Under Independent Choices, participants receive cash for care services and are responsible for managing their own care providers.
The Oregon Independent Choices Program (ICP) provides qualified Oregon Medicaid recipients with monthly cash payments and the flexibility to manage or self-direct their own care rather than receive care services managed by the state. The Independent Choices program is based on the Medicaid model of Cash and Counseling and is a Medicaid state plan program option. ICP was originally a pilot program, but is now available statewide.
In this model of program, individuals are empowered to employ their own care providers. Friends, neighbors, and family members, including the adult children, and in Oregon, even spouses can be hired as paid caregivers. Participants receive cash payments from the state and are responsible for paying their “employees.” If participants are not capable of acting as an employer, they can retain a third-party organization or legal guardian to perform those services on their behalf. However, to avoid conflicts of interest, the legal guardian and the care provider cannot be the same individual.
An element of this program that makes it unique, even among Medicaid waivers in different states, is that Medicaid does not establish the rate that care service providers are paid. Typically, state Medicaid rates are 60% – 75% of the state average ($10.75 – $14.75 / hour). In this program, participants have both the freedom and the responsibility to negotiate the hourly rate they pay their care providers. In areas of the state where the going rates for caregiving services are higher, this aspect of the program allows the participants to find and retain high quality employees.
A final point worth mentioning is that the goal of this program is to prevent the premature or unnecessary institutionalization of disabled or elderly individuals. Therefore, to participate in this program, individuals must be willing and able to live at home and not in a skilled nursing or assisted living residence.
The Oregon Department of Human Services administers the Independent Choices Program and has set forth the following requirements. Participants must be residents of Oregon, 18 years of age and older, who are willing and able to self-direct and receive care services in their homes. They must be willing to open a separate bank account, where monthly payments will be directly deposited, allowing the applicant to pay for services and other benefits. Applicants must also be eligible for Oregon Medicaid’s HCBS services, which consider the applicant’s level of impairment and their financial situation.
Functionally, individuals must need the type of care available in a nursing home. This does not mean they are designated as disabled or must live in a nursing home, only that they require the level of care typically provided in nursing homes. The applicant must also be able to show a stable living environment, indicated by an ability to manage money for three months prior to application.
Financially, there are income and resource limits that differ depending on the age of the candidate. As of 2020, for persons 65 and older, Oregon Medicaid and the Independent Choices Program have set the monthly income limit for a single applicant at $2,349 (300% of the Federal Benefit Rate). The federal government will adjust this limit annually according to the current FBR.
Separate from the income requirements, the total available balances in an applicant’s bank accounts and other liquid assets should not exceed $2,000. Many items are excluded from being counted as a resource. Personal effects, such as wedding rings, irrevocable burial trusts, and even one’s vehicle and home can be considered exempt. With the home, there are some caveats: The applicant, or the applicant’s spouse, must live in the home, and the available home equity should not be more than $595,000.
Giving away assets to lower one’s countable assets is not a feasible option for meeting the asset limit. This is because Medicaid in Oregon has a look-back period of 5 years. Essentially, Medicaid checks all past asset transfers within 60-months of one’s application date, and if one has gifted assets or sold them under fair market value, a penalty period of ineligibility may result.
If you or your loved one’s finances make you ineligible, yet you still require assistance paying for care, you might consider working with an Oregon long term care benefits planner. These individuals assist in re-structuring one’s assets so that they become Medicaid eligible. Persons considering this route must consult with a Medicaid planner in advance of submitting their Medicaid application paperwork. Read more about Medicaid planning.
The intent of this program is to avoid unnecessary nursing home placements and also allow individuals to determine their own care needs and allocate funds as they best see fit. That said, an eligible individual’s care spending is subject to approval by the administering agency. Typically, the types of services and goods that are considered eligible fall into one of the following two categories.
1) Personal Care Services – assistance with the activities and instrumental activities of daily living, such as bathing, grooming, toileting, meal preparation, eating, mobility, transferring, housekeeping, shopping for groceries and other essentials, medication management, and laundry.
2) Assistive Technology – appliances and devices that increase the individual’s ability to live independently, such as a washing machine and dryer, microwave oven, talking clock, vehicle lift, a ramp allowing access to the home, and so forth.
Applications for the Independent Choices program are managed by the local Area Agencies on Aging (AAA) offices. Find your local Oregon AAA in your county. One can also call the statewide toll-free number for the Aging and Disability and Resource Connection of Oregon at 855-673-2372 for assistance. A brochure for the program can be downloaded here.
Please note that this program is limited to approximately 2,600 participants, which means a waitlist for services may exist.