Oregon Medicaid Long Term Care Eligibility

Oregon's Medicaid long-term care program operates under OSIPM — the Oregon Supplemental Income Program for the Blind or Disabled. Eligibility is evaluated through three separate gates: a financial income test, an asset test, and a functional needs assessment. An Income Cap Trust may address income above the cap, but the other requirements still apply, so understanding all three before starting the application process saves families from costly surprises.

The Income Gate: $2,982 Per Month

Oregon is a strict income-cap state. For 2026, the monthly gross income limit is $2,982, calculated as 300% of the SSI Federal Benefit Rate ($994).

"Gross" means all income before any deductions — Social Security benefits, pension payments, IRA distributions, rental income, annuity payments. If your parent's total monthly income exceeds $2,982 by even one dollar, they are disqualified from OSIPM.

Oregon does not allow income spend-down. Unlike states where applicants can subtract medical expenses from income to meet the limit, Oregon requires applicants above the cap to establish an irrevocable Income Cap Trust (Miller Trust). All income flows into the trust, and a trustee distributes it in a strict statutory order each month.

The Asset Gate: $2,000 for a Single Applicant

Countable assets must not exceed $2,000. Countable assets include bank balances, CDs, stocks, mutual funds, and both spouses' retirement accounts (IRAs and 401ks).

Exempt assets — not counted toward the limit — include:

• The primary home (if equity does not exceed $752,000 and the applicant intends to return, or if a spouse or protected child lives there)
• One vehicle
• Household furnishings and personal effects
• A prepaid, irrevocable burial arrangement

For married couples where only one spouse needs care, federal spousal impoverishment protections shelter a portion of joint assets. The community spouse can retain 50% of the couple's countable assets, up to a maximum of $162,660, with a protected floor of $32,532. The applicant spouse is limited to their separate $2,000 ceiling.

The Functional Gate: CAPS Assessment, SPL 1–13

Financial eligibility alone does not qualify someone for services. The applicant must also demonstrate a clinical need for long-term care through Oregon's CAPS (Client Assessment and Planning System) assessment.

An ODHS Aging and People with Disabilities (APD) case manager conducts the in-person assessment, scoring the applicant's ability to perform activities of daily living — mobility, eating, elimination, bathing, dressing, and cognitive function. The scores generate a Service Priority Level (SPL) from 1 (highest need) to 18 (lowest need).

Paid Medicaid long-term care is limited to SPL 1 through 13. An applicant assessed at SPL 14 or higher is denied standard Medicaid long-term care, regardless of income and asset eligibility. These individuals may qualify for Oregon Project Independence (traditional OPI or OPI-M) instead, which has different eligibility criteria.

The 60-Month Lookback

When ODHS processes a long-term care application, it reviews all financial transactions from the preceding 60 months using the state's Asset Verification System. Gifts, property transfers below fair market value, and actions taken to avoid receiving assets are treated as disqualifying transfers.

The penalty is calculated by dividing the total uncompensated value by Oregon's 2026 average private-pay nursing facility rate of $14,585 per month. A $72,925 gift made within the lookback window creates a five-month penalty period during which Medicaid will not pay for care — and the penalty clock does not start until after the applicant enters care and meets all other eligibility criteria.

What OSIPM Covers

Once approved, OSIPM covers long-term care services in multiple settings:

• Nursing facilities (the state pays the full cost minus the resident's patient liability)
• Assisted living and residential care facilities through the K Plan (Medicaid covers care services; the resident pays room and board up to $773/month)
• Adult foster homes (same K Plan structure)
• Home-based care through the K Plan Consumer-Employed Provider model
• Adult day services

Connecting Eligibility to the Full Care Decision

Understanding Medicaid eligibility is one piece of a larger decision process. Families also need to navigate the advance directive and POA, compare care settings, evaluate specific facilities, and understand appeal rights if services are denied. Our Oregon care decision guide maps the complete pathway from legal authority through financial qualification, facility placement, and post-placement protections.

See more Oregon guides →