Oregon Project Independence – Medicaid (OPI-M): Benefits & Eligibility

Last updated: May 23, 2024


Overview of Oregon Project Independence – Medicaid

Oregon Project Independence – Medicaid (OPI-M) is a unique Medicaid-funded program for seniors or physically disabled adults who require assistance with their daily living activities and are at risk of requiring long-term services and supports via OR Medicaid (Oregon Health Plan), such as the State Plan Personal Care Program (SPPC) or the Aged & Physically Disabled Waiver (APD Waiver). Via OPI-M, a variety of home and community based services are available. This includes adult day care, emergency response systems, meal delivery, home modifications for safety and accessibility, and personal care assistance. There is also a family caregiver assistance component. Informal (unpaid) caregivers of OPI-M beneficiaries can receive education and training specific to the needs of the care recipient. Respite care is also available, giving caregivers a break from their caregiving duties.

The program participant has the option of receiving personal care assistance via an in-home care agency provider or self-directing their own care via the Consumer-Employed Provider Program (CEP). With the participant-directed option, the program participant is responsible for finding, hiring, managing, scheduling, and firing their own caregiver, or “homecare worker” (HCW), as it is formally called. HCW’s must be 18+ years old, capable of performing the required tasks, complete a provider enrollment packet, pass a background check, and attend a homecare worker orientation. While friends and relatives, including an adult child, can be hired as the homecare worker, a spouse cannot be hired. The financial aspects of being an employer, such as tax withholding and issuing caregiver payments, are handled by the state.

Program participants can live in one’s home or the home of a loved one. They cannot live in an assisted living residence, residential care facility, or an adult foster care home.

OPI-M is an entitlement program. This program will not maintain a wait list; meeting eligibility requirements equates to immediate receipt of program benefits.

The Oregon Project Independence – Medicaid (OPI-M) Program is a Section 1115(a) Medicaid Demonstration Waiver. It was approved by the Centers for Medicare & Medicaid Services (CMS) on February 13, 2024 and began its implementation on June 1, 2024. It is anticipated to be fully operational sometime in 2025. Originally, a separate program, Family Caregiver Assistance Program (FCAP), to support unpaid family caregivers was proposed. However, OPI-M and FCAP merged under OPI-M.

 Relationship to the Original OPI – Oregon Project Independence – Medicaid (OPI-M) is a new Medicaid-funded program that began its implementation on June 1, 2024 and expands the Oregon Project Independence (OPI) Program. OPI is a state-funded program administered by Area Agencies on Aging (AAAs) that provides in-home assistance for persons aged 60+, and younger persons diagnosed with dementia, who are not on Medicaid. The OPI Pilot Program (OPI Expansion) serves persons aged 19-59 who have physical disabilities. Given funding is limited, wait lists for assistance exist. OPI-M is prioritizing persons currently on the OPI waitlist to help eliminate these wait lists.


Benefits of the Oregon Project Independence – Medicaid

The following services and supports are available via OPI-M. The exact benefits one receives is based on an individualized service plan.

– Adult Day Services / Adult Day Care
– Assistive Technology – $5,000 limit
– Assisted Transportation / Escort Services / Non-Medical Transportation
– Caregiver Education / Training
– Case Management / Service Coordination
– Chore Services – i.e., yard work, sidewalk maintenance, heavy housework
– Community Caregiver Support Services – i.e., facilitated support groups, group-based activities, paid wellness services
– Evidence-Based Health Promotion – individual or group programs (i.e., Fit & Strong!, SHARE for Dementia, A Matter of Balance)
– Emergency Response Systems
– Home Delivered Meals
– Home Modifications – $5,000 limit
– In-Home Support / Personal Care Services (up to 40 hours every 2 weeks) – can include respite care
– Long Term Care Community Nursing Services – i.e., assessment, monitoring, assigning, teaching
– Options Counseling – counseling to assist persons in making long-term care decisions
– Special Medical Equipment / Supplies
– Supports for Consumer Direction / Advocacy

OPI-M does not provide medical benefits (Oregon Health Plan / Medicaid). However, some OPI-M beneficiaries may also be eligible for the Oregon Supplemental Income Program- Medical (OSIPM), the Medicaid program through which seniors and adults with disabilities receive medical care.


Eligibility Requirements for Oregon Project Independence – Medicaid

OPI-M is for Oregon residents who are elderly (aged 65+), or younger (aged 18-59) and physically disabled. Persons cannot simultaneously receive OPI-M benefits and be enrolled in other Medicaid-funded long-term services and supports programs, such as the SPPC Program or the APD Waiver. Persons who qualify for these programs, however, can instead choose to receive assistance via OPI-M. Note that persons who enroll in OPI-M will have continuous coverage for 24-months even if there is change in their circumstances, such as an increase of income and assets.


