The Consumer-Employed Provider (CEP) program 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, 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.
Participants are able to 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 provider; 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 the caregiver 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 be 65 years or older, or 18 and older and physically disabled. They must also 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.
There are multiple limits for the CEP program depending on marital status. In 2023, a single applicant may not have a gross monthly income that exceeds $2,742. 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 2023, the amount can be as much as $3,715.50 / month. This is referred to as a Monthly Maintenance Needs Allowance and is intended to ensure the non-applicant spouse, commonly called the community spouse, has enough income on 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.
For 2023, 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 $148,620 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 the equity in the home is under $688,000 — a single car, furniture and household items, some jewelry, and burial insurance.
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 re-structure their monetary holdings to conform to Medicaid limits. Read more.
Participants work with a case manager who will assess the needs of the individual and then help develop a service plan to meet those needs. Services available under CEP include assistance with the following:
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.
Health Related Taks: Examples of assistance include insulin injection, testing blood sugars, wound care, and tube feeding.
Medicaid eligible persons interested in participating in this program should contact their local Area Agency on Aging office. One can also call the Oregon Department of Human Services at 800-282-8096 for assistance applying.
The CEP Program Handbook is available as a 64 page PDF file and can be downloaded here.