Oregon Health Plan Eligibility for Long-Term Care

Your parent just got discharged from the hospital and needs ongoing nursing or in-home care. The bill is climbing fast, and someone mentioned "OHP" might cover it. But Oregon's Medicaid system — officially the Oregon Health Plan — has rules that trip up families who don't know the thresholds.

Here's what actually determines whether your parent qualifies for long-term care coverage under OHP Plus, and how to avoid the mistakes that cause denials.

OHP Plus vs. Standard OHP: Why It Matters

Not all Oregon Health Plan coverage is equal. OHP Plus is the full-benefit Medicaid program that covers long-term care — nursing facility stays, in-home personal care through the K Plan, and skilled nursing after hospitalization. Standard OHP covers basic medical but won't pay for ongoing custodial care.

For long-term care eligibility, your parent must qualify for OHP Plus specifically. That means meeting both financial and functional criteria.

Income and Asset Limits for 2026

Oregon is an income-cap state, which creates a hard cutoff that catches many families off guard.

Income limit: Your parent's gross monthly income cannot exceed $2,982 (300% of the federal SSI benefit rate for 2026). This includes Social Security, pensions, and any other recurring income. If they're even one dollar over, they're disqualified — unless they set up an Income Cap Trust (Miller Trust).

Asset limit: A single applicant can hold no more than $2,000 in countable assets. This includes bank accounts, investments, and retirement accounts. Oregon counts IRAs and 401(k) plans for both spouses, which catches families who assume retirement accounts are protected.

What's exempt: The primary home (up to $752,000 in equity if a spouse still lives there), one vehicle, household goods, and prepaid irrevocable burial contracts.

The Miller Trust Requirement

If your parent's income exceeds $2,982 per month, Oregon won't allow them to "spend down" the excess on medical bills like some states do. Instead, they must establish an Income Cap Trust — commonly called a Miller Trust.

This irrevocable trust holds all of the applicant's income. A designated trustee distributes funds according to state rules: personal needs allowance ($81.28), spousal maintenance allowance if applicable, medical premiums, and the remainder goes to the care facility as patient liability.

The state of Oregon is named as remainder beneficiary, meaning any funds left in the trust after death go toward repaying Medicaid costs. An elder law attorney typically charges $500–$1,500 to set one up, and it must be in place before the Medicaid application can be approved.

Spousal Protections That Prevent Financial Devastation

When one spouse needs long-term care and the other stays home, Oregon applies maximum federal spousal impoverishment protections:

• Community Spouse Resource Allowance: The at-home spouse keeps half of the couple's joint countable assets, up to $162,660 (with a floor of $32,532)
• Monthly Maintenance Allowance: If the at-home spouse's own income falls below $2,705 per month, a portion of the applicant spouse's income can be redirected to them — up to $4,066.50 per month if housing costs are high
• Home equity cap: The primary residence is exempt as long as the community spouse lives there, up to $752,000 in equity

How to Apply Through the ONE Portal

Oregon consolidated its benefits applications through the ONE (Oregon Needs Estimation) online portal. You can apply for OHP at one.oregon.gov or through your local Aging and People with Disabilities (APD) office.

For long-term care specifically, the APD office handles the functional assessment that determines whether your parent meets the nursing-facility level of care required for K Plan or waiver services. The financial application typically takes 45 to 90 days to process.

Critical timing: If your parent is being discharged to a nursing facility, start the Medicaid application immediately — even before discharge. Facilities that accept "Medicaid-pending" residents can begin care while the application processes, and OHP allows retroactive coverage for up to three months.

The Functional Eligibility Hurdle

Financial qualification alone doesn't unlock long-term care benefits. Your parent must also pass a functional assessment using Oregon's Client Assessment and Planning System (CAPS). A trained assessor evaluates physical, cognitive, and social functioning to assign a Service Priority Level (SPL) from 1 to 18.

Only patients at SPL 1 through 13 qualify for state-paid services. The assessment focuses on mobility, eating, elimination, and cognition — needing help with bathing or dressing alone won't qualify someone.

What to Do Right Now

If your parent is in the hospital or facing a care transition, contact your local ADRC of Oregon at 855-673-2372 to start the intake process. Don't wait for discharge — the earlier you begin, the less likely you'll face a gap in coverage.

For families navigating the full discharge-to-home transition, the Oregon Hospital Discharge Guide walks through every step: from securing legal authority and appealing an unsafe discharge to qualifying for K Plan services and protecting family assets from estate recovery.

See more Oregon guides →