Oregon Medicaid for seniors and long-term care

Last verified: June 2026

OHP for older adults and people with disabilities

Oregon Health Plan covers a range of long-term services and supports (LTSS) for seniors and adults with disabilities. The path into these programs differs from standard OHP Plus enrollment. Rather than applying through ONE.Oregon.gov, older adults and people with disabilities typically contact the Aging and Disability Resource Connection (ADRC) — Oregon's single entry point system for LTSS.

Oregon administers LTSS through the Oregon Department of Human Services (ODHS), Aging and People with Disabilities (APD) program. CCOs provide physical and behavioral health to LTSS-eligible Medicaid members, but the coordination of home and community-based services runs through ODHS/APD rather than through CCOs directly.

Key LTSS programs in Oregon

Financial eligibility for long-term care Medicaid

Long-term care Medicaid in Oregon uses non-MAGI eligibility rules. Both income and assets are considered. The standard asset limit for a single individual seeking nursing facility or HCBS Medicaid is $2,000 in countable assets. For married couples, federal spousal impoverishment protections apply — the community spouse retains a Community Spouse Resource Allowance (CSRA) based on the couple's total assets.

The primary home is generally exempt while the applicant intends to return or while a spouse or dependent child lives there. One vehicle is exempt regardless of value. Per OHA and ODHS eligibility rules, specific asset and income thresholds change annually. ADRC counselors can review your specific situation at no charge.

Estate recovery in Oregon

Oregon operates a Medicaid estate recovery program under 42 U.S.C. § 1396p. OHA seeks recovery from the estates of individuals who were age 55 or older when they received certain Medicaid-funded long-term care services, including nursing facility care and HCBS waiver services. Recovery is deferred while a surviving spouse, minor child, or blind or disabled child is living. Oregon has specific hardship waiver provisions for families facing financial difficulty due to estate recovery claims. The ODHS estate administration unit handles estate recovery — contact ODHS for more information if you are managing the estate of a deceased Medicaid recipient.

Starting the application process for LTSS

Contact the Aging and Disability Resource Connection (ADRC) at 1-855-ORE-ADRC (1-855-673-2372). ADRC provides free, unbiased counseling about LTSS options — both Medicaid and non-Medicaid programs. Staff can conduct a needs assessment, explain program differences, assist with applications, and connect you with local ODHS/APD offices. The ADRC does not administer benefits itself; it is an information and referral hub that simplifies the entry into Oregon's long-term care system.

Medicaid as the primary payer for long-term care

Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.

Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. Oregon's share of that population is administered through Oregon Health Plan (OHP). The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.

Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.

Nursing facility coverage

Oregon Health Plan (OHP) covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.

If income exceeds the institutional Medicaid limit, Oregon may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether Oregon uses this approach with Oregon Health Plan (OHP).

Home and community-based services (HCBS)

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through Oregon Health Plan (OHP) differs from what's available in neighboring states.

Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.

Contact Oregon Health Plan (OHP) to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

Asset limits for long-term care Medicaid

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.

Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.

Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult Oregon Health Plan (OHP) or a Medicaid planning attorney before transferring assets.

Spousal protections

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.

The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. Oregon's current CSRA is set by Oregon Health Plan (OHP) and published on their website.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).

What long-term care Medicaid typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments