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Medicaid Portland OR

Medicaid Attorney Near Me

Medicaid Portland OROregon Estate & Elder Law has offices near Portland. Our team of attorneys specializes in elder law and provides a variety of services, including veteran benefits, wills and estates, and probate. Our estate planning attorneys can help you understand Medicaid’s eligibility requirements in Oregon. We can also help during a confusing time or crisis to evaluate options to preserve assets and qualify you for Medicaid.

Medicaid Eligibility

Our team is here to assist you through the Medicaid eligibility process. It can be difficult to navigate on your own, and that is why the team at Oregon Estate and Elder Law is here.

Medicare Coverage

A common misconception is that Medicare will pay for long-term care costs. However, Medicare generally will not cover long-term care except in certain, specific circumstances.

Medicare will briefly cover the costs incurred while staying in a skilled nursing facility. First, a determination is required that the care you are receiving is “skilled care.” If so, Medicare will pay for those costs for up to 20 days, and then a co-payment will be required. Medicare will stop payment for all services after a 100-day stay at a skilled nursing facility. Also, Medicare may stop all payments if it is determined that the condition for which you need skilled care is no longer improving.

Medicare will not cover hospital expenses incurred beyond 150 days, skilled nursing costs beyond 100 days, and will not cover any custodial nursing home care or non-skilled home health care.

Medicaid

Medicaid is a government program that pays for both medical costs and long-term care costs. Medicaid is a “means-tested” government program, which means that to qualify, you must meet strict financial requirements as well as other eligibility requirements. Upon application, a Medicaid caseworker will evaluate the individual’s ability to function independently and their need for assistance with ADLs. Those applicants who need more assistance will have a higher priority for eligibility in the Medicaid system.

Oregon is an income cap state, which means that Oregon applies a limit on the amount of income that an individual receives. That amount must be no higher than Oregon’s limit at the time of application for Medicaid. Currently, an individual’s income is limited to $2,382 per month to qualify for Medicaid.

Oregon also has a limit on the amount of resources a person can have on hand. In Oregon, a single individual may retain no more than $2,000 in assets to qualify for Medicaid. The limits for a married couple are evaluated differently because the well-spouse (often referred to as the community spouse) may retain between $26,076 and $130,380 of assets. The amount of assets that the well-spouse may retain depends on the total value of assets the married couple owned when one spouse begins long-term care for a 30-day continuous period.

However, certain assets are exempt and will not be counted by Medicaid, including the following:

  • Your personal residence (with an equity limit of $603,000) is exempt if you are planning to return to your residence, or if a spouse, child under 21, or a disabled person resides in it;
  • One automobile;
  • Personal property including household furnishings, furniture, clothing, jewelry, etc.;
  • A pre-paid burial fund with a value under $1,500; and
  • The value of life insurance policies if the total face value of the policies is under $1,500.

Medicaid Assurance

The average cost of a nursing facility in Oregon in 2021 is $9,551 per month. With private payment or “self-insuring,” you will pay between $90,000 to $150,000 per year for nursing home care. Rather than depleting your life savings, there are options available to protect your assets.

Medicaid Planning

A plan is necessary to prevent running out of money, leaving home unprotected, and risking the health of family caregivers. An elder law attorney can assist families during a confusing time or crisis to evaluate options to preserve assets and qualify for Medicaid.

Five-Year Lookback

If Medicaid is ever needed, the Medicaid application will require you to list all gifts over the past five years, including gifts or transfers for less than fair market value. Depending on the total value of all gifts over that period, Medicaid will impose a penalty period and an amount of time before an individual can receive Medicaid benefits.

It is best to plan ahead. An elder law attorney can assist you in creating a plan to avoid any penalty period before eligibility or the need to make any uncompensated transfers when long-term care is necessary.

Estate Recovery

Federal law requires state Medicaid programs to recover certain Medicaid benefits paid on a person’s behalf. For those individuals who are 55 or older, each state is required to seek recovery of the amount the state’s Medicaid program spent on each person’s behalf. However, states may not recover from the estate of a Medicaid enrollee who is survived by a spouse, child under 21, or a blind or disabled child. However, on the passing of the spouse, the Medicaid claim may then be pursued. States may impose liens on real property to recover payment for Medicaid benefits.

Oregon law currently allows “expanded estate recovery,” providing the state the ability to recover from one’s probate estate and from other property ownership, including a life estate.
An elder law attorney can assist you with designing a plan to protect your real property and other assets from estate recovery.

