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.
Under CEP, adult children can be employed as caregivers by the aging parents.
The Client-Employed Provider Program (CEP) is a program for Medicaid eligible, Oregon seniors and persons with disabilities that require assistance with their Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). As implied by the name—Client Employed Provider—the individuals receiving care act as the employer of the care provider or “homecare worker.” Homecare workers can work part-time, full-time, or even reside in the aging individual’s home to be on call for 24-hour care. These workers provide the eligible individual assistance with tasks, such as toiletry, dressing, mobility, eating, grooming, shopping, and housekeeping, enabling the individual to continue to live at home.
This program is based on the Medicaid cash and counseling model, in which the participants direct their own care services; this is also referred to as self-direction or consumer-direction. Via CEP, program participants are also able to designate a friend or relative to handle the responsibilities of employing a personal caregiver for them. In addition, neighbors, friends, and family members are eligible to be hired as paid caregivers. Adult children are eligible, and even spouses can be hired as personal care providers. It is worth noting that Oregon also has another program in which spouses can be hired. It is called the Spousal Pay Program. Generally, the state prohibits the participant from hiring the same individual who is acting as their official representative or Durable Power of Attorney to prevent the possibility of abuse or fraud.
The CEP program is similar to another Oregon Medicaid program called Independent Choices in that the participant is responsible for choosing their care providers; however under CEP, the state or case manager plays a larger administrative role. Individuals enrolled in CEP do not receive cash to pay their caregivers; rather they authorize the state to make payments to them on their behalf. In both programs, participants hire, supervise, train, and even dismiss their caregivers, but in the CEP program, the case manager can provide more assistance with these processes.
Individuals must require assistance with the activities of daily living and be able to manage their care providers or work with a family member to do so. In addition, they must be financially eligible to receive Medicaid. Determining financial eligibility for Medicaid’s CEP Program is complicated and involves a detailed review of the individual’s or the couple’s income and financial resources.
Oregon Medicaid 2022 Income Limits
There are multiple limits for the CEP Program depending on marital status. A single applicant may not have a gross monthly income that exceeds $2,523. A married couple with both spouses applying can have up to twice that amount. For married couples with just one spouse applying for Medicaid, a portion of the applicant’s income can be transferred to the non-applicant spouse. As of 2022, the amount can be as much as $3,435 / month. This is referred to as a Monthly Needs Allowance and is intended to ensure the non-applicant spouse, commonly called the community spouse, has enough income in which to adequately live. Only the applicant’s income — not their spouse’s income — is counted when one member of the couple is applying for Medicaid. This is called the ‘name on the check’ rule.
Oregon Medicaid 2022 Resource Limits
Single applicants are permitted $2,000 in countable resources and married couples (with both spouses as applicants) up to $4,000. The rules are different for married couples with just one Medicaid applicant. The non-applicant spouse is able to retain up to $137,400 in joint assets. This is called the Maximum Resource Standard or Community Spouse Resource Allowance and is also in place in order to prevent the community spouse from becoming impoverished. In addition, the applicant spouse is able to retain up to $2,000. It is worth noting that many resources are considered non-countable. These include the home, given the applicant or his or her spouse lives in the home and it is valued under $636,000, a single car, furniture and household items, some jewelry, and burial insurance.
Asset Transfer Guidelines
To prevent families from simply giving away their assets to qualify for Medicaid, the State of Oregon looks at past asset transfers to determine if they were made for less than the fair market value of the asset. Should they discover such transfers — or gifts — the applicant is penalized for the under-market value of the transfer in care costs. The state may “look back” on the transfer of assets for the 5-years preceding one’s Medicaid application. This is referred to as the Medicaid Look-Back Period.
Medicaid candidates in Oregon who exceed the financial limits might consider working with a Medicaid planner to help them qualify for the CEP Program. These professionals help applicants to re-structure their monetary holdings to conform to Medicaid limits. Read more.
Benefits and Services
Activities of Daily Living – assistance with the ADLs includes activities such as bathing, dressing, toileting, grooming, and mobility.
Instrumental Activities of Daily Living – assistance with the IADLs includes housekeeping, laundry, meal preparation, meal planning, grocery shopping, shopping for other essentials, medication administration, and transportation.
What are Activities of Daily Living and why are they important?
Activities of Daily Living are five essential tasks that an individual regularly does in the normal course of a day. These are defined by the government and are often used to establish eligibility for different financial assistance programs. Learn more about ADLs and instrumental Activities of Daily Living.
How to Apply / Learn More
Medicaid eligible persons interested in participating in this program should contact their local Seniors and Persons with Disabilities / Area Agency on Aging office. The CEP Program Handbook is available as a 50 page PDF file and can be downloaded here.