Oregon Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

Oregon provides long-term care resources to seniors through the Department of Human Services,Senior & People with Disabilities Division. Oregon provides long-term care resourcesin a variety of settings, which may include assisted living or residential based facilities or even in-home care. The Aging and Disability Resource Connection of Oregon (ARDC) provides information on these long-term care resources. More information can also be found at your local Area Agency on Aging.

Oregon offers many options to fund long-term senior care, including:

  • Long-Term Care Insurance — Long-Term Care Insurance can help pay for long-term care costs. Long-term care insurance may not be appropriate for everyone. The Oregon Insurance Division can help you decide if it’s right for you;
  • Oregon Project Independence — Oregon Project Independence is a program designed to help people stay in their homes who do not receive Medicaid Long-Term Care services. Services may include: Home-Delivered Meals; Transportation Assistance; Respite; Help in the home; and,
  • Medicaid Long-Term Care Services — Medicaid pays the long-term care costs for eligible, low-income individuals. There are several programs that may provide assistance, each with different eligibility criteria. Services can be provided in a person’s home or care setting.

Medicaid long-term care services are available to seniors over 65 years old who want to remain in their own home or in a community setting but otherwise require a nursing home level of care through the Oregon Aged & Physically Disabled Waiver.

Medicaid Waiver Program for Assisted Living and In Home Care

Oregon Aged & Physically Disabled Medicaid Waiver (HCBS Aged & Physically Disabled Waiver)

Services

Services include: Adult day service programs provide a variety of health, social and other support services in a safe setting. This is usually during normal business hours; Meal programs provide meals in group settings; Senior centers provide many social and educational services; Transportation services help get people to and from medical appointments, shopping centers and other places; Chronic disease self-management programs help people learn to better manage ongoing health conditions. Examples are diabetes, heart disease, depression, fibromyalgia and arthritis. These programs can also help you prevent falls and take control of your health and life; Home health care often includes skilled, short-term services such as nursing or physical therapy. A doctor must order them for a specific condition; Personal care services provide help with basic activities such as bathing and dressing; Homemaker and chore services include activities like meal preparation and routine household chores. These are sometimes called personal care services; and Home-delivered meals for qualified individuals.

Eligibility

  1. Health: Applicants must require a Nursing Home Level of Care.
  2. Financial: Applicants must meet certain income and asset limits, under the state’s institutional Medicaid financial eligibility rules, which use a special income limit. For 2017, the individual income limit is $2,205 per month and individual asset limit is $2,000 (or $3,000 for a married couple both applying). In an applicant’s income is too high, the state allows for the use of a Miller Trust, also known as a Qualified Income Trust, to access the benefit by funneling income into the trust for the purpose of paying for medical care. A non-applicant spouse may also keep up to $120,900 in assets and receive up to $3,022.50 in monthly allowance without affecting the applicant’s financial status for determination of the benefit.

Practical Considerations

The use of a Miller Trust for applicants whose income is too high is an advantage in Oregon’s Aged & Physically Disabled Waiver. Oregon also is currently implementing a Section 1115 Demonstration Waiver that might change how the state operates Medicaid waiver programs for seniors.