Under the K Plan, long-term home and community supports are made available for seniors and physically disabled individuals. This program was formally known as Community First Choice.
The program allows Oregon residents who are eligible for the state Medicaid plan who require an institutional level of care (such as nursing home care) to receive assistance with daily living activities, like bathing, grooming, light housecleaning, meal preparation, and grocery shopping. Other supports include community transportation, durable medical equipment, home modifications, and more.
The K Plan provides an alternative to long-term home and community based Medicaid waivers. Medicaid waivers are not entitlement programs, which means there are a limited number of slots available for participant enrollment. But with the K Plan, since it’s part of the state Medicaid program and is an entitlement program, anyone who is eligible for services is able to receive them.
Under the K Plan, family members can be compensated to provide care for their loved ones.
With the K Plan, seniors are able to receive the care they need to continue to live at home or in the home of a family member rather than be placed in an institution. Eligible applicants may also choose to receive services outside of their homes, such as in an adult foster care home, adult group home, assisted living, or memory care home for persons with Alzheimer’s.
An added benefit of the K Plan is that all long-term care services are consumer-directed, as long as the individual has the capacity to direct their own services. This means an individual is able to choose the person they wish to provide care, including a family member. In unique situations, even a spouse can be hired as the caregiver.
To be eligible for the K Plan, one must be an Oregon resident who is eligible for medical coverage and long-term care services via Oregon’s state Medicaid plan. In the case of seniors (65 years and older), the relevant Medicaid program is the Oregon Supplemental Income Program-Medicaid (OSIPM). One must also require an institutional level of care, such as in a hospital or nursing home facility.
The financial criteria for OSIPM follows.
To be eligible for this Medicaid program, the income limit is 300% of the Federal Benefit Rate (FBR). As of 2023, this means a single individual cannot have income in excess of $2,742 / month, or more than $32,904 / year. For married couples, with both spouses as applicants, the income limit is $5,484 / month.
For married couples with just one spouse as an applicant, there is a special spousal impoverishment rule in place. This is called a monthly maintenance needs allowance, and it allows the applicant spouse to transfer up to $3,715.50 / month in income to his or her non-applicant spouse.
Liquid assets, such as checking accounts, savings accounts, stocks, and bonds, are limited to $2,000 for a single individual and $4,000 for a married couple (when both spouses are applicants). While these figures might seem quite low, many assets are considered exempt (non-countable). For instance, one’s home, as long as the equity is under $688,000, is not counted toward the asset limit given the applicant or their spouse lives in it. Other exemptions include household items, personal effects, a vehicle, and pre-paid burial / funeral arrangements.
Furthermore, when only one spouse of a married couple is an applicant, the non-applicant spouse can keep up to $148,620 of the couple’s joint assets as a community spouse resource allowance. This is in addition to the $2,000 the applicant spouse is able to retain.
Candidates should be aware that while Oregon Medicaid has strict financial thresholds for eligibility, there is flexibility to allow persons whose income or assets exceed the aforementioned amounts to become eligible for the program.
However, one should not give away cash or valuable assets in order to lower one’s countable assets. This is because Oregon has a 5-year Medicaid look-back period, and if one violates this rule, he or she may be penalized with a period of Medicaid ineligibility. By working with a Medicaid planner, many families who need care but cannot afford it can become eligibility. Learn more.
Under the K Plan, a large number of benefits and supports are available in a variety of settings, including one’s home, a foster care home, or an assisted living residence. These services are determined by one’s specific care plan and may include the following:
One must be receiving medical assistance through the state Medicaid plan in order to receive services via the K Plan. One can apply for the state Medicaid plan, and hence the K Plan, through their local Seniors & Peoples with Physical Disabilities Office. For a list of local offices, click here.
As part of the application process for CFC, a functional needs assessment is done and an annual plan of care is established. An annual recertification is generally conducted. However, for some groups of people, such as seniors with Alzheimer’s disease, the recertification is waived, as there is no hope of recovery / improvement.
For additional information about the K Plan program, click here.