Oregon Medicaid Definition
In Oregon, Medicaid is also called the Oregon Health Plan (OHP) and is administered by the Oregon Health Authority (OHA). The program through which the elderly receive medical care is the Oregon Supplemental Income Program-Medical (OSIPM).
Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. While there are many different eligibility groups, this page is focused on Medicaid eligibility for elderly Oregon residents who are 65 years of age and older. Specifically, long term care Medicaid is covered. In addition to nursing home care, assisted living services, and adult foster care services, OR Medicaid pays for many non-medical support services that help frail seniors remain living at home.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Oregon seniors may be eligible. These programs have slightly different financial and medical eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Oregon offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – This is an entitlement program; Anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – This is not an entitlement program; The number of program participants is limited and wait lists may exist. Services are intended to delay the need for nursing home care and may be provided at home, adult day care, adult foster care, or in assisted living. More on waivers.
3) Regular Medicaid / Aged Blind and Disabled – This is an entitlement program; As long as eligibility requirements are met, services can be received. Various long-term care benefits, such as personal care assistance or adult day care, may be available.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from an Oregon Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT:
Not meeting all the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Oregon. More.
|2022 Oregon Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,523 / month*||$2,000||Nursing Home||$5,046 / month*||$4,000||Nursing Home||$2,523/ month for applicant*||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,523 / month||$2,000||Nursing Home||$5,046 / month||$4,000||Nursing Home||$2,523/ month for applicant||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$841 / month||$2,000||Help with ADLs||$1,261 / month||$3,000||Help with ADLs||$1,261 / month||3,000||Help with ADLs|
What Defines “Income”
Any income that a Medicaid applicant receives is counted. This income can come from any source. Examples include employment wages, Veteran’s benefits, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Holocaust restitution payments and Covid-19 stimulus checks are not counted as income by Medicaid and have no impact on eligibility.
When just one spouse of a married couple is applying for nursing home Medicaid or a HCBS Medicaid waiver, only the income of the applicant is counted. This means the non-applicant spouse’s income is disregarded and does not impact the income eligibility of the applicant spouse. However, the non-applicant spouse (also called a community spouse) may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. The MMMNA is the minimum amount of income a non-applicant spouse is said to require to avoid spousal impoverishment. The MMMNA is $2,288.75 (effective 7/1/22 – 6/30/23). If a non-applicant’s monthly income is under $2,288.75 , income can be transferred from their applicant spouse, bringing their income up to this level.
In Oregon, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $686.63 / month (effective 7/1/22 – 6/30/23). However, in 2022, in no case can a spousal income allowance push a non-applicant’s monthly income over $3,435. This is the Maximum Monthly Maintenance Needs Allowance. Learn more about how the spousal allowance is calculated.
In addition to providing spousal support, the monthly maintenance needs allowance also effectively lowers the applicant spouse’s countable income.
Income is counted differently when only one spouse applies for Regular Medicaid / Aged Blind and Disabled; The income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. More about how Medicaid counts income.
What Defines “Assets”
Countable (non-exempt) assets include cash and most anything that can easily be converted to cash to pay for long-term care. Other non-exempt assets include stocks, bonds, investments, credit union, savings, checking accounts, and real estate in which one does not reside. There are also many assets that are exempt (non-countable). Exemptions include personal belongings, such as clothing, household furnishings, an automobile, irrevocable burial trusts, term life insurance, and generally one’s primary home. If a non-applicant spouse lives in the home, it is automatically exempt. If not, the Medicaid applicant must live in the home, or have “intent to return”, and their home equity interest must not be more than $636,000 (in 2022). Equity interest is the amount of the home’s value, minus any debt against the home, owned by the applicant.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, the non-applicant spouse of a nursing home or Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can retain 50% of the couples’ assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets is under $27,480, 100% of the assets, up to $27,480 can be retained by the non-applicant.
Oregon has a Medicaid Look-Back Period of 60-months that immediately precedes one’s Medicaid application date. During this period, Medicaid checks to ensure no assets were sold or given away under fair market value. This includes gifts, as well as asset transfers one’s spouse has made. If one violates the look-back rule, a penalty period of Medicaid ineligibility will be established.
