When Medicaid in Oregon Will Pay for a Nursing Home, Assisted Living, or Home Health Care

The average monthly cost of a private room in a nursing home in Oregon surpassed $15,500 in 2023. Oregon seniors likely to need long-term care (LTC) should plan ahead to ensure they have a way to pay for that care.

Long-term care is usually paid for by private funds, nursing home insurance, or Medicaid. If you can't afford to pay using your own funds and don't have long-term care insurance, Oregon's Medicaid program (the Oregon Health Plan), administered by the Oregon Health Authority (OHA), might cover your care.

Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, long-term care for people who meet certain requirements, such as being over 65, disabled, or blind. The Oregon Health Plan (OHP) provides LTC assistance in certain circumstances. Other types of OHP services have eligibility guidelines that are different from the rules for long-term care.

Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more can qualify for Medicaid benefits if both of the following apply:

• the Oregon Health Plan determines they need institution-level care, and
• they meet specified income and resource qualifications.

The Oregon Health Plan also operates certain Medicaid-funded programs that allow seniors in need of assistance to remain living independently, in their homes and communities, instead of in a nursing home. These include Medicaid waiver plans, known as Home and Community-Based Services (HCBS) waivers, and other specific Oregon programs.

Medicaid Coverage for Nursing Homes in Oregon

If you're 65 or older, blind, or disabled and meet the Medicaid income and resource requirements, the Oregon Health Plan provides coverage for nursing home residents through the Oregon Supplemental Income Program-Medical (OSIPM).

To qualify for OSPIM coverage for nursing home care, you must be financially eligible and you must need the kind of care that nursing homes provide. (Or. Admin. R. 461-135-0750.) Nursing homes provide many care services, such as:

• 24-hour supervised nursing care
• personal care
• therapy
• nutrition management
• organized activities, and
• other services.

OHP will look at how limited your "activities of daily living" are to determine your eligibility for a Medicaid-paid nursing home. (The state defines activities of daily living to include things you must do every day to care for yourself, including activities like:

• eating
• bathing
• dressing
• using the restroom, and
• thinking and understanding (cognition). (Or. Admin. R. 411-070-0005(3).)

For more information or to apply for Medicaid, visit the Oregon Health Authority OHP web page. You can apply online through the state's Oregon Eligibility (ONE) website. Or call your local Oregon Department of Human Services (ODHS) office to apply.

Typically, your nursing care facility can assist you with Oregon's Medicaid application process. For other questions about the Oregon Health Plan and nursing home coverage, call OHP Customer Service at (800) 699-9075.

Medicaid Income Rules in Oregon

In Oregon, to qualify for Medicaid-paid nursing home care, you can have a monthly income up to 300% of the federal benefit rate (three times the SSI payment level). Oregon's LTC income limits can be higher than the income limit for other health care benefits from Medicaid.

The 2025 federal benefit rate for a single person is $967. So, you can have a monthly income up to $2,901 in 2025 and qualify for Medicaid-paid nursing home care in Oregon. Note that any income you receive from any source is considered.

When both spouses are applying for Medicaid-paid LTC, the income limit doubles to $5,802 per month (in 2025). That's because Oregon doesn't count your spouse's income in determining your eligibility for OSPIM coverage for nursing home care, and your income doesn't count toward your spouse's eligibility. (Or. Admin. R. 461-110-0530(4)(c).)

The state doesn't count the non-applicant spouse's income to ensure the spouse living at home has enough funds to live on. Additionally, a non-applicant spouse is entitled to a minimum monthly needs allowance, which can range from $2,555 to $3,948.

If you qualify for Medicaid and live in a nursing home, you'll be expected to spend almost all of your income on your care. OHP allows nursing home residents receiving Medicaid to keep about $77 per month as a personal needs allowance—$90 if they receive a VA pension based on unreimbursed medical expenses. (Or. Admin. R. 461-155-250(4).)

Medicaid Asset Rules in Oregon

Medicaid for LTC has different resource rules—which you must satisfy to be eligible for coverage—than those for other Oregon Health Plan programs. Resources are assets like:

• real estate
• personal property
• life insurance with a cash value
• vehicles
• motorhomes
• boats
• bank accounts, and
• cash.

You'll have to total up all of your non-exempt, countable assets to determine how much you have in resources.

If you're single, you can have only up to $2,000 in assets with a few allowable exclusions, such as a car and your home (up to a value of $730,000 in 2025). If you're married, your non-applicant spouse at home can keep as much as 50% of your combined assets up to $157,920 (in 2025) worth of joint assets. (Or. Admin. R. 461-160-0580.)

Oregon Medicaid HCBS Waiver Programs, Assisted Living, and Home Care Options

Oregon residents can also qualify for Medicaid LTC services delivered outside of a nursing home facility setting. The state has programs with different eligibility requirements that offer certain other benefits so that seniors at home or in the community can obtain needed services.

Aging and Physically Disabled Waiver

Through the Aging and Physically Disabled (APD) waiver, Oregon provides waiver case management and transition services for eligible seniors and people with physical disabilities. This program is designed to assist individuals qualified to live in an institutional setting, like a nursing home, and receive nursing home care but who prefer to return to live in the community. The APD waiver offers recipients services, including:

• transitional services for one-time set-up expenses, such as:
• moving costs
• housing application fee assistance
• security and initial deposits
• purchases of household items and essentials, and
• other similar items
• case management, and
• wellness education.

Community First Choice Option

Under Oregon's K Plan, also known as the Community First Choice (CFC) Option, the state offers another alternative to institution-based nursing care and provides certain long-term home and community support to eligible individuals. This plan offers supportive services for individuals who require nursing home-level care and need benefits, such as:

• adult day care
• meal delivery and preparation
• help with activities of daily living
• home modifications, and
• other services that allow individuals to live outside of institutions.

For more information about the K Plan, you can contact the Oregon Department of Human Services.

Other Community-Based Programs

Oregon offers other related programs that can provide Medicaid recipients further flexibility and options for receiving and managing care outside of the nursing facility setting, including the Consumer-Employed Provider Program (CEP) and Independent Choices Program (ICP). Both CEP and ICP allow eligible seniors and adults (over 18) with disabilities to act as employers of and manage their care providers, who assist with certain daily living activities.

Oregon's Spousal Pay program pays non-applicant spouses to provide care to their in-need spouses, also including assistance with activities of daily living.

For more information about Oregon's CEP, ICP, and Spousal Pay programs, you can contact your local Area Agencies on Aging (AAA) or Aging and People with Disabilities (APD) office through the Oregon Department of Human Services (DHS). You can also call the Oregon Aging and Disability and Resource Connection (ADRC) at (855) 673-2372, or call DHS at (503) 945-5600.