Oregon Medicaid Long Term Care Eligibility
Oregon Long Term Care
Oregon is an income cap state, meaning that in order to be eligible for Medicaid long term care benefits there is a hard income limit. Non income cap states allow applicants to spend down money for their care, whereas income cap states require the amount to be no higher than their limit at time of application.
Services in your home — These services include personal assistance, nursing tasks, and help with housekeeping.
Care facilities — Find information about types of care facilities, licensed care services, and other resources to help you make an informed decision.
1. Residency and Citizenship – the applicant must be an Oregon resident and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. Persons must need care for thirty (30) consecutive days.
- Medicaid evaluates applicants on a scale of 1-18 to determine their level of need. This has also been called ‘survivability’ need (the applicant’s ability to ‘survive’ without assistance). Level 1 is for people who need the highest level of care. A Level 1 patient needs full assistance with all of his activities of daily living (ADLs). Level 18 patients are independent and need little to no help, although they do require a structured environment. Level 17 patients generally need assistance with dressing and bathing. Medicaid is currently allowing eligibility for Level 1-13 applicants only. Applicants in service levels 14-18 may not receive assistance. No new applications for levels 14-18 are currently being accepted. Case managers make an assessment and determine what level someone is at depending on a number of personal questions. Eligibility depends on the applicant’s answers.
3. Income Limitations – If single, the applicant’s monthly income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than $2,349 to become eligible for Medicaid. Income that is not considered countable includes a personal needs allowance ($60/month per individual). If the applicant receives a veteran’s pension they can keep $90 per month in addition to the $60 personal needs allowance. If the person receives community-based care the personal needs allowance is raised to $163/month.
- For persons receiving Supplemental Security Income (SSI) benefits the income limit is $735/month for an individual or $1,103/month for an eligible couple.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is listed as exempt.
Exempt Assets for an applicant in Oregon include:
i. $2,000 or less in cash/non-exempt assets if single. If the assets exceed the limit on the first of the month the applicant is ineligible for the entire month.
ii. One home is exempt (equity limit $595,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum.
iii. One automobile, no equity amount specified.
iv. A burial fund with a value of $1,500 or less.
v. Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.
vi. Value of life insurance if face value is $1,500 or less. If it exceeds $1,500 in total face amount, then the cash value in these policies is countable.
Amount of assets community spouse may retain: The community spouse can keep non-exempt resources owned by one or both spouses with a maximum of $128,640. If the community spouse’s assets do not equal the minimum of $25,728, the community spouse is able to retain assets from the institutionalized spouse until the minimum is reached.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $2,113.75. The maximum amount of income that can be retained is $3,216.00/month varying by case, depending on unique living expenses. If applicable, up to $446 in food stamp utility allowance is not figured into the total.
Oregon long term care insurance partnership:
This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used, you may apply for Medicaid with $155,000 worth of assets exempted.
Page on aging and people with disabilities: http://www.oregon.gov/dhs/spwpd/pages/ltc/main.aspx
Choosing a long-term care setting—how to start: http://www.oregon.gov/dhs/spwpd/pages/ltc/ltc_guide/howdoistart.aspx