Oregon Medicaid for Seniors & Long-Term Care

The K Plan (1915(k) Community First Choice) is Oregon's primary HCBS program for individuals who meet nursing facility level of care. It covers personal care, assistance with activities of daily living (ADLs), home health aide services, and support for community integration, and is funded through Section 1915(k) of the Social Security Act, which provides a 6% enhanced federal match.

Oregon's Aging and People with Disabilities (APD) program also operates two federally approved Medicaid waivers alongside the K Plan: the 1915(c) Aged and Physically Disabled Waiver, which covers waiver case management, community transition costs, and housing support services for people moving out of an institutional setting, and the 1915(b)(4) Case Management and Agency with Choice Freedom of Choice Waiver, which lets AAAs, APD offices, and participating tribes deliver waiver case management. Both waivers are renewed periodically with CMS.

Oregon Project Independence (OPI) is a state-funded program for lower-acuity seniors who don't meet nursing facility level of care. OPI provides limited in-home services — help with personal care, housekeeping, and meal preparation — to help seniors remain at home safely. It is not federally matched; it is funded by Oregon, and income-based client contributions may apply.

Oregon also has a robust adult foster home system — a distinctive feature of Oregon's long-term care landscape. Medicaid pays for care in licensed adult foster homes and residential care facilities for eligible seniors and adults with physical disabilities, serving as an alternative to nursing facilities for members who need supervision but not skilled nursing.

Oregon Medicaid covers skilled nursing facility care for members who meet both clinical (nursing facility level of care) and financial eligibility criteria. Residents contribute most of their income toward care, retaining a monthly Personal Incidental allowance set by ODHS. 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.

Long-term care Medicaid in Oregon uses non-MAGI eligibility rules, and 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, and the 2026 monthly income limit is $2,982 (300% of the SSI Federal Benefit Rate). For married couples, federal spousal impoverishment protections apply — the community spouse retains a Community Spouse Resource Allowance (CSRA) of between $32,532 and $162,660 for 2026, 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, and one vehicle is exempt regardless of value. Per OHA and ODHS eligibility rules, these asset and income thresholds change annually. ADRC counselors can review your specific situation at no charge. Medicaid also has a 60-month (5-year) lookback period for asset transfers — transfers for less than fair market value within that window can trigger a penalty period during which Medicaid will not pay for care.

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse is entitled to keep a minimum amount of assets — the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them through the minimum monthly maintenance needs allowance (MMMNA). Oregon's current CSRA is set by OHA and published on their website.

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 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 entry into Oregon's long-term care system.