Does Medicaid pay for in home care in Oregon? (2023)

Does Medicaid pay for in home care in Oregon?

Medicaid pays the long-term care costs for eligible, low-income individuals. There are several programs that may provide assistance, each with different eligibility criteria. Services can be provided in a person's home​ or in a care setting.

Participants must be residents of Oregon, 18 years of age and older, who are willing and able to self-direct and receive care services in their homes. They must be willing to open a separate bank account, where monthly payments will be directly deposited, allowing the applicant to pay for services and other benefits.

A family member, friend, or professional can get paid to be a caregiver in Oregon but with stipulations and requirements. In Oregon, the program to pay caregivers is called the Independent Choices Program (ICP). Under this program, clients can hire family members or others to provide the care they need.

Qualifying Assisted Living residents in Oregon may pay for assisted living through the state's Medicaid program. Assisted Living services are covered directly through the K Plan, also called the Community First Choice State Plan Option, as well as indirectly through the Aged and Physically Disabled waiver.

The average cost of in-home care in Oregon is $5,148 per month, according to the Genworth 2019 Cost of Care Survey.

Medicaid will help cover the cost of assisted living, including memory care, or Alzheimer's care. Eligibility requirements must be met (see below for more). Such requirements, available programs and benefits vary based on your state of residence.

Twelve states (Colorado, Kentucky, Maine, Minnesota, New Hampshire, New Jersey, North Dakota, Oregon, Texas, Utah, Vermont, and Wisconsin) allow these state-funded programs to pay any relatives, including spouses, parents of minor children, and other legally responsible relatives.

You can hire relatives, friends, neighbors, and other caregivers to provide you with IHSS.

What does Medicaid cover in Oregon?

OHP is Oregon's Medicaid program. It provides free coverage for people in Oregon who meet eligibility criteria. Coverage includes doctor visits, hospital care, mental health services, dental, and some vision care.

There are also many assets that are exempt (non-countable). Exemptions include personal belongings, such as clothing, household furnishings, an automobile, irrevocable burial trusts, term life insurance, and generally one's primary home. If a non-applicant spouse lives in the home, it is automatically exempt.

Oregon Medicaid Asset Limits 2019

Individuals in Oregon are allowed to keep $2,000 when they apply to Medicaid for long term care. If they are over this amount, they must spend down on care.

But sometimes, an elderly adult needs hands-on assistance all day and night. So, how much does 24/7 in-home care cost? The average cost of 24/7 care at home stacks up to around $15,000 a month, whether that's 24-hour companion care or home health care.

Oregon's Medicaid service will cover memory care indirectly through two separate waiver programs. These programs are the Aged and Physically Disabled Waiver and the Oregon K Plan.

Assisted Living / Memory Care

In 2021, according to Genworth's Cost of Care Survey 2020, the average monthly statewide cost of assisted living in Oregon is $4,659. This is approximately 9% more costly than the national average, which is currently at $4,300 / month.

Federal Poverty Level thresholds to qualify for Medicaid

The Federal Poverty Level is determined by the size of a family for the lower 48 states and the District of Columbia. For example, in 2022 it is $13,590 for a single adult person, $27,750 for a family of four and $46,630 for a family of eight.

To be eligible for Oregon Medicaid, you must be a resident of the state of Oregon, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.

The previous income limit for these programs was 185% of the federal poverty level, or $1,986 a month for an individual or $3,386 for a family of three. This change took effect in Oregon on Jan. 1, 2022, and approximately 18,000 new households are expected to be eligible to enroll in SNAP.

Medicaid is one of the most common ways to pay for a nursing home when you have no money available. Even if you have had too much money to qualify for Medicaid in the past, you may find that you are eligible for Medicaid nursing home care because the income limits are higher for this purpose.

How do you pay for assisted living?

SSI benefits may be available to your friend or family member, based on his or her financial situation, living circumstances, and other factors. SSI is need-based and requires a review of financial details in addition to personal information and medical records.

Unfortunately, the simple answer is no. Social Security programs don't directly pay caregivers. However, there are still many ways a caregiver can interact with Social Security programs to benefit a loved one.

Medicare pays your Medicare-certified home health agency one payment for the covered services you get during a 30-day period of care. You can have more than one 30-day period of care. Payment for each 30-day period is based on your condition and care needs.