Waiver Description
Oregon’s Spousal Pay Program is unique in the world of Medicaid’s consumer-directed programs. As the name implies, the program pays the spouse of an individual who requires significant assistance with their activities of daily living, provided the care recipient spouse and their caregiving spouse meets all the eligibility requirements. This program allows the participant greater control over who is hired to provide their care.
When a couple qualifies for this program, the spouse becomes an official homecare worker and joins the Oregon Home Care Commission. Caregiver spouses receive a salary, pay taxes and union fees, and are eligible for unemployment insurance. It should be noted that since it is expected that spouses care for each other, the number of hours for which an individual is authorized to receive care might be lower when participating in the Spousal Pay Program than were the individual to receive care under other Oregon Medicaid programs, such as the Client-Employed Provider Program.
The administrator of the Spousal Pay Program is the Oregon Department of Human Services.
What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers, allow qualifying program participants to receive services outside of a nursing home. Medicaid’s standard benefit is to pay for nursing home care. However, those who wish to live at home, in assisted living or in adult foster care, sometimes Medicaid will pay for nursing-home-level care in those locations if it can be obtained at a lower cost than in a nursing home.
Eligibility Guidelines
General Requirements
The caregiver and spouse must be residents of Oregon, legally married, and residing at home (not in a skilled nursing home or assisted living facility). The individual in need of care must require fairly extensive care, and if not for the Spousal Pay Program, would need nursing home care. The individual must also require full assistance with at least 4 of the activities of daily living — bathing, dressing, grooming, eating, toileting, and mobility — and have a diagnosed, progressive and debilitating condition. Some examples of qualifying diagnoses include cancer in late stages, seizures that occur frequently and unpredictably, and spinal cord injuries.
The caregiving spouse must pass a criminal history check and meet the other Oregon Department of Human Services requirements for providing care. In addition to aiding with their spouse’s ADLs, it is expected that caregiver spouses manage the home, perform housekeeping, do laundry and grocery shopping, provide transportation, manage medications, and prepare meals.
Financial Requirements
As mentioned previously, the Spousal Pay Program is a Medicaid program. Therefore, individuals must financially qualify for this special version of the Oregon Health Plan for seniors.
Income Limits
Oregon Medicaid income limits for 2024 for an individual or a married applicant whose spouse is not also receiving Medicaid benefits is $2,829. This amount is adjusted annually in accordance with the Federal Cost of Living Adjustment.
Asset Limits
For 2024, the countable resource limit for an individual applicant is $2,000. The primary home is considered exempt if the applicant lives in the home and the equity is under $713,000. A single vehicle, household goods, personal items, and burial plots are also considered exempt assets, meaning their value is not included in an applicant’s countable resources.
Over the Financial Limits?
Being over the financial limits does not automatically mean one cannot become eligible for the Spousal Pay Program. There are ways to lower one’s countable income and assets without jeopardizing one’s eligibility or violating Medicaid’s Look-Back Rule. That said, it is strongly advised one contact a professional Medicaid planner if he or she is over the specified income and/or asset limit(s) for assistance in restructuring their finances.
Benefits and Services
Caregiving spouses receive payment for providing care services. Typically, this is an hourly wage agreed upon by the Oregon Home Care Commission and the state of Oregon.
In addition to their wages, the caregiving spouse also receives other benefits of Commission participation, such as unemployment insurance, paid vacation time, and disability benefits should they themselves become disabled.
How to Apply / Learn More
To apply for the Spousal Pay Program, interested couples should contact their local Area Agency on Aging. Or one can call Oregon’s Department of Human Services at 800-282-8096.
Additional information about this program is available here.
