Overview of Oregon’s State Plan Personal Care Program
Oregon’s State Plan Personal Care Program (SPPC) provides in-home personal care assistance for state residents who are elderly or disabled and require assistance with their Activities of daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) in order to live independently. ADLs and IADLs include bathing, personal hygiene, dressing, transitioning (i.e., from the bed to a chair), preparing meals, and light housecleaning. Assistance may be hands-on, but it may also include verbal reminders and prompts, which is especially beneficial for persons with cognitive issues, such as those with Alzheimer’s disease or similar dementias.
The program participant has the option of receiving care assistance via a home care agency provider or self-directing their own care. With the participant-directed option, the program participant is responsible for finding, hiring, managing, scheduling, and firing their own caregiver, which SPPC formally calls a “homecare worker”. SPPC homecare workers must be 18+ years old and capable of performing the required tasks. Furthermore, they must complete a provider enrollment packet, undergo a background check, and attend a homecare worker orientation. While friends and relatives 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 who cannot self-direct their own care have the option to elect a representative, including a family member or friend, to do so on their behalf. A representative cannot also be the “homecare worker” (paid caregiver).
Program participants can reside in their own home or the home of a friend or family member. They cannot live in an adult foster care home or an assisted living residence.
SPPC is an entitlement program; meeting eligibility requirements equates to immediate receipt of program benefits. Put differently, there is never a wait list to receive personal care assistance via this program.
The State Plan Personal Care (SPPC) Program is part of Oregon’s State Plan Medicaid program. One might also hear SPPC called PC20, which stands for Personal Care 20 hours / month. Medicaid in Oregon is called the Oregon Health Plan. The Oregon Supplemental Income Program Medical (OSIPM) is the program through which persons who are elderly or disabled receive medical care.
While Home and Community Based Services (HCBS) can be provided via a Medicaid Waiver or a state’s Regular Medicaid Plan, HCBS through Medicaid State Plans are an entitlement. Put differently, meeting the program’s eligibility requirements guarantees an applicant will receive benefits. On the other hand, HCBS via Medicaid Waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they have been filled, a waitlist for benefits begins. Furthermore, HCBS Medicaid Waivers require a program participant require the level of care provided in a nursing home, while State Plan HCBS do not always require this level of care.
Benefits of the State Plan Personal Care Program
Program participants can receive up to approximately 270 hours per year of personal care assistance. Follows is a list of activities with which assistance might be provided.
– Cognitive Assistance – i.e., making decisions, memory, orientation
– Delegated Nursing Tasks
– Health Status Monitoring
– Homemaker Services – i.e., housecleaning, laundry, taking out the garbage
– Toileting / Bowel or Bladder Care
– Meal Preparation
– Medication / Oxygen Management
– Mobility / Transfer / Repositioning
– Personal Hygiene – i.e., bathing, shaving, washing hair, dressing
– Shopping / Non-Medical Transportation
– Medical Appointment Assistance – i.e., making appointments, arranging transportation
– Money Management
–Technology Use for Communication – i.e., telephone
Program participants may also be able to receive home delivered meals.
Eligibility Requirements for State Plan Personal Care Program
SPPC is for Oregon residents who are elderly (aged 65+) or 18+ years old and disabled. Additional eligibility criteria follows.
Financial Criteria: Income, Assets & Home Ownership
Income
The applicant income limit is equivalent to 100% of the Federal Benefit Rate (FBR), which increases annually in January. In 2025, the income limit for a single applicant is $967 / month. Married couples, regardless of if one or both spouses are applicants, can have a monthly income up to $1,450.
Assets
In 2025, the asset limit is $2,000 for a single applicant. For married couples, the asset limit is $3,000 (regardless of whether one or both spouses are applicants).
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.
While there is a 60-month Look-Back Rule, during which Medicaid checks past asset transfers of those applying for Nursing Home Medicaid or Home and Community Based Services via a Medicaid Waiver, this is not applicable for the State Plan Personal Care Program.
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, 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.
– The applicant has a disabled or blind child (of any age) living in the home.
– The applicant has a minor child (under 21 years of) living in the home.
Unlike many Oregon Medicaid programs that offer long-term care, the SPPC Program does not have a home equity interest limit for home exemption.
Medicaid has an Estate Recovery Program that follows the death of a beneficiary. Via this program, the state attempts to recover care costs for which was paid during the beneficiary’s lifetime. This reimbursement is often collected through the sale of the deceased beneficiary’s home. Learn more about the potential of Medicaid taking the home.
Medical Criteria: Functional Need
While many Medicaid long-term care programs require an applicant need a Nursing Facility Level of Care (NFLOC), this is not required. In fact, SPPC is not available to persons who require this level of care. However, applicants must have a personal care need, which is demonstrated by requiring assistance at least monthly with one of the following tasks: Basic personal hygiene (i.e., bathing, shaving, dressing, nail care), toileting / bowel or bladder care, mobility / transferring or repositioning, nutrition (i.e., preparing meals, eating / drinking), delegated nursing tasks, or medication / oxygen management. Relevant to some persons with Alzheimer’s disease or a related dementia, cognitive impairments, such as memory loss, lack of focus, and difficulty making plans, can result in one of the above personal care needs. However, a diagnosis of dementia in and of itself does not mean one will meet the functional criteria.
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.
Utilizing Miller Trusts, called Income Cap Trusts in Oregon, can be 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, it is thought Income Cap Trusts are not permitted for applicants to become income-eligible for the SPPC Program.
When persons have assets over the limit, they can “spend down” excess assets on ones that are exempt (not counted). While this includes purchasing clothing and home furnishings, Irrevocable Funeral Trusts (IFTs) are another option. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Medicaid-Compliant Annuities, which turn lump sums of cash into a monthly income stream, are also a good option for some persons. However, one must be aware that annuity payments will be counted towards Medicaid’s income limit. There are many alternative options 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 Oregon to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, while it is thought that Medicaid’s 60-month Look-Back Rule does not apply to the State Plan Personal Care Program, it does apply to Nursing Home Medicaid and other OR long-term care Medicaid programs. Commonly, persons require more extensive care as time passes, and therefore, it is critical one not violate the Look-Back Rule. Therefore, while there are many planning strategies, they should only be implemented with careful planning and 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 Certified Medicaid Planner.
How to Apply for Oregon’s State Plan Personal Care Program
Before You Apply
Prior to submitting an application for the State Plan Personal Care Program, 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 Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.
As part of the application process, applicants need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, previous bank statements, 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 SPPC, seniors and adult applicants who are disabled should contact their local Area Agency on Aging (AAA) office or Aging and People with Disabilities (APD) office. See contact information by county. Alternatively, persons can call the Oregon Department of Human Services at 1-800-282-8096.
Although not necessarily intended for a consumer audience, additional information about the State Plan Personal Care Program can be found here. Persons can also contact the Aging and Disability Resource Connection (ADRC) of Oregon at 1-855-673-2372. The Oregon Department of Human Services (ODHS) Office of Aging and People with Disabilities (APD) administers the SPPC 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. 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.