HEALTH SYSTEMS DIVISION

Hospital Presumptive Eligibility Process

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