Will Medicaid Pay for Nursing Home Care?

Whether you are nearing retirement age or your loved ones are getting older, you have likely considered nursing home care. This includes understanding the enormous costs of long-term care for older people. Medical costs for long-term care can burn through your retirement savings and other assets.

On top of that, the laws and rules for determining how to manage those care costs are complex. Medicaid planning can help you prepare for when you may need nursing home care. For more information about getting Medicaid to pay for your long-term care, talk to an Oregon elder law attorney.

The Costs of Skilled Nursing Care

Costs vary by region and location. The average annual cost of nursing home care is about $112,000 for a semi-private room and $64,000 for assisted living.

About one-third of nursing home residents pay out of pocket for those costs. The remaining two-thirds of skilled nursing facility residents pay for their care through Medicaid. With so many people relying on Medicaid to pay for care, it’s likely you or a loved one will need to understand its rules.

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Who Qualifies For Medicaid?

Medicaid is different from Medicare. Medicare is health insurance for seniors aged 65 and older and generally covers hospitalization and medical expenses. Medicaid services assist those with low income, including many seniors.

Medicaid benefits include long-term care services in nursing homes and assisted living facilities. States administer Medicaid programs. In Oregon, the Oregon Health Authority administers Medicaid benefits for seniors.

To qualify for nursing home coverage, you have to require a nursing home level of care. This generally means you need help with activities of daily living, including bathing, dressing, eating, and mobility. This includes people with cognitive impairment or medical care requiring skilled nursing.

To be eligible for financial assistance with nursing, in-home, or assisted living care, seniors must demonstrate:

• A need for the type of care or services
• Meet financial eligibility and asset limits

These financial eligibility limits change often. As of 2026, the asset limit for an individual needing nursing home care in Oregon is $2,000. For married couples, the rules are more complex. The asset and income limits also depend on whether the spouse remains in the community (“community spouse”) or is also applying for Medicaid benefits.

What Are Exempt Assets?

Assets typically consist of the applicant’s countable assets from banking and investment accounts. However, some assets are exempt from Medicaid eligibility calculations.

The largest exemption is for real estate used as the applicant’s or the applicant’s spouse’s residence. The value of the home is exempt from Medicaid countable assets if the “equity value” in the home is $752,000 or less. These exemption limits change often, based on the federal minimum and maximum limits.

Other assets that are exempt from counting toward Medicaid eligibility include:

• One vehicle
• Personal effects
• Household items
• Pre-paid burial and funeral arrangements

Planning for Medicaid

Seniors often have income or assets over and above the income limit. However, there are numerous ways for seniors to qualify for Medicaid.

Applicants often get themselves in trouble by making decisions without expert advice. An elder law attorney can provide information about qualifying for a state Medicaid program and submitting a Medicaid application.

One area of concern is the transfer of assets, especially if it appears the transfer was intended to gain eligibility. Applicants are subject to a five-year look-back period for the transfer of any asset for less than fair market value. If the transfer does not comply with Medicaid rules, the applicant could lose coverage or face penalties.

In Oregon, applicants with income above the limit can use a popular technique known as the Income Cap Trust. The beneficiary is the applicant, who chooses a trustee. The trustee distributes the beneficiary’s allowable income each month. The trust can pay certain expenses, like health care costs and taxes. The remainder goes to the care facility for nursing home costs.

A requirement of this type of trust and other Medicaid planning methods is that the state must be named the remainder beneficiary. This is because the estates of Medicaid recipients are often required to reimburse the program for costs it covers. Applicants must keep this in mind when estate planning.

Find an Experienced Elder Law Attorney

The rules regarding assets, income, Medicaid eligibility calculations, and what Medicaid covers are complex. There are many planning strategies and hurdles to qualify for Medicaid benefits. Anyone with questions about Medicaid long-term medical care should contact an experienced Oregon elder law attorney.