Oregon has a statewide nursing home pre-admission screening process. Individuals who enter a nursing home are approved for varying lengths of stay, depending upon the reason for admission and the likelihood of, and timetable for, improvement, and are reviewed periodically to evaluate their potential for discharge to the community.1 Because the state has a "mature" long term care system that is widely known among community organizations, service providers, referral sources, families and consumers, it has a strong capacity to divert people from nursing homes.2
Nursing Home Relocation Services, begun in 1982, are still an important part of Oregon's long term care system, though the average nursing home resident in 2002 is much more impaired. Because HCBS care coordination staff caseloads are high, some Area Agencies on Aging have created relocation specialist positions. Relocation costs may be paid by exempting resident income generally paid to the nursing home, or through the HCBS waiver program.
Mollica, R.L. and Jenkens, R., State Assisted Living Practices and Options: A Guide for State Policy Makers, Coming Home Program, Robert Wood Johnson Foundation, September 2001.
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.
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.
Sparer, M., Health Policy for Low-Income People in Oregon, Urban Institute, September, 1999.
Level of Care Criteria
To receive Medicaid coverage of nursing home care, individuals must have functional limitations that match at least one of the following levels:
- Dependent in mobility, eating, toileting, and cognition.
- Dependent in mobility, eating, and cognition.
- Dependent in mobility, or cognition, or eating.
- Dependent in toileting.
- Needs substantial assistance with mobility, and assistance with toileting and eating.
- Needs substantial assistance with mobility and assistance with eating.
- Needs substantial assistance with mobility and assistance with toileting.
- Needs minimal assistance with mobility, and assistance with eating and toileting.
- Needs assistance with eating and toileting.
- Needs substantial assistance with mobility.
- Needs minimal assistance with mobility and assistance with toileting.
- Needs minimal assistance with mobility and assistance with eating.
- Needs assistance with toileting.
- Needs assistance with eating.
- Needs minimal assistance with mobility.
- Dependent in bathing or dressing.
- Needs assistance in bathing or dressing.6
Services to about 3,600 people in levels 14 to 17 were eliminated in budget reductions in early 2003, and were not restored. Oregon's 2003-2005 budget continues long term care services for people in levels 1 through 11. Subject to federal approval, the budget also restores funding for services to people in levels 12 and 13--about 1,200 clients who need help in such areas as mobility and eating.
6. A computerized scoring system weights and adds multiple measures of physical and mental functioning to determine if the criteria are met. The scoring system is also used to determine reimbursement levels for services provided through the waiver program.