Qualified Income Trust (“Income Cap Trust”)

Medicare VS Medicaid Portland ORIn Oregon, if a Medicaid applicant’s monthly income from all sources exceeds $2,382.00, a Qualified Income Trust (“QIT”) is required. The QIT will allow the applicant to qualify for Medicaid in Oregon and to be eligible for long-term nursing home care benefits.

The QIT is an Irrevocable Trust that appoints a Trustee, other than the Medicaid applicant, to manage the QIT. Once the QIT is established, all of the Medicaid applicant’s monthly income will be deposited into the bank account that is owned by the QIT. The Trustee will manage the QIT and will assist with the monthly deposits into the QIT. Once the income is deposited into the QIT each month, the Trustee also has the duty to then transfer the bulk of the income to the local Medicaid agency. The local Medicaid agency will determine the total amount that is required each month; however, it is typically the entire amount of monthly income minus a personal needs allowance (currently $64.94).

The QIT must contain a ‘payback provision,’ allowing the Oregon Medicaid agency to recover the total amount the agency paid on behalf of the Medicaid applicant. Typically, the remaining QIT funds (if any) after the Medicaid applicant passes away will be subject to Medicaid’s claim.

Supplemental Needs

Supplemental needs trusts (SNT) are designed to provide funds for a disabled, blind, or aged person to maintain or enhance the person’s quality of life while also ensuring that certain government benefits are not taken away. A properly drafted supplemental needs trust protects trust funds from being considered “available” or “counted” for means-tested government benefit eligibility. “Means-tested” means a benefit that is only given to people who meet the financial qualifications. If an individual is receiving means-tested benefits or might receive them in the future, a supplemental needs trust may be appropriate to avoid disqualification from those government programs.

To receive means-tested government benefits, an individual’s assets and income will be examined to determine if they are eligible. If there are assets and income available to pay for an individual’s basic needs, such as food and shelter, then the amount of government benefits can be reduced or taken away. A supplemental needs trust is drafted with specific provisions to restrict the trust funds from being available for the beneficiary’s basic needs so that the funds do not affect eligibility for means-tested government benefits. Common means-tested government benefits include Supplemental Security Income (“SSI”) and Medicaid.
Government programs providing benefits that are not means-tested are often referred to as entitlement benefits. These benefits do not contain the same strict financial eligibility limits as means-tested government benefits. Common entitlement benefits include Social Security Disability Insurance (“SSDI)” and Medicare.

First-Party Supplemental Needs Trusts

First-party supplemental needs trusts are often referred to as “payback trusts.” A first-party supplemental needs trust is established with funds that belong to the disabled individual. First-party supplemental needs trusts are controlled by a federal act, the Omnibus Reconciliation Act of 1993 (“OBRA”). OBRA provides certain requirements for the funds not to be considered for eligibility of means-tested benefits.

The first-party supplemental needs trust must:

  • Benefit an individual who is disabled as defined by the Social Security Administration;
  • Benefit an individual under the age of 65;
  • Contain only the disabled individual’s own assets;
  • Be set up by a parent, grandparent, legal guardian or conservator, or a court; and
  • Include a “pay-back provision,” stating that upon the disabled beneficiary’s death, any state that provided Medicaid assistance to the disabled person can demand reimbursement from the trust for the amount the Medicaid agency spent assisting the disabled person.

Third-Party Supplemental Needs Trust

What distinguishes a third-party supplemental needs trust from a first-party supplemental needs trust is the source of funds used to establish the trust. A third-party supplemental needs trust is funded with assets belonging to someone other than the disabled beneficiary. Third-party supplemental needs trusts are more common than first-party supplemental needs trusts.

Third-party supplemental needs trusts are often set up by parents, grandparents, and other family members to provide and protect funds for a disabled individual who is receiving or may receive means-tested government benefits in the future. The parents, grandparents, or other family members who set up the trust are referred to as the trust Grantors or Settlors. The Settlors have the right to choose where any remaining funds will go on the death of the disabled person. Third-party supplemental needs trust funds are not subject to recovery under payback rules after the disabled person’s death and will not be handed over to the state.

When you need an attorney near Portland, Oregon Estate and Elder Law is here to help! Call today to speak with one of our experienced attorneys!

