Oregon Medicaid Long-Term Care Eligibility for 2025

Oregon Long-Term Care

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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.
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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.

Further Reading:

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