Oregon Medicaid Income Limit for Long-Term Care in 2026

Your parent's Social Security check plus their pension adds up to $3,100 per month. In many states, they could subtract medical expenses until their countable income drops below the threshold. Oregon doesn't work that way — and that one difference costs families months of delays and thousands in private-pay bills.

The 2026 Income Cap

Oregon sets a hard monthly gross income limit of $2,982 for long-term care Medicaid (OSIPM pathway). This figure equals 300% of the Federal Benefit Rate and adjusts every January. It applies equally to nursing home Medicaid and the K Plan Community First Choice home and community-based services.

Gross income means everything before deductions: Social Security, pensions, annuity payments, rental income, veteran benefits, and any other recurring income source. Oregon counts it all.

The critical distinction: Oregon is a categorically needy state, not a medically needy state. There is no mechanism to deduct medical bills from income to reach the threshold. If gross income exceeds $2,982 by even one dollar, the application is denied — unless an Income Cap Trust is in place.

When Both Spouses Apply

If both spouses need long-term care, the combined income limit doubles to $5,964 per month. Each spouse's income is evaluated independently when only one applies, but the over-income spouse still needs the trust.

The Income Cap Trust Solution

For applicants earning more than $2,982, Oregon requires a Qualified Income Trust — locally called an Income Cap Trust (or Miller Trust). This is not optional. The trust must be:

1. Drafted by an attorney or using a state-approved template
2. Signed before the Medicaid application is submitted through the ONE portal
3. Funded with a dedicated checking account at a participating bank

Each month, the applicant's income is deposited into the trust account. From there, it's disbursed in a strict order set by state rules:

• Personal needs allowance: $81.28 (nursing home) or $221.00 (assisted living/adult foster home)
• Spousal maintenance (MMNA): if the community spouse's own income falls below $2,705
• Health insurance premiums: Medicare Part B, supplemental, and prescription plans
• Patient liability: the remaining balance, paid directly to the care facility

Filing through the ONE portal before the trust is active and funded results in an automatic denial that adds 45 or more days to the timeline.

OPI-Medicaid: The Higher-Income Alternative

Parents who need in-home help but earn above $2,982 may qualify for OPI-Medicaid instead. This 1115 waiver program has an income limit of $5,320 per month (400% FPL) and an asset limit of $103,645. It covers in-home services, has no enrollment cap, and is entirely exempt from estate recovery. The tradeoff: OPI-M doesn't cover nursing home or assisted living placement.

What to Do If Your Parent Is Over the Income Limit

Don't file the application first. The sequence matters:

1. Calculate your parent's total gross monthly income from all sources
2. If it exceeds $2,982, consult an elder law attorney to draft the Income Cap Trust
3. Open the trust bank account and make the first deposit
4. Then submit the OHP application through ONE.Oregon.gov

The Oregon Medicaid Long-Term Care & Asset Protection Guide includes a pre-application income worksheet and a step-by-step Income Cap Trust setup checklist to help you get the sequence right the first time.

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