Medicaid Planning in Oregon: What You Need to Know About Miller Trusts, MAPTs, and Eligibility
The cost of long-term care in Oregon is staggering. Nursing homes often run $10,000 a month or more, and assisted living or memory care isn’t far behind. Medicare doesn’t cover it. Private insurance often falls short. And unless you’re among the very wealthy, paying entirely out of pocket will drain savings quickly.
That leaves Medicaid. It’s the only government program that steps in to cover long-term care once your own resources are exhausted. But qualifying isn’t simple. You have to pass both medical and financial tests, and Oregon adds another layer of complexity as what’s called an “income cap” state. That leads to tools like the Miller Trust (also called an Income Cap Trust), as well as longer-term strategies like the Medicaid Asset Protection Trust, or MAPT.
Here’s how the system works—and what it means for Oregon families.
The Medical Standard
First, Medicaid eligibility starts with the medical requirement. In Oregon, that’s called “nursing home level of care.”
This doesn’t mean you have to live in a nursing home right now. It means you can’t safely perform basic activities of daily living without substantial help. That includes bathing, dressing, toileting, eating, or moving around. It can also include cognitive conditions, like dementia, that make it unsafe to live alone.
Only once you meet this medical threshold do your finances come into play. You can’t qualify just because you’re broke, and you can’t qualify just because you’re sick. You have to meet both tests.
The Financial Limits
On the financial side, there are two gates: assets and income.
For assets, a single applicant can generally only have about $2,000 in countable resources. Some things are exempt: your primary residence (if you or your spouse still live there), one vehicle, personal belongings, and certain burial arrangements.
For married couples, the law protects the healthy spouse from complete impoverishment. In 2025, the “community spouse” can keep about $154,000 in countable resources, while the spouse applying for care is still limited to $2,000.
Income is a separate test. Oregon’s cap is currently $2,742 per month in gross income. If you’re even one dollar over, you don’t qualify. That’s where the Miller Trust comes in.
The Miller Trust (Income Cap Trust)
A Miller Trust doesn’t reduce your income—it changes how it’s handled. An attorney drafts the trust, a new bank account is opened, and your income above the cap flows through that account each month. The funds aren’t extra spending money. They’re used to pay your share of the nursing home bill.
But here’s the key: Medicaid no longer counts the excess income against you. Without the trust, you’d be disqualified. With it, you pass the test.
How much income do you keep? Not much. Oregon allows a $75 personal needs allowance each month. The rest goes toward care. If you’re married, your spouse may also be entitled to a “spousal allowance” to avoid leaving them destitute.
Medicaid Asset Protection Trusts (MAPTs)
Income is only half the picture. What about assets? That’s where MAPTs come in.
A Medicaid Asset Protection Trust is an irrevocable trust designed to shelter assets from being counted against you when you apply for Medicaid. You transfer assets like your home or investments into the trust. Once inside, they’re no longer considered yours for Medicaid purposes.
But timing is critical. Medicaid has a five-year lookback rule. If you transfer assets into a MAPT within five years of applying, the state treats them as still yours and penalizes you with a period of ineligibility.
That means MAPTs are long-term planning tools. They work best when created while you’re healthy, years before care is needed. Once assets are in, you can’t pull them back out for yourself—but you can decide who inherits them after your death. In some cases, you can still receive income from them, though that income may later flow through a Miller Trust to preserve eligibility.
Crisis Planning
What if you didn’t plan ahead and the need for care is urgent? All isn’t lost. Attorneys can use other tools—like spousal transfers, Medicaid-compliant annuities, or strategic spend-downs—to protect at least some of the estate. It’s rarely as favorable as long-term planning, but it’s often far better than simply paying $10,000 a month until the money runs out.
Putting It Together
The usual sequence looks like this:
Years before care, create and fund a MAPT if asset protection is a priority.
When care becomes necessary, get medically evaluated.
If income exceeds the cap, set up a Miller Trust.
Spend down or reposition non-exempt assets to reach the limits.
File the Medicaid application.
The process is complicated, but it doesn’t have to be chaotic. With the right tools and timing, families can preserve resources, protect spouses and children, and ensure quality care.
Why This Matters
Medicaid planning isn’t about gaming the system. It’s about protecting middle-class families from financial devastation while still ensuring care is available.
At Track Town Law, I help clients build estate plans that address both the expected and the unexpected. That includes planning for long-term care with strategies like Miller Trusts and MAPTs. All of my estate plans are offered on a flat-fee basis, so you’ll know exactly what you’re getting and what it costs.
If you think it might be time to prepare—for yourself, your spouse, or your parents—you can book a free consultation today.
