance for needy families including such aid based on the unemployment of a
parent, whether or not the woman is eligible for cash assistance.
(q) Would be eligible for temporary assistance for needy
families pursuant to 42 U.S.C. 607 based upon the unemployment of a parent,
whether or not the state provides cash assistance.
(r) Except as otherwise provided in this section and to the
extent of available funds, is a pregnant woman or child for whom federal
financial participation is available under Title XIX of the federal Social
Security Act.
(s) Is not otherwise categorically needy and is not eligible
for care under Title XVIII of the federal Social Security Act or is not a
full-time student in a post-secondary education program as defined by the
Department of Human Resources by rule, but whose family income is less than the
federal poverty level and whose family investments and savings equal less than
the investments and savings limit established by the department by rule.
(3) "Income" means income as defined in ORS 413.005
(3).
(4) "Investments and savings" means cash, securities
as defined in ORS 59.015, negotiable instruments as defined in ORS 73.0104 and
such similar investments or savings as the Department of Human Resources may
establish by rule that are available to the applicant or recipient to
contribute toward meeting the needs of the applicant or recipient.
(5) "Medical assistance" means so much of the
following medical and remedial care and services as may be prescribed by the
Department of Human Resources according to the standards established pursuant
to ORS 414.065, including payments made for services provided under an
insurance or other contractual arrangement and money paid directly to the
recipient for the purchase of medical care:
(a) Inpatient hospital services, other than services in an
institution for mental diseases;
(b) Outpatient hospital services;
(c) Other laboratory and X-ray services;
(d) Skilled nursing facility services, other than services in
an institution for mental diseases;
(e) Physicians' services, whether furnished in the office, the
patient's home, a hospital, a skilled nursing facility or elsewhere;
(f) Medical care, or any other type of remedial care recognized
under state law, furnished by licensed practitioners within the scope of their
practice as defined by state law;
(g) Home health care services;
(h) Private duty nursing services;
(i) Clinic services;
(j) Dental services;
(k) Physical therapy and related services;
(L) Prescribed drugs, dentures, and prosthetic devices; and
eyeglasses prescribed by a physician skilled in diseases of the eye or by an
optometrist, whichever the individual may select;
(m) Other diagnostic, screening, preventive and rehabilitative
services;
(n) Inpatient hospital services, skilled nursing facility
services and intermediate care facility services for individuals 65 years of
age or over in an institution for mental diseases;
(o) Any other medical care, and any other type of remedial care
recognized under state law;
(p) Periodic screening and diagnosis of individuals under the
age of 21 years to ascertain their physical or mental defects, and such health
care, treatment and other measures to correct or ameliorate defects and chronic
conditions discovered thereby;
(q) Inpatient hospital services for individuals under 22 years
of age in an institution for mental diseases; and
(r) Hospice services.
(6) "Medical assistance" includes any care or
services for any individual who is a patient in a medical institution or any
care or services for any individual who has attained 65 years of age or is
under 22 years of age, and who is a patient in a private or public institution
for mental diseases. "Medical assistance" includes "health
services" as defined in ORS 414.705. "Medical assistance" does
not include care or services for an inmate in a nonmedical public institution.
(7) "Medically needy" means a person who is a
resident of this state and who is considered eligible under federal law for
medically needy assistance.
(8) "Resources" means resources as defined in ORS
413.005 (4). For eligibility purposes,
"resources" shall not include charitable contributions raised by a
community to assist with medical expenses.
Approved by the Governor
July 7, 1999
Filed in the office of
Secretary of State July 7, 1999
Effective date October 23,
1999
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