This document provides income eligibility limits for hospital presumptive eligibility determinations in Oregon for various programs. It lists the monthly income limits for six programs based on family size: Parent or Other Caretaker Relative, Adults and Medicaid Children Ages 1-18, Pregnant Woman and Medicaid Children Under 1, Former Foster Care Youth, Breast and Cervical Cancer Treatment Program (BCCTP), and CHIP Children. Hospitals should use only the listed monthly income limits to determine if an applicant is financially eligible for hospital presumptive eligibility.
This document provides income eligibility limits for hospital presumptive eligibility determinations in Oregon for various programs. It lists the monthly income limits for six programs based on family size: Parent or Other Caretaker Relative, Adults and Medicaid Children Ages 1-18, Pregnant Woman and Medicaid Children Under 1, Former Foster Care Youth, Breast and Cervical Cancer Treatment Program (BCCTP), and CHIP Children. Hospitals should use only the listed monthly income limits to determine if an applicant is financially eligible for hospital presumptive eligibility.
This document provides income eligibility limits for hospital presumptive eligibility determinations in Oregon for various programs. It lists the monthly income limits for six programs based on family size: Parent or Other Caretaker Relative, Adults and Medicaid Children Ages 1-18, Pregnant Woman and Medicaid Children Under 1, Former Foster Care Youth, Breast and Cervical Cancer Treatment Program (BCCTP), and CHIP Children. Hospitals should use only the listed monthly income limits to determine if an applicant is financially eligible for hospital presumptive eligibility.
Quick Guide to Income Eligibility (effective March 1, 2023)
Hospitals - Refer to the following table when making Hospital Presumptive Eligibility determinations based on the information required in Part 1 of the OHP 7260 form. Determine the family size for each applicant. Count the monthly gross income (before taxes) of everyone included in the family size for the specific program. If the applicant’s income is equal to or under the income limit for a program, the applicant is considered financially eligible for that program. Only calculate HPE eligibility based on monthly income. Do not consider annual income amounts. NOTE: Income standards for HPE are not the same as the income standards for regular OHP eligibility. The 5% disregard is not added, and other distinctions may apply as well. Please use this table exclusively for Hospital Presumptive Eligibility determinations. Income Group/Description Family Size Limit Do not count Parent or Other Caretaker Relative 1 $399 Parents or caretaker relatives of dependent 2 515 children in the home under age 18 or age 18 and in 3 611 high school 4 747 Child(ren)’s income Family size includes: 5 872 o Applicant Educational income 6 998 o Legal spouse of applicant 7 1,114 Child support o Applicant’s children/step-children under 8 1,230 age 19 SSI 9 1,321 o Applicant’s unborn children 10 1,456 o Unborn children of each pregnant member Each additional of the applicant’s family size +136 person
Adults and Medicaid Children Ages 1-18 1 $1,616
Adults age 19 through 64 2 2,186 Children age 1 through 18 3 2,756 Not pregnant 4 3,325 Child(ren)’s income Not eligible for Parent/Caretaker Relative 5 3,895 Parent’s income (if Income limit is 133% of Federal Poverty Level 6 4,465 applicant is over age (FPL) 7 5,035 18) Family size includes: 8 5,604 o Applicant Educational income o Legal spouse of applicant 9 6,174 10 6,744 Child support o Applicant’s children/step-children under age 19 SSI o Unborn children of each pregnant member of the applicant’s family size Each additional o If applicant is a child, include the child’s person +570 parents/step-parents and siblings/step- siblings under age 19
Pregnant Woman and Medicaid Children Under 1 1 $2,248 Child(ren)’s income
Women under age 65 who are pregnant 2 3,041 Children under age 1 3 3,833 Parent’s income (if Income limit is 185% of FPL 4 applicant is over age 4,625 Family size includes: 18) 5 5,418 o Applicant 6 6,210 Educational income o Legal spouse of applicant 7 7,003 Child support o Applicant’s unborn children 8 7,795 Income Eligibility for HPE Determination Sites Last updated 2/9/2023 o Applicant’s children/step-children under 9 8,588 SSI age 19 10 9,380 o Unborn children of each pregnant member of the applicant’s family size o If applicant is a child, the child’s Each additional +793 parents/step-parents and siblings/step- person siblings under age 19
Former Foster Care Youth
Aged out of foster care in Oregon on or after their 18th birthday 1 Was in foster care with a PERC 19 on their 18th birthday Not eligible for any of the programs listed above Do not count any excluding Medicaid Adult – Screen for Former No income income for this Foster Care Youth before Medicaid Adult, BCCTP, limit program. and CHIP Age 18 through 25 Adoptions Assistance individuals (PERC 19) and foster care individuals with a PERC “GA” should not be approved for this program.
Breast and Cervical Cancer Treatment Program 1 $3,038
(BCCTP) 2 4,109 Less than 65 years old 3 5,180 Diagnosed as needing treatment for breast or 4 6,250 cervical cancer or specific precancerous conditions 5 7,321 Not eligible for any of the programs listed above 6 8,392 Child(ren)’s income Income limit is 250% of FPL 7 9,463 Family size includes: 8 10,534 Educational income o Applicant Child support o Legal spouse of applicant o Applicant’s children/step-children under SSI age 19 o Unborn children of each pregnant member Each additional +1071 of the applicant’s family size person o If applicant is a child, include the child’s parents/step-parents and siblings/step- siblings under age 19
CHIP Children 1 $3,645
Age 0 through 18 2 4,930 Not eligible for any of the programs listed above 3 6,215 Income limit is 300% of FPL 4 7,500 Family size includes: Child(ren)’s income 5 8,785 o Applicant 6 10,070 Educational income o Legal spouse of applicant 7 11,355 Child support o Applicant’s unborn children o Applicant’s children and step-children 8 12,640 SSI o Unborn children of each pregnant member 9 13,925 of the applicant’s family size 10 15,210 o Applicant’s parents/step-parents Each additional o Siblings and step-siblings under age 19 +1,285 person
Income Eligibility for HPE Determination Sites Last updated 2/9/2023
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