Nursing Home Care

Nursing homes provide care on a 24-hour basis in a hospital-like environment and provide skilled care, rehabilitation, and end-of-life care. These homes are required to have licensed nursing staff in the facility 24 hours per day.

Residents most suitable for nursing homes are people who need a fairly protective setting. Many residents have medical and behavioral needs that cannot be met in other care settings.

Oregon requires that all residents be screened before they enter a nursing home. This screening assures that a client’s needs match the level of care the facility can offer and also helps the client explore other options.

Nursing homes are inspected, licensed, and monitored by the State of Oregon’s Senior and Disabled Services Division in compliance with both state and federal regulations.

A detailed guide, Nursing Facility Tips ( PDF* file), is available to download by clicking the preceding link.

Eligibility
Medicaid is the state and federal program that provides health care for the financially needy who are blind, aged, or have disabilities. Medicaid also pays for long-term care in a variety of settings for clients who are in need of nursing facility care. As a general rule, a single applicant can have no more than $2,000 in savings and an amount for burial costs, In addition, one vehicle and the client’s primary residence are usually not counted in the eligibility process.

While Medicaid eligibility is based upon federal poverty levels for income and resources, a provision of the Medicaid rules allows married couples to reserve a greater amount of resources. This provision, the Spousal Impoverishment Law, is designed to preserve a portion of a married couple’s resources when one spouse requires long term care.  The intent of the law is to prevent the impoverishment of the community spouse while allowing the spouse needing care to apply for and receive Medicaid services.

The Medicaid program and Spousal Impoverishment Protection rules are complex and can change at any time. Staff at Senior & Disabled Services (S&DS) can explain how the Medicaid program operates and how you may benefit from the Spousal Impoverishment Protection rules.

Information on Transfer of Assets can be found at www.cms.hhs.gov/medicaid/eligibility/assets.asp.

Resource Assessment
Completing a Resource Assessment and determining a spend down amount involves several variables and will depend upon your individual circumstances.  There is no cost for requesting a Resource Assessment and you are not required to make an application for Medicaid at the same time.  Please call S&DS at (541) 682-4038 if you have questions about the Medicaid program or if you want to request a Resource Assessment.

S&DS' staff will complete a Resource Assessment to determine your total countable resources at the time care began. Countable resources included those such as savings, stocks, bonds and other financial investments. Exempt resources, those not-counted, include the primary residence and one vehicle.  Staff will provide a more detailed list of countable and exempt resources during the Resource Assessment.  This total will then be used to calculate the amount of resources that can be protected while still receiving long-term care for one spouse. The community spouse is allowed to keep the greater of:

1. $18,552—the State community spouse resource allowance
2. One half the total countable resources at the time care began (not to exceed $92,760)
3. A court ordered community spouse resource allowance

In addition to the amount allowed for the community spouse, the spouse who requires care is also allowed to keep the Medicaid resource limit of $2,000. The Spousal Impoverishment Protection rules can allow for an amount in excess of $92,760 under certain circumstances.  This higher amount is subject to the couple’s income and involves a detailed calculation.  S&DS staff will determine if you are entitled to keep a higher amount or resources when completing a Resource Assessment.

A Resource Assessment can be a valuable financial planning tool and will specify the amount of resources that are over the allowable limit.  This amount is commonly called the spend down. The term spend down is often misunderstood.  While it is true that this money can be spent on someone’s care in order to establish future eligibility, Medicaid eligibility is actually established when a couple’s countable resources are reduced to one of the above amounts.

Examples
For example, Mr. and Mrs. Gregory may have total countable resources of $40,000 and a spend down of $18,000.  Suppose they spend $20,000 over the course of the year on care for the spouse and that their monthly income is sufficient to pay for the care. Their countable resources are still $40,000 after paying for care for one year. While it is true they have spent $20,000, they have not established Medicaid eligibility as their resources were not reduced to one half the countable resources at the time care began.

($40,000 ÷ 2 = $20,000 + $2,000 = $22,000)

Let’s consider another example of another couple, Mr. and Mrs. Jackson, who did meet the spend down. They also started with $40,000 in countable resources. One spouse is hospitalized for a stroke and requires a nursing facility placement. The Jacksons do not have sufficient income to pay for the nursing facility stay and withdraw funds from savings to supplement their income. One year later, they find themselves with only $22,000 in savings. The Jacksons could then make an application for Medicaid as their resources have been reduced to one half the countable resources at the time care began ($20,000) plus $2,000 for a total of $22,000.  Senior & Disabled Services would still need to determine the couple’s Medicaid eligibility based upon several other factors.  However, for purposes of meeting a spend down, the Jacksons would not be required to deplete any more of their savings.

Disqualifying Transfers
Although the rules do not state specifically how the money can be spent, giving away resources or selling items for less than their fair market value can be considered disqualifying transfers. Certain resource transfers can result in a period of ineligibility for Medicaid.  Using resources to pay for a spouse’s long-term care is often the primary means of spending down resources, or more accurately, reducing countable resources.  However, some applicants meet the spend down by purchasing items for themselves or modifying their home.  You may also want to consult an Elder Law attorney or financial planner familiar with Medicaid law to discuss other options.

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