Healthy Oregon (Medicaid) Independent Choices Program (ICP)

Last updated: October 20, 2021

 

Overview of Oregon’s Independent Choices Program

Oregon’s Independent Choices Program (ICP) allows elderly and disabled state residents to receive long-term care assistance in their homes to delay and / or prevent nursing home admissions. Via this self-directed program, persons are given a monthly cash benefit with which to select and purchase in-home services and goods, such as personal care assistance and homemaker services. Persons might also purchase an item that replaces the need for assistance with a specific daily living activity, allowing for greater independence. For instance, a microwave oven might allow one to prepare meals rather than depend on someone to do it for them.

This participant-directed program also allows persons to choose by whom services are provided. The program participant becomes the “employer” and is responsible for finding, hiring, managing, scheduling, and firing their own caregiver, which ICP formally calls an “employee provider”. Friends and relatives, including adult children and spouses, can be hired to provide care, given they are 18+ years old, capable of the assigned tasks, and pass a background check. The program participant manages their own budget, which allows them to determine how much their caregiver is paid, though it must be no less than minimum wage. They are also responsible for paying taxes and issuing caregiver payments. Program participants can use a portion of their budget to pay for a financial services agency to assist with this financial responsibility.

Program participants who cannot self-direct their own care have to option to elect a representative, such as a relative or friend, to do so on their behalf. A representative cannot also be the “employee provider” (paid caregiver).

 Oregon seniors might also be interested in the Consumer-Employed Provider Program (CEP). Like the Independent Choices Program (ICP), it is a consumer-directed program that enables friends and relatives to be hired to provide care. However, it differs from ICP in that the state plays a larger administrative role. Program participants do not receive a monthly cash budget to pay their caregiver. Instead, the caregiver is enrolled as a CEP provider and is paid by the state. Another self-directed program, but specific to paying spouses as caregivers, is the Spousal Pay Program.

Program participants can live in one’s home or the home of a loved one. Persons cannot live in an assisted living residence or an adult foster care home and be eligible for ICP.

ICP is not an entitlement program. This means meeting eligibility requirements does not equate to immediate receipt of program benefits. Instead, the waiver has a limited number of participant enrollment slots, and when these slots are full, a waitlist for program participation forms.

The Independent Choices Program is a 1915(j) Medicaid State Plan Option. It allows for program participants to self-direct their own care. Originally a pilot program that began in 2001 in 5 counties, this program became statewide in 2009. Medicaid in Oregon is called the Oregon Health Plan (OHP). The Oregon Supplemental Income Program-Medical (OSIPM) is the program through which the elderly and disabled receive medical care.

 What is Participant-Directed Care?
Participant-directed care may also be called self-directed care or consumer-directed care. In Medicaid-speak, it is commonly called “Cash & Counseling”. With participant-directed care, program participants are allotted a budget and given freedom to select long-term services and supports to assist them in living independently. Most popular is the option to hire the caregiver of their choosing to provide assistance, such as personal care and homemaker services. Friends and relatives, including adult children, are commonly able to be hired. Furthermore, it is becoming increasingly common that one’s spouse can be hired as the caregiver.

 

Benefits of the Independent Choices Program

A program participant’s monthly cash benefit amount is based on individual needs, existing support, and the maximum hours of assistance required to meet one’s needs. A service plan with approved services and goods is created with a case manager. Follows are ways in which one might spend their budget.

– Personal Care Assistance – includes assistance with activities of daily living and instrumental activities of daily living. Examples bathing, personal hygiene, dressing, toileting, mobility, transitioning, eating, meal preparation, light housework, and grocery shopping.
– Goods to increase one’s independence in place of personal assistance – i.e., washing machine and dryer that is easily accessible, wheelchair ramp to access the home, microwave, adaptive clock, van wheelchair lift.

Program participants may also use up to 10% of their monthly budget as a discretionary fund, given the expense is approved by one’s case manager and there is no other means to pay for it. Examples of ways in which funds might be used are prescription drugs or medical co-pays, home / rental insurance, and checks for one’s ICP checking account.

 

Eligibility Requirements for Independent Choices Program

ICP is for Oregon residents who are elderly (65+), or younger (18+) and physically disabled, who are eligible for the Oregon Supplemental Income Program-Medical (OSIPM). Program participants must live in a stable home environment for a minimum of three months prior to application, which may be demonstrated by current payments of utilities and rent/mortgage. Persons must also have a checking account designated solely for ICP. Additional eligibility criteria are as follows:

 The American Council on Aging provides a quick and easy Medicaid eligibility test for Oregon seniors requiring ongoing assistance. Start here

 

Financial Criteria: Income, Assets & Home Ownership

Income
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR), which increases on an annual basis in January. In 2021, an applicant, regardless of marital status, can have a monthly income up to $2,382. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,382 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of his/her spouse. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a spousal income allowance, also called a monthly maintenance needs allowance.

