Long-Term Care Medicaid in Oregon: 2026 Guide

In Oregon, Long-Term Care Medicaid is run by the Oregon Department of Human Services (ODHS) through its Aging and People with Disabilities (APD) program, working with local Area Agencies on Aging (AAAs). Long-Term Care Medicaid can pay for nursing facility care, in-home care and care in community-based settings. This guide explains the 2026 rules in plain language.

At a glance: Oregon 2026 figures

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with the Oregon Department of Human Services before relying on them.

What Long-Term Care Medicaid covers in Oregon

Nursing facility care. Medicaid pays for care in a certified nursing facility. You pay most of your income toward the cost each month, and Medicaid pays the rest.

In-home services. ODHS Aging and People with Disabilities (APD) in-home services pay for help with activities of daily living and household tasks you are assessed as needing. Many are offered under Oregon’s K Plan, and other available services include home-delivered meals, adult day services and emergency response systems. Care can be given by homecare workers or agencies.

Community-based care. APD can also pay for services in contracted care settings: adult foster homes, residential care facilities, assisted living facilities and specialized living residences.

PACE. A Program of All-Inclusive Care for the Elderly is another way to get services.

How Medicare fits in. Medicare Part A covers skilled nursing facility care only for a limited time. You generally need a medically necessary inpatient hospital stay of at least 3 days in a row first (time under observation or in the emergency room does not count), and you must need daily skilled nursing or therapy. In 2026, Medicare charges nothing for days 1 to 20 after the Part A deductible ($1,736) is met, $217 a day for days 21 to 100, and nothing after day 100, when you pay all costs. Medicare limits this coverage to 100 days in each benefit period. Medicaid can be a way to pay for long-term nursing home care after Medicare coverage ends.

Who qualifies

A person generally must:

• be 65 or older, or 18 or older with a disability;
• live in Oregon and be a U.S. citizen or qualified non-citizen;
• meet Oregon’s service priority level for long-term care. A case manager from APD or your local Area Agency on Aging does an in-person assessment (CA/PS) to set your service priority level, and you must meet levels 1 to 13;
• meet the income and asset rules below, as decided by ODHS.

Income rules

Oregon has an income limit for long-term care services, and a trust may be available for people whose income is higher.

Once you are on Medicaid in a nursing facility, most of your income goes to the facility. You keep a personal needs allowance of $81.28 a month, and money can be set aside for a spouse at home and for health insurance premiums. People receiving services at home or in community settings keep a different amount.

Asset rules

In 2026, a single applicant can have up to $2,000 in countable resources, and a couple $3,000 (Oregon Administrative Rule 461-160-0015).

Countable resources include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above set amounts and real estate other than the home.

Usually exempt:

• Your home (equity up to $752,000) if you live there or plan to return, or a spouse or dependent relative lives there
• One vehicle
• Household goods and personal belongings
• Burial plots and limited burial funds, within ODHS rules

Spousal protections

• Assets: Under Oregon Administrative Rule 461-160-0580, the spouse at home can keep the greater of half the couple’s countable resources, up to $162,660, or $32,532 in 2026, plus the home, one car and belongings.
• Income: The spouse at home keeps their own income, and part of the applicant’s income can be set aside for them if their income is low.

Look-back and penalties

When you apply, Oregon looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

• Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
• Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
• Selling a house or car to a relative for much less than it is worth.
• Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($16,760 a month (for a first penalty month on or after October 1, 2026)).

Example: Suppose you gave your daughter $50,000 three years before applying. $50,000 divided by $16,760 is about 3 months without Medicaid payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in Oregon

Oregon’s estate recovery program is run by ODHS.

• What is recovered: Medicaid paid for long-term care and related services received at age 55 or older, and for some people of any age in a nursing facility.
• When it is put off: federal rules prevent recovery while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
• Hardship waivers: ODHS can waive or put off recovery in some situations. Ask ODHS for the current rules.
• Family members and personal representatives can contact the ODHS Estate Administration Unit with questions.

