Oregon Spousal Pay Program

Page Reviewed / Updated - Feb. 2019

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.

Waiver Description

Oregon’s Spousal Pay Program is almost unique in the world of Medicaid’s consumer directed programs. As the name implies, the program pays the spouse of an individual that requires significant assistance with his/her activities of daily living, provided the care recipient spouse and his/her caregiving spouse meets all the eligibility requirements. This program is based on the Cash and Counseling model, which allows the participant greater control over who is hired to provide his/her care.

When a couple qualifies for this program, the spouse becomes an official Homecare Worker and joins the Homecare Workers Union. Caregiver spouses receive a salary, pay taxes and union fees, and are eligible for unemployment insurance. It should be noted that since it is expected that spouses care for each other, the number of hours for which an individual is authorized to receive care might be lower when participating in the Spousal Pay Program than were the individual to receive care under other Oregon Medicaid programs, such as the Client-Employed Provider Program.

The administrator of the Spousal Pay program is the Oregon Department of Human Services.

Eligibility Guidelines

The caregiver and spouse must be residents of Oregon, legally married, and residing at home (not in a skilled nursing home or assisted living facility). The individual in need of care must require fairly extensive care, and if not for the Spousal Pay Program, would need nursing home care. The individual must also require full assistance with at least 4 of the following activities of daily living: bathing, dressing, grooming, eating, toileting, and mobility, and have a diagnosed, progressive and debilitating condition. Some examples of qualifying diagnoses include cancer in late stages, seizures that occur frequently and unpredictably, and spinal cord injuries.

As mentioned previously, the Spousal Pay Program is a Medicaid program. Therefore, individuals must financially qualify for this special version of the Oregon Health Plan for seniors. Oregon Medicaid income limits for 2019 for a married applicant whose spouse is not also receiving Medicaid benefits is $2,313. This amount is adjusted annually in accordance with the Federal Cost of Living Adjustment. For 2019, the countable resource limit for an individual applicant is $2,000. The primary home is considered exempt if the applicant lives in the home and it is valued under $585,000. A single vehicle, household goods, personal items, and burial plots are also considered exempt assets, meaning their value is not included in an applicant's countable resources.

The caregiving spouse must pass a criminal history check and meet the other Oregon Department of Human Services requirements for providing care. In addition to aiding with their spouse’s ADLs, it is expected that caregiver spouses manage the home, perform housekeeping, do laundry, do the grocery shopping, provide transportation, manage medications, and prepare meals.

Being over the financial limitations does not automatically mean one cannot become eligible for the Spousal Pay Program. There are ways to lower one’s countable income and assets without jeopardizing one’s eligibility or violating Medicaid’s Look-Back Rule. That said, it is strongly advised one contact a professional Medicaid planner if he or she is over the specified income and/or asset limit(s) for assistance in restructuring finances.

Benefits and Services

Caregiving spouses receive payment for providing care services. Typically, this is an hourly wage agreed upon by the Homecare Workers Union and the state of Oregon. The exact amount changes annually, but as of April 1, 2018, the average hourly rate was $14.65 per hour.


 

In addition to their wages, the caregiving spouses also receive other benefits of union participation, such as unemployment insurance, paid vacation time, and disability benefits should they themselves become disabled.

How to Apply / Learn More

To apply for the Spousal Pay Program, interested couples should contact the local Area Agency on Aging / Senior and Persons Disabilities Office. Alternatively, they can call 1-800-282-8096 or 503-947-5162.

Additional information about this program is available here, but please keep in mind, it is not written for a consumer audience. Therefore, the wording can be complex and difficult to understand.