Oregon

What is Oregon Medicaid Long-Term Care?

Medicaid is a jointly funded state and federal health care program for low-income individuals of all ages. This focuses on long-term care Medicaid eligibility for elderly Oregon residents aged 65 and older. Medicaid in Oregon covers services like nursing home care, assisted living, adult foster care, and non-medical services to help seniors remain in their homes. There are three categories of Medicaid long-term care programs available for Oregon seniors.

What are the Categories of Medicaid Long-Term Care Programs in Oregon?

1. Institutional / Nursing Home Medicaid – This is an entitlement program where anyone who qualifies will receive assistance, but benefits are provided only in nursing homes.
2. Medicaid Waivers / Home and Community-Based Services (HCBS) – This program is not an entitlement, as the number of participants is limited, and waiting lists may exist. Services are designed to delay the need for nursing home care and may be provided at home, in adult day care, adult foster care, or assisted living.
3. Regular Medicaid / Aged Blind and Disabled – This is an entitlement program where anyone who qualifies can receive services. Long-term care benefits, such as personal care assistance or adult day care, may be available.

What Are the Eligibility Criteria for a Single Nursing Home Applicant in 2025?

In 2025, a single Nursing Home Medicaid applicant in Oregon must meet these requirements:

• Income Limit: Under $2,901 per month
• Asset Limit: Under $2,000
• Level of Care: Requires nursing home care

What Are the 2025 Oregon Medicaid Long-Term Care Eligibility Guidelines?

*Note: The figures listed here are applicable to various Medicaid programs and their income limits may differ depending on your living situation.

How is Income Defined in Oregon Medicaid?

What is Countable vs. Non-Countable Income?

Most income received by a Medicaid applicant counts towards the income limit, including wages, pension payments, Social Security Income, and more. Certain income sources, like Holocaust restitution payments and VA Aid & Attendance Pension, are exempt from being counted.

How is Income Treated for a Married Couple?

When one spouse applies for Nursing Home Medicaid or a Medicaid Waiver, only the income of the applicant is considered. The non-applicant spouse’s income is disregarded. However, the non-applicant spouse may receive a Minimum Monthly Maintenance Needs Allowance (MMMNA) if their income falls below a certain threshold.

Effective from 7/1/25 – 6/30/26, the MMMNA is $2,643.75. If the non-applicant’s income is less than this amount, funds may be transferred from the applicant spouse to increase the non-applicant’s income to the MMMNA level.

What Happens When Only One Spouse Applies for Regular Medicaid?

When only one spouse applies for Regular Medicaid, the income of both the applicant and non-applicant spouse is considered. There is no MMMNA for the non-applicant spouse in this scenario.

What is Considered Countable vs. Non-Countable Assets?

How Are Assets Treated for a Married Couple?

Assets are considered jointly owned, regardless of which spouse is applying. However, there is a Community Spouse Resource Allowance (CSRA) that protects a portion of the couple’s assets for the non-applicant spouse. In 2025, the non-applicant spouse can retain 50% of the couple’s assets, up to a maximum of $157,920.

What is Medicaid’s Look-Back Rule?

Oregon has a 60-month Medicaid Look-Back Period preceding the application date for Nursing Home Medicaid or Medicaid Waivers. Medicaid checks for asset transfers made below market value during this period. Violations result in a Penalty Period of ineligibility. There is no Look-Back Period for Regular Medicaid.

How Does the Home Exemption Work for Oregon Medicaid?

In Oregon, the home is generally exempt from Medicaid’s asset limit if the applicant or their spouse lives in the home. If no one is living in the home, there is a home equity interest limit of $730,000 in 2025.

What Are the Medical and Functional Need Requirements?

To qualify for Medicaid long-term care, applicants must have a medical need for assistance. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Additional functional needs are necessary for services under Regular Medicaid.

How Can One Qualify for Oregon Medicaid if Over the Limits?

What is a Qualified Income Trust (QIT)?

Also called a Miller Trust, a Qualified Income Trust allows applicants who exceed the income limit to still qualify for Medicaid. Excess income is placed into the irrevocable trust, which can only be used for medical expenses.

What is an Asset Spend Down?

Individuals with assets above the Medicaid limit can become eligible by spending down excess assets on exempt items such as home modifications or prepaying funeral expenses.

What is Medicaid Planning?

Medicaid Planning involves working with a professional to employ strategies to become eligible for Medicaid, even if a person exceeds the income or asset limits.

What Are the Specific Oregon Medicaid Programs for Seniors?

Oregon Medicaid offers several programs to help seniors remain in their homes or move to community-based settings like adult foster care or assisted living. These programs include:

1. Aged & Physically Disabled (APD) Waiver
2. Independent Choices Program (ICP)
3. Consumer-Employed Provider Program (CEP)
4. K Plan (Community First Choice Option)
5. Spousal Pay Program
6. State Plan Personal Care (SPPC)
7. Oregon Project Independence
8. Program of All-Inclusive Care for the Elderly (PACE)

How Can Seniors Apply for Oregon Medicaid?

Seniors can apply online through ONE.Oregon.gov or submit a paper application by mail or fax. It’s important to meet all eligibility requirements before applying. Assistance is available through local offices and customer service centers.