How to apply

• Online: the ONE portal, Oregon’s benefits website
• In person: at your local APD or AAA office.
• For information first: the Aging and Disability Resource Connection (ADRC) of Oregon.

After you apply, a case manager will contact you to set up the needs assessment.

Applying for a spouse or parent. If you are applying for someone else, you may need legal authority to act for them, or you can be named as an authorized representative on the application. Gather statements for every account, not just the main one, and write down when the person’s care needs began. If the person is already in a nursing home, ask the facility’s business office or social worker which Medicaid forms they need from you and when, and tell the agency if any requested document is hard to get, since agencies can often give extra time when you ask before the deadline.

After you apply. ODHS will send you a written notice saying whether you qualify, from what date, and how much of your income goes toward your care each month. If you disagree with a decision, you have the right to ask for a hearing (appeal). The notice explains how to ask and the deadline for asking. Keep copies of everything you send and receive, and report changes in income, assets or address when they happen.

Gather what you can before you apply. The caseworker may ask for:

• Photo ID, Social Security card and Medicare card
• Proof of age and of U.S. citizenship or immigration status
• Proof that you live in the state (for example, a utility bill or lease)
• Proof of all income: Social Security award letter, pension statements, annuity statements
• Bank, credit union and investment statements (often for the full 60-month look-back period)
• Deeds, property tax bills and the value of any real estate
• Life insurance policies (showing cash value) and prepaid funeral or burial contracts
• Vehicle titles
• Health insurance cards and long-term care insurance policies
• Power of attorney or guardianship papers, if someone is applying for you
• For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in Oregon

• ODHS Aging and People with Disabilities and local AAAs: applications, assessments and case management.
• ADRC of Oregon: free information about long-term care options.
• SHIP (State Health Insurance Assistance Program): free Medicare counseling.
• Oregon Long-Term Care Ombudsman: free advocates for residents of nursing facilities, assisted living, residential care and adult foster homes.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including Oregon:

• Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
• Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). Oregon’s 2026 home equity limit, $752,000, is already below the new cap, so this change is not expected to affect Oregon’s limit.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

• Oregon K Plan (Community First Choice)
• Oregon Aged and Physically Disabled Waiver
• Oregon Consumer-Employed Provider Program
• Oregon Independent Choices Program
• Oregon Project Independence
• Oregon Spousal Pay Program
• Oregon State Plan Personal Care

Frequently asked questions

Does Oregon Medicaid pay for assisted living? It can pay for services in contracted assisted living facilities, residential care facilities and adult foster homes.

Who decides whether I need long-term care? A case manager from APD or your local AAA does a needs assessment to decide whether you meet Oregon’s service priority level.

How much can my spouse keep? In 2026, the greater of half the couple’s assets (up to $162,660) or $32,532, plus the home, a car and belongings.

What is the personal needs allowance? $81.28 a month for a nursing facility resident. The rest of your income, after allowed deductions, goes toward your care.

How long is the penalty for a gift? Divide the gift by $16,760 (for a first penalty month on or after October 1, 2026) to get the number of months. A $20,000 gift would mean about 1.2 months without Medicaid payment for long-term care.

Will the state take my home after I die? ODHS can seek repayment for long-term care paid after age 55, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.

Figures change periodically. Double-check current amounts with the Oregon Department of Human Services before relying on them.

Sources

• OAR 461-160-0015, resource limits
• OAR 461-160-0580, community spouse resource allowance
• OAR 461-145-0220, home equity
• OAR 461-160-0620, personal needs allowance
• OAR 461-140-0296, transfer penalty divisor
• ONE portal
• OAR 411-015, long-term care service priorities
• ODHS, In-Home Services Overview
• Medicare.gov, Skilled nursing facility care
• CMS, 2026 SSI and spousal impoverishment standards
• Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.