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.
The Aged and Physically Disabled (APD) Medicaid Waiver helps elderly and physically disabled Oregon residents to transition from an institutional setting, such as a nursing home, back into the community. In addition, seniors are able to receive case management services.
Previously under this waiver, a variety of services were provided to help seniors remain independent and living in the community, such as home delivered meals, in-home care services, and home modifications. However, with the implementation of the Oregon K plan, a state plan option, also referred to as Community First Choice, these services are no longer available via the APD Waiver. Instead, the majority of them are provided via CFC. Eligible applicants are able to receive services via both CFC and the APD Waiver, given no services are duplicated. Learn more here.
Oregon seniors are fortunate in that the state also offers multiple Medicaid waivers. Unlike the Oregon K state plan, where applicants can receive services via both the state plan option and the APD Medicaid Waiver, those enrolled in a Medicaid Waiver cannot concurrently receive services from more than one waiver program. However, they can choose the waiver that is most appropriate for their needs. Other programs in which the reader may be interested include the Spousal Pay, Independent Choices, and Client Employed Provider programs.
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 $2,523 per month (in 2022) in gross income. Married couples, with both spouses as applicants, are considered as single applicants, and each spouse is allowed up to $2,523 per month. This amount is currently equal to 300% of the Federal Benefit Rate (FBR). In some cases, married applicants whose spouses are not applying for the APD Waiver (or Medicaid) can effectively lower their income by transferring up to $3,435 / month in income to their non-applicant spouse. This is referred to as the Maximum Monthly Needs Allowance and is intended to prevent spousal impoverishment of non-applicant spouses.
Oregon Medicaid Asset Limits
The value of a single applicant’s resources — not including their home equity valued at or under $636,000 — 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 $2,000 individual limit. If both spouses in a married couple are applying, each spouse is permitted $2,000 in countable assets. However, if one spouse is not applying, the non-applicant spouse is permitted up to $137,400 in countable assets as a community spouse resource allowance. The applicant spouse is still able to retain $2,000.
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 are limited to the following:
- Community Transition Services – for persons leaving nursing homes and returning to the community. This may include moving costs, assistance with application fees for housing, security deposits, initial utility deposits, purchase of household items, such as furniture, and essentials, like bedding and cookware.
- Case Management
How to Apply / Learn More
This program is available statewide in all Oregon counties and is operated by the Oregon Department of Human Services. It has been approved to assist approximately 42,000 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.