Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Financial Criteria

12/01/2003

  • There are two groups financially eligible for nursing home services:

    • Group A includes individuals who are eligible because they are receiving SSI, or they have incomes no higher than the SSI/SSP level.

    • Group B includes persons with incomes up to the special income standard of 300 percent of SSI, which is $1,656. This group must spend all of their income (minus a personal needs allowance and other permitted deductions) on nursing home care before the state will begin to pay.

  • Asset limits for both groups are $2,000 for an individual and $3,000 for a couple when both members of the couple are in a nursing home. When only one member of a couple applies and there is a community spouse, spousal impoverishment protections apply.

  • The monthly personal needs allowance is $30 for individuals and $60 for couples.

  • Because Oregon does not have a Medically Needy program,3 in accordance with federal law, categorically eligible individuals in need of nursing home care--whose income exceeds the special income standard but is insufficient to cover the cost of care--may place income in excess of the special income level in a Miller Trust, and receive Medicaid coverage for nursing home care and other Medicaid state plan services.

  • Federal Medicaid law requires states to have estate recovery programs, which allows the states to claim assets, such as a home, that could not be counted when calculating eligibility. Oregon has the nation's most effective estate recovery program, in 1997 collecting nearly 5 percent of its Medicaid nursing home expenditures, far more than any other state.4 In 2002, the state collected an average of $1 million a month.


  1. Prior to February 2003, the state had a Medically Needy Program for the aged, blind and disabled, which covered only prescription drugs and mental health services, but not long term care. The program was terminated due to budget constraints.

  2. Sparer, M., Health Policy for Low-Income People in Oregon, Urban Institute, September, 1999.

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