Oregon’s Aged and Physically Disabled Medicaid Waiver

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

The Aged and Disabled Waiver helps elderly and physically disabled Oregon residents to receive care at home instead of in a nursing home even though they are medically qualified for nursing home placement. This type of Medicaid waiver is often referred to as a nursing home diversion program and it is popular with both state officials and families. Many families prefer their loved one receive care in a familiar and comfortable setting. Another benefit of this program is that the fact that caring for someone at home can be less expensive than in a residential care facility.

Under this Waiver a variety of services are provided to help seniors remain independent and living in the community.  Most importantly, personal care services can be provided at home, in assisted living, or in adult day care during daytime hours. 

Oregon seniors are fortunate in that the state offers multiple waivers. Although they cannot concurrently receive services from more than one, they can choose the waiver that is most appropriate for their needs. Other programs in which the reader may be interested include the Spousal PayIndependent Choices and Client Employed Provider programs.

 

Eligibility Guidelines

All Oregon residents who apply for this waiver must demonstrate eligibility in four areas: Age, functional ability, financial assets, and income. This waiver is open to adults 18 and over if they have a physical disability. However, the primary target group is seniors aged 65 and over. The elderly will qualify without a full disability, provided they have an assessed need for nursing home level care.

The financial assets and income requirements match that of Oregon Institutional (nursing home) Medicaid. These requirements depend on the marital status of the applicant.

Oregon Medicaid Income Limits 

Single applicants can have up to $2,205 per month (in 2017) in gross income. This amount is currently equal to 300% of the Federal Benefit Rate (FBR). Married applicants whose spouses are not applying for the A&D Waiver (or Medicaid) can effectively lower their income by not counting any income in the name of the non-applicant spouse.

Oregon Medicaid Asset Limits 

The value of a single applicant's resources—not including their home under $560,000—cannot exceed $2,000. Pre-needs contracts for funeral expenses and a single vehicle are also exempt, although some life insurance policies are countable towards the $2000 individual limit. If both spouses in a married couple are applying, they are permitted $3,000 in countable assets. However, if one spouse is not applying, they are permitted up to $120,900 in countable assets.

Qualifying When Over Limits 

Previously, Oregon offered Medically Needy Medicaid that helped families who couldn't afford their care costs even though they were over the limits. This program has been discontinued. Instead, for those seniors who are over the income limit, they have the option to use a Miller Trust (Qualifying Income Trust). A Medicaid professional advisor can assist families to properly set up and manage the income trust account according to Oregon law. Learn more here.

 

Benefits and Services

The types of benefits covered by Oregon's Aged and Physically Disabled Waiver include the following:

  • Adult Day Care - group care during daytime hours
  • Adult Residential Care - such as non-relative/relative adult foster homes or assisted living residences. This allows assistance with activities of daily living and instrumental activities of daily living. 
  • Community Transition Services - for persons leaving nursing homes and returning to the community
  • Environmental Accessibility Adaptations - to increase the independence of participants. This covers adaptations such as lifts, ramps, walk in tubs, widening of doorways, etc. 
  • Home Delivered Meals - Hot or prepared, nutritiously balanced
  • In Home Care Services - as needed
  • Non-Medical Transportation Assistance - coordination of transportation for adult day care
  • Case Management
  • Behavioral Support Services
  • Specialized Living Services

 

How to Apply / Learn More

This program is available statewide in all Oregon counties. It has been approved to assist approximately 30,000 state residents. Typically, there are slots available. However, it is possible to be put on a wait list.

To learn more, interested individuals should contact the Aging and Disability Resource Center in their county.