Qualifying When Over the Limits
Oregon elderly residents (65 and over) who do not meet the eligibility requirements in the table above can still qualify for long-term care Medicaid.
1) Qualified Income Trusts (QIT’s) – Also called Miller Trusts, and specifically Income Cap Trusts in Oregon, QITs allow nursing home Medicaid and Waiver applicants who are over the income limit to still qualify for Medicaid. Money deposited into this type of trust does not count towards Medicaid’s income limit. In simple terms, one’s excess income (over the Medicaid limit) is directly deposited into the irrevocable QIT, in which a trustee is named, giving that individual legal control of the money. Irrevocable means the terms of the trust cannot be changed or canceled. Furthermore, the money in the account can only be used for very specific purposes, such as paying long term care services and medical expenses accrued by the Medicaid enrollee. Upon the death of the Medicaid participant, any remaining funds must be paid to the state of Oregon.
2) Asset Spend Down – Persons who have assets over Medicaid’s limit can still become asset eligible by “spending down” excess assets on non-countable ones. Examples include home modifications (wheelchair ramps, roll-in showers, and stair lifts), vehicle modifications (wheelchair lifts, adaptive control devices, and floor modifications to allow one to drive from a wheelchair), prepaying funeral and burial expenses, and paying off debt. Remember, when spending down assets, it is vital that one does not give away assets or sell them under market value. Doing so violates Medicaid’s look back period. When “spending down”, it is best to keep documentation of how assets were spent as evidence the look back period was not violated.
3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For these individuals, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid’s estate recovery program. Read more or connect with a Medicaid planner.
Specific Oregon Medicaid Programs
1) Aged & Physically Disabled Waiver – This Medicaid Waiver, abbreviated as APD, assists seniors and physically disabled persons in transitioning from an institutionalized setting, like a nursing home facility, back into a community setting, such as one’s home or an adult foster care home.
2) Independent Choices Program (ICP) – This is an option under Oregon’s Regular Medicaid plan that allows participants to manage their own care services. Via monthly cash assistance, one can hire the care provider of their choosing, which includes spouses and adult children.
3) Client-Employed Provider Program (CEP) – Similar to ICP, seniors are able to hire and manage their own personal care provider to assist with Activities of Daily Living (ADLs) and Independent Activities of Daily Living (IADLs). Examples include assistance with bathing, mobility, eating, housekeeping, and meal preparation.
4) K Plan – More formally called the Community First Choice (CFC) Option, this state plan option provides supportive services for Oregon residents who require a nursing home level of care. Benefits include adult day health, home modifications, meal delivery, and more.
5) Spousal Pay Program – This is a unique program that pays non-applicant spouses to assist their senior applicant spouses with daily living activities. This includes personal hygiene, bathing, dressing, meal preparation, and light housecleaning.
6) State Plan Personal Care (SPPC) – Under Oregon’s Regular Medicaid program, this benefit is an entitlement and covers personal care in the home.
7) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care, and Medicare are combined into a single program. Additional benefits, such as dental care and eye care, may be available.
How to Apply for Oregon Medicaid
Elderly individuals can apply for Oregon Medicaid online at ONE.Oregon.gov. Alternatively, a completed paper application can be mailed to OHP Customer Service, P.O. Box 14015, Salem OR, 97309-5032 or faxed to 503-378-5628. Free local assistance with the application process is available. Click here to find help or call OHP Customer Service at 800-699-9075. One can also request a mailed application from OHP Customer Service. The application process may vary depending on the Medicaid program for which one is applying. In addition to OHP Customer Service, persons might find their local Area Agency on Aging office helpful.
Senior applicants must be certain that all eligibility criteria is met prior to submitting a Medicaid application. Persons who have excess income and / or assets, should strongly consider Medicaid planning to help prevent denial of benefits. The application process can be lengthy and confusing, particularly since specific documentation must be included with the application. For general information about the long-term care Medicaid application process, click here.