Financial Criteria: Income, Assets & Home Ownership

The applicant income limit is equivalent to 400% of the Federal Poverty Level (FPL), which increases annually in January. In 2024, an applicant can have up to $5,020 / month in income. When an applicant is married, only the applicant’s income is considered; the income of their spouse is disregarded. While many long-term care Medicaid programs allow a non-applicant spouse a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance, from their applicant spouse, this is not permitted via OPI-M.

 OPI-M allows applicants higher income and assets than other Medicaid-funded long-term care programs, such as the Aged and Physically Disabled Waiver and State Plan Personal Care Program. Furthermore, unlike other Medicaid-funded programs, once approved for OPI-M, one is permitted continuous Medicaid eligibility for up to 2 years, even if one’s income and assets increase and they would otherwise not be eligible.

In 2024, the individual asset limit is $87,215. This figure is equivalent to six times the monthly Medicaid-funded nursing facility rate in OR, which in 2024, is $478.15 / month. For married couples, with both spouses as applicants, each spouse can have up to $87,215 in assets. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are limited. This is because the assets of a married couple are considered to be jointly owned. In this case, the applicant spouse can retain up to $87,215 in assets and the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA). The CSRA allows the non-applicant spouse to keep 50% of the couple’s assets, up to $154,140. If 50% of the couple’s assets falls under $30,828 the non-applicant spouse can keep all of the couple’s assets, up to this amount.

Some assets are not counted towards the 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.

The Medicaid Estate Recovery Program (MERP) is not applicable to OPI-M beneficiaries. Via MERP, following a long-term care Medicaid recipient’s death, a state’s Medicaid agency attempts reimbursement of long-term care costs for which it paid for that individual. Via OPI-M, persons can receive long-term care without the state attempting reimbursement of costs. This means that one’s assets are protected for family as inheritance.

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. 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 home, and in 2024, their home equity interest is no greater than $713,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– 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.


Medical Criteria: Functional Need

Many long-term care programs require an applicant need a Nursing Facility Level of Care (NFLOC), but Oregon Project Independence – Medicaid does not. For OPI-M, one must require assistance with their Activities of Daily Living (ADLs). These activities include transferring from the bed to a chair, mobility, eating, toileting, bathing, and dressing. The tool used to determine if one meets the functional need is the Client Assessment and Planning System (CAPS). An applicant’s ability to complete Instrumental Activities of Daily Living (i.e., housekeeping, medication management, shopping, laundry) are also 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 be functionally eligible. 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. OPI-M serves persons with a service priority level between 1 and 18.

 Learn more about long-term care Medicaid in Oregon.


Qualifying When Over the Limits

Having financial means over Oregon Project Independence – Medicaid’s limit(s) does not necessarily mean an applicant cannot still qualify for the program. There are a variety of Medicaid 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.

Utilizing Miller Trusts, called Income Cap Trusts in Oregon, is a common strategy used to lower an applicant’s monthly countable income for long-term care Medicaid eligibility. Essentially, “excess” income is deposited into the trust, no longer counting as income. However, Income Cap Trusts are not permitted for applicants to become income-eligible for the OPI-M.

When persons have assets over the limits, Irrevocable Funeral Trusts (IFTs) are an option. 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. These planning 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 Project Independence – Medicaid

Before You Apply

Prior to submitting an application for OPI-M, 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.

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.


Application Process

To apply for Oregon Project Independence – Medicaid, applicants should contact their local Area Agency on Aging (AAA) office or Aging and People with Disabilities (APD) office. See contact information by county. OPI-M began implementation on June 1, 2024. Persons on the waiting list for OPI are prioritized. It is anticipated that OPI-M will be fully implemented sometime in 2025.

Eligibility for Medicaid-funded medical benefits is determined separately, and therefore, persons have to apply for this program separately. Relevant to seniors, this program is OSIPM (Oregon Supplemental Income Program-Medical). One can apply via one’s local AAA or APD office as with OPI-M.

Although not necessarily intended for a consumer audience, persons can learn more about Oregon Project Independence – Medicaid here. Persons can also contact their county AAA or APD office for more information.

The Office of Aging and People with Disabilities (APD) within the Oregon Department of Human Services (ODHS) administers Oregon Project Independence – Medicaid.


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. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.

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