Oregon Medicaid Eligibility for Long Term Care: Income & Asset Limits

Oregon Medicaid Long-Term Care Definition

Medicaid is a jointly funded state and federal health care program for low-income individuals of all ages. While there are varying coverage groups, this page is focused on long-term care Medicaid eligibility for elderly Oregon residents aged 65 and older. 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. There are three categories of Medicaid long-term care programs for which OR seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; the number of program participants is limited and waiting 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.

3) Regular Medicaid / Aged Blind and Disabled – An entitlement; if 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.

In Oregon, Medicaid is also called the Oregon Health Plan (OHP). The program through which the elderly receive medical care is the Oregon Supplemental Income Program-Medical (OSIPM). While Medicaid is jointly funded by the state and federal government, it is administered by the state under federally set parameters. The administering agency for OSIPM is the Oregon Department of Human Services.

Income & Asset Limits for Eligibility

The three categories of Medicaid long-term care programs have varying financial and medical eligibility requirements. Further complicating eligibility is that the financial criteria change annually, vary with marital status, and that Oregon offers multiple pathways towards eligibility.

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 of the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Oregon. More.

Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly all income that a Medicaid applicant receives is counted towards the income limit. Countable income includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments do not count as income. Furthermore, in OR, the VA Aid & Attendance Pension, which is above and beyond the Basic VA Pension, is not counted as income.

Treatment of Income for a Couple
When just one spouse of a married couple applies for Nursing Home Medicaid or a HCBS Medicaid Waiver, only the income of the applicant is counted. The non-applicant spouse’s income is disregarded and does not impact the income eligibility of their 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.

Effective 7/1/23 – 6/30/24, the MMMNA is $2,465. If a non-applicant’s monthly income is under this amount, income can be transferred to them from their applicant spouse, bringing their income up to $2,465 / month. In Oregon, a non-applicant spouse can further increase their Spousal Income Allowance if their housing and utility costs exceed a “shelter standard” of $739.50 / month (eff. 7/1/23 – 6/30/24). In 2024, the Maximum Monthly Maintenance Needs Allowance a non-applicant spouse can receive is $3,853.50. To be clear, the Spousal Income Allowance combined with a non-applicant’s own income cannot exceed $3,853.50/ month. Learn more about how this 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 and non-applicant spouse is calculated towards the applicant’s income eligibility. There is no Monthly Maintenance Needs Allowance for a non-applicant spouse. More about how Medicaid counts income.

Asset Definition & Exceptions

Countable vs. Non-Countable Assets
Countable (non-exempt) assets are counted towards the asset limit. This includes cash and most anything that can easily be converted to cash to pay for long-term care. Examples include stocks, bonds, investments, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. In Oregon, IRAs / 410Ks are also counted. 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.

Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. There is, however, a Community Spouse Resource Allowance (CSRA) that protects a larger amount of a couple’s countable assets for the non-applicant spouse of a Nursing Home Medicaid or Medicaid Waiver applicant. In 2024, the community spouse (non-applicant spouse) can retain 50% of the couples’ assets, up to a maximum of $154,140. If the non-applicant’s half of the assets is under $30,828, 100% of the assets, up to this amount can be retained by the non-applicant. There is no CSRA for a non-applicant spouse of a Regular Medicaid applicant.

Medicaid’s Look-Back Rule
Oregon has a Medicaid Look-Back Period of 60-months that immediately precedes one’s Medicaid application date for Nursing Home Medicaid or a Medicaid Waiver. During this period, Medicaid checks to ensure no assets were sold or gifted under fair market value. This includes asset transfers made by one’s spouse. If one violates the Look-Back Rule, a Penalty Period of Medicaid ineligibility will be established. There is no Look-Back Period for Regular Medicaid applicants.

The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, this rule allows one to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s 60-month Look-Back Period.

Oregon Medicaid Home Exemption Rules

For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of the home’s equity that is owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. There is no home equity interest limit for Regular Medicaid. Other exemptions exist.

While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, Oregon’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

Medical / Functional Need Requirements

An applicant must have a medical need for Medicaid long-term care. For Medicaid nursing home care and Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Furthermore, additional criteria may be required for some program benefits. For example, for home modifications, an inability to safely and independently live at home without modifications might be required. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NFLOC is not necessarily required.

Qualifying When Over the Limits

Oregon elderly residents (aged 65+) who do not meet the financial eligibility requirements above can still qualify for long-term care Medicaid.

1) Qualified Income Trusts (QIT’s) – Also called Miller Trusts, or specifically Income Cap Trusts in Oregon, these trusts allow Nursing Home Medicaid and Waiver applicants who are over the income limit to still become income-eligible. 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 making 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. When spending down assets, it is vital that one does not give away assets or sell them under fair 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 this rule was not violated.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they 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. Connect with a Medicaid Planner.

Specific Oregon Medicaid Programs

In addition to paying for nursing home care, Oregon Medicaid offers the following programs relevant to the elderly that helps them to remain living at home, in adult foster care homes, or in assisted living residences.

1) Aged & Physically Disabled (APD) Waiver – Assists seniors and adults with physical disabilities in transitioning from an institutionalized setting, like a nursing home facility, back home or into a community setting, such as an assisted living residence or an adult foster care home.

2) Independent Choices Program (ICP) – A self-directed option 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) Consumer-Employed Provider Program (CEP) – Formerly the Client-Employed Provider Program, 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 and eye care, may be available.

How to Apply for Oregon Medicaid

Elderly individuals can apply for Oregon Medicaid / Oregon Health Plan 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. Familiarizing oneself with general information about the long-term care Medicaid application process can be helpful.