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Medicaid offers a wide variety of services, including doctor visits, hospital stays, medical transportation, medical equipment and supplies, prescriptions, limited vision and dental care, hearing aids and long term care services (adult day care, adult foster home, residential facility care, assisted living facility care, and nursing home care). Medicaid does not pay the individual money; instead, it sends payments directly to the health care providers.
To be eligible for Medicaid in Oregon, the Medicaid applicant must meet three eligibility requirements. These include:
Once the applicant has been approved for Medicaid, the caseworker will determine the amount of the Medicaid recipient’s liability (the amount he or she will pay to the state each month for the services he or she is receiving). Medicaid rules provide for standard deductions from the applicant’s income, and in certain circumstances, the Medicaid applicant is able to transfer a portion of his or her income to the community spouse, to ensure that he or she has enough income to meet his or her living expenses.
The Medicaid caseworker will stay in contact to ensure the Medicaid recipient is receiving the appropriate level of services, and will reassess the Medicaid recipient’s financial eligibility each year. During the evaluation, both spouse’s income will be looked at, but only the Medicaid recipient’s income will be counted. Any assets that are transferred to the recipient’s spouse will not be considered. When the Medicaid recipient dies, the state will have a claim against his or her estate up to the value of services provided. If the Medicaid recipient is survived by a spouse, the claim will not become due until the death of the surviving spouse.
An Income Cap Trust is necessary when a Medicaid applicant’s gross income is over the allowed limit of $2,022. The state of Oregon adjusts this limit annually. The sole purpose of the Income Cap Trust is to qualify the applicant for Medicaid benefits. During the Medicaid application process, the client will meet with an attorney to establish the Income Cap Trust agreement. Attached to the Income Cap Trust are schedules that lists the applicant’s income, and the authorized distributions.
Once established, the Trustee opens a bank account, deposits the recipient’s income, and makes payments as directed under the trust agreement. From this, payments are made as directed on Schedule B. Examples of distributions include payments to support a spouse, the purchase of a funeral plan, payment of incurred medical expenses, and maintenance of a home during temporary absences. The function of the Income Cap Trust is to capture the Medicaid recipient’s income each month, make allowed distributions, and end each month with a zero balance. The state of Oregon is the named remainder beneficiary, and upon the Medicaid recipient’s death, will receive the balance of the account, if there is one.