In OR, there is a minimum income allowance, set at $2,177.50 / month (effective July 2021 – June 2022). This is intended to bring a non-applicant spouse’s monthly income up to this amount. There is also a maximum income allowance, which is $3,259.50 / month (effective January 2021 – December 2021), and is dependent on the non-applicant spouse’s shelter and utility costs. This monthly maintenance needs allowance is intended to ensure the non-applicant spouse does not become impoverished. To be clear, a non-applicant spouse’s own monthly income combined with the income allowance from the non-applicant spouse cannot exceed $3,259.50.

Assets
In 2021, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, each spouse can have up to $2,000 in assets. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are limited, though the non-applicant spouse is allocated a larger portion of the assets to prevent spousal impoverishment. (Unlike with income, Medicaid considers the assets of a married couple to be jointly owned). In this case, the applicant spouse can retain up to $2,000 in assets and the non-applicant spouse can keep up to $130,380. This larger allocation of assets to the non-applicant spouse is called a community spouse resource allowance.

Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Medicaid has a look back rule and violating it results in a penalty period of Medicaid ineligibility.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our spend down calculator.

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take their home. Fortunately, for eligibility purposes, OR Medicaid considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has “intent” to return to the home and his / her home equity interest is no greater than $603,000. Home equity interest is the current value of the home minus any outstanding mortgage.
– A spouse lives in the home.
– The applicant has a disabled or blind child (any age) living in the home.
– The applicant has a minor child (under 21) living in the home.

To learn more about the potential of Medicaid taking the home, click here.

 

Medical Criteria: Functional Need

An applicant must require a nursing facility level of care (NFLOC). For ICP, the tool used to determine if this level of care need is met is the Client Assessment and Planning System (CAPS). An applicant’s ability to complete activities of daily living (i.e., transferring from the bed to a chair, mobility, eating, toileting, bathing) and instrumental activities of daily living (i.e., housekeeping, medication management, shopping, laundry) are assessed. Relevant to some persons with Alzheimer’s disease or a related dementia, behavioral problems, such as regular attempts to leave the facility or removal of one’s clothes, are also considered. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC. A service priority level is generated during the assessment process. There are 18 levels, with 1 being the highest level of assistance required and 18 the least. For ICP, an applicant must receive a service priority level between 1 and 13.

 For more information about long-term care Medicaid in Oregon, click here.

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for OR Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.

When persons have income over the limits, Miller Trusts, also called a qualified income trust can help. “Excess” income is deposited into the trust, no longer counting as income.

When persons have assets over the limits, trusts are an option. Irrevocable Funeral Trusts (IFTs) are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. IFTs are just one way in which applicants can “spend down” excess assets on exempt assets. Persons can also buy household appliances and furnishings, trade in their vehicle, or take a vacation. There are many alternative solutions when the applicant has assets exceeding the limit.

Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid planners are educated in the planning strategies available in OR to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. There are also planning strategies that not only help one meet Medicaid’s financial criteria, but also protect assets from Medicaid’s estate recovery program. These strategies often violate Medicaid’s 60-month look back rule, and therefore, should be implemented well in advance of the need for long-term care. However, there are some workarounds, and Medicaid planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid planner.

 

How to Apply for Oregon’s Independent Choices Program

Before You Apply

Prior to submitting an application for ICP, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid eligibility test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid eligibility test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.

Since the Independent Choices Program is not an entitlement program, there may be a waitlist for program participation. The program is approved for a maximum of approximately 2,600 beneficiaries per year. In the case of a waitlist, an applicant’s access to a participant slot is based on the date of application for ICP.

 

Application Process

To apply for the Independent Choices Program, applicants should contact their local Area Agency on Aging (AAA) office or Aging and People with Disabilities (APD) office. Contact information by county can be found here. Alternatively, persons can call the Oregon Department of Human Services at 1-800-282-8096.

For additional information about the Independent Choices Program, click here. Persons can also contact their county AAA or APD office. The link for contact information can be found above. The Oregon Department of Human Services (ODHS) administers the Independent Choices Program.

 

Approval Process & Timing

The Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). However, despite the law, applications are sometimes delayed even further. Furthermore, as a wait-list may exist, approved applicants may spend many months waiting to receive benefits.

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