Who qualifies for Medicaid?
Medicaid is a federal program that was enacted in 1965 that pays for both medical and long-term care costs. Each state interprets the federal law and has their own unique eligibility rules. To receive Medicaid benefits, the applicant must meet their state’s strict eligibility criteria. Medicaid is a needs-based government program that includes both a “means-test” and a medical test. Medicaid is a means-tested government program, which means that in order to qualify the applicant must meet certain financial requirements.

In Oregon, there is an individual resource limit of $2,000. The Medicaid applicant may keep only $2,000 to qualify for the program. However, many assets are exempt and are not counted in the $2,000 calculation. For example, the following assets may be exempt: your residence, personal property, vehicle, and even life-insurance policies. You should meet with an elder law attorney to determine if certain assets will be exempt.

Medicaid also requires a medical test. After beginning the Medicaid application process, a Medicaid caseworker will evaluate the individual’s ability to function independently and their need for assistance with ADLs (activities of daily living). ADLs refers to basic, personal tasks of everyday life and includes bathing, toileting, eating, dressing, and transferring (moving room to room).

An elder law attorney can help you understand if you already meet these financial and heath care limits and can also advise you on the proper planning tools to make the eligibility process straight-forward.


What is the difference between Medicare and Medicaid?
Medicare is broad health insurance provided through the United States government. Medicare is generally available for individuals who are age sixty-five or older, younger people with disabilities, and people with End State Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Medicare has two components: Part A is Hospital Insurance and Part B is Medicare Insurance. If you are age sixty-five or older, you are eligible for Part A and are not required to pay premiums if you or your spouse worked and paid Medicare taxes for at least ten years.

You may also receive Part A once reaching age sixty-five without paying premiums if you meet the following criteria:

You are receiving Social Security or railroad retirement benefits; or
You are eligible to receive Social Security or railroad retirement benefits, but have not filed for them; or
You or your spouse had Medicare-covered government employment

If you or your spouse did not pay Medicare taxes while working, you may be able to buy Part A if you are age sixty-five or older and a citizen or permanent resident of the United States.

If you are under age sixty-five, you may receive Part A Medicare benefits without paying premiums if:

You have been entitled to receive Social Security or railroad retirement disability benefits for a period of twenty-four months; or
You are a kidney dialysis or in need of a kidney transplant

A helpful tool to determine if you are currently eligible and an estimated premium can be found on Medicare’s website, medicare.gov eligibility tool.

Most individuals do not have to pay premiums to receive Part A, however, everyone must pay for Part B if they want to receive the additional benefits. Often the monthly premium is deducted from other government benefits like Social Security, railroad retirement benefits, or other civil service retirement programs. Three is also an option for Medicaid to send you an invoice for the Part B premiums owed.

For individuals who do not qualify due to their or spouse’s work record, you can buy Part A and Part B by paying monthly premiums. However, the individual must be a United States citizen or have been a legal resident for at least five years and must also be age sixty-five or older.


Is Medicaid better than private insurance?
Medicaid typically costs less than private insurance and can often provide more comprehensive benefits. Research shows that Medicaid’s costs per beneficiary or enrollee are significantly lower than for those with private insurance. There is a much lower out-of-pocket costs for Medicaid enrollees, and its lower payment rates to health care providers and lower administrative costs result in a very efficient program. A 2013 study by the Kaiser Commission on Medicaid and the Uninsured found that adults on Medicaid costs about twenty-two percent less than if they were covered under private insurance. The study can be found on the following webpage: what-difference-does-medicaid-make2.pdf

However, not everyone is eligible to receive Medicaid. Medicaid has stricter eligibility requirements than private insurance. The United States federal government has set minimum standards to be eligible for Medicaid, but the eligibility and the benefits covered vary substantially in each state.

Often the costs of private insurance can be offset if an individual’s employer is covering the insurance premiums. Private insurance is often preferable for people with minor children or dependents.


How to apply for Medicaid?
There are various options available to begin the application process, and you can apply at any time of the year.
A helpful place to start may be to contact your local Medicaid office. The following Oregon website provides a tool for finding your local Medicaid office: https://www.oregon.gov/dhs/Offices/Pages/Seniors-Disabilities.aspx
You can apply using a paper application which can be downloaded and printed using the following link: download the application. You can also request a paper application which can be mailed to you by calling OHP Customer Service at 1-800-699-9075. You may also apply online using the State of Oregon’s website.
Elder law attorneys can also help with the application process for families who are overwhelmed with the required steps.