Oregon Medicaid Long-Term Care Eligibility for 2025

Oregon Long-Term Care

Oregon is an income-cap state, meaning that to be eligible for Medicaid long-term care benefits, there is a hard income limit. Non-income cap states allow applicants to spend down income to qualify, whereas income-cap states require applicants to meet the limit at the time of application.

Programs:

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.

Eligibility:

1. Residency and Citizenship – Applicants must be Oregon residents and U.S. citizens or have proper immigration status.

2. Age/Disability – Applicants must be 65 years or older, blind, or disabled. They must meet medical requirements consistent with the level of care requested and need care for 30 consecutive days.

Medicaid evaluates applicants on a scale of 1-18 to determine their level of need, referred to as their “survivability” need. Levels 1-13 are eligible for assistance, with Level 1 requiring the highest care. Levels 14-18 are ineligible. Case managers assess applicants and assign levels based on personal circumstances.

3. Income Limitations – For single applicants, monthly income (from wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must not exceed $3,021. Income exclusions include:

A personal needs allowance of $62/month for individuals in nursing homes or facilities.
A personal needs allowance of $173/month for individuals receiving community-based care.
Veterans receiving a pension can retain an additional $90/month.

4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into Exempt and Available. Exempt assets are protected, while available assets must be liquidated and used for care costs before eligibility is granted. Oregon enforces a 5-year look-back period for asset transfers below fair market value or gifts, which may result in penalties.

Exempt Assets for 2025:

i. $2,000 or less in cash or non-exempt assets for single applicants. For married applicants, the limit is $3,000 if both spouses require care.

ii. One home is exempt (equity limit $788,000) if the applicant intends to return, or if a spouse, child under 21, or disabled dependent resides there.

iii. One automobile, no equity limit specified.

iv. Burial funds valued at $1,500 or less. Irrevocable burial trusts may have higher limits.

v. Non-saleable property, household furnishings, furniture, clothing, jewelry, and personal effects.

vi. Life insurance policies with a face value of $1,500 or less. Policies exceeding this value count their cash surrender value as an asset.

Spousal Rules:

Community Spouse Asset Allowance: The community spouse may retain non-exempt resources up to $152,020. If their assets are below $30,027, additional resources can be transferred from the institutionalized spouse.

Community Spouse Income Protection: The community spouse can retain part of the institutionalized spouse’s income if their monthly income is less than $2,389. Depending on living expenses, the community spouse may retain up to $3,898.50/month.

Oregon Long-Term Care Insurance Partnership:

This program is a partnership between the state and private insurance companies. Partnership policies protect assets dollar-for-dollar based on the policy’s maximum benefit payout. For example, a policy with a benefit of $165,000 protects $165,000 in assets. Married couples must each purchase individual policies to qualify. Once the policy’s benefits are exhausted, the protected assets remain exempt from Medicaid eligibility calculations.