Page Reviewed / Updated - March 18, 2020
Under the K Plan, long-term home and community supports are made available for seniors and physically disabled individuals under Oregon’s state Medicaid plan. This option is also referred to as the K Option, the 1915(k) state plan option or more formally as the Community First Choice (CFC) Option.
The program allows Oregon residents who are eligible for the state Medicaid plan, and who also 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 / CFC provides an alternative to long-term home and community based Medicaid waivers. Medicaid waivers are not entitlement programs, which means that there are a limited number of slots available for participant enrollment. Stated differently, eligibility does not automatically mean one is enrolled in the program. Since CFC is part of the state Medicaid program and is an entitlement program, anyone who is eligible for services is able to receive them.
With CFC, more residents of Oregon are able to receive long-term home and community benefits from Medicaid. This is a win-win. 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, and the state saves money by avoiding the need to pay for more costly, nursing home care. That being said, eligible applicants may also choose to receive services outside of their homes, such as in an adult foster care home, adult group home, in assisted living, or a memory care home for persons with Alzheimer's.
An added benefit of CFC is that all long-term care services, including attendant care, 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.
The Community First Choice Option is approved under the Affordable Care Act (abbreviated as ACA).
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). To be eligible for this Medicaid program, there is an income limit of 300% of the Federal Benefit Rate (FBR). As of 2020, this means a single individual cannot have income in excess of $2,349 / month or more than $28,188 / year. For married couples, with both spouses as applicants, the income limit is slightly higher at $3,525 / month or $42,300 / year. 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 allows the applicant spouse to transfer up to $3,216 / month in income to his / 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 $3,000 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, valued at or under $595,000, 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 $128,640 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.
There are no age or disability requirements for eligibility purposes. However, in addition to being eligible for the OSIPM, one must also require an institutional level of care, such as in a hospital or nursing home facility.
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 / CFC, 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 Community First Choice / K Plan. One can apply for the state Medicaid plan, and hence, CFC / K Plan, through their local Seniors & Peoples with Physical Disabilities Office. For a list of local offices, click here.
For additional information about the Community First Choice Program, 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.