Medicaid Planning in Oregon: What You Need to Know About Miller Trusts, MAPTs, and Eligibility

Oregon's long-term care Medicaid program is the only government safety net for families facing nursing home costs that can often exceed $15,000 a month. Qualifying requires navigating both a medical standard and financial limits — and the most effective planning tools require years of lead time. Here's how the system works.

The cost of long-term care in Oregon is staggering. Nursing homes frequently run $10,000 a month or more. Memory care often costs much more. Medicare doesn't cover long-term custodial care. 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

Medicaid eligibility starts with a medical determination. In Oregon, that's called Nursing Facility Level of Care.

This doesn't mean you have to live in a nursing home. It means you can't safely perform basic activities of daily living without substantial help — 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 separate tests: assets and income.

Assets. A single applicant can have no more than $2,000 in countable resources. Some assets are exempt: your primary residence if you or your spouse still live there (subject to a home equity cap), one vehicle, personal belongings, and certain prepaid burial arrangements. IRAs and 401(k)s are counted as assets in Oregon — this surprises many applicants who assume retirement accounts are protected.

For married couples where one spouse is applying, Oregon protects the healthy spouse from complete impoverishment. In 2026, the Community Spouse Resource Allowance allows the at-home spouse to keep up to $162,660 in countable assets, while the spouse applying for care is limited to $2,000.

Income. Oregon is an income-cap state. That means there's a hard monthly ceiling — $2,982 per month in gross income in 2026 — above which an applicant doesn't qualify. Unlike spend-down states that allow excess income to be offset by medical expenses, Oregon does not. If you're even one dollar over the cap, you don't qualify without a Miller Trust.

The Miller Trust (Income Cap Trust)

A Miller Trust doesn't reduce your income — it changes how the excess is handled so that Medicaid no longer counts it against you.

An attorney drafts the trust, a dedicated bank account is opened in the trust's name, and income above the monthly cap flows into that account each month. The funds aren't available for personal spending. They're used under strict rules to pay the applicant's share of care costs.

With the trust in place, Medicaid treats the applicant as within the income limit and coverage proceeds.

Key mechanics:

• The applicant cannot serve as their own trustee — a family member, friend, or professional fiduciary must serve in that role

• The state of Oregon is named as the remainder beneficiary — any funds remaining at the applicant's death must be paid to ODHS to reimburse Medicaid costs

• In 2026, the personal needs allowance is $81.28 per month — that's what the applicant retains for personal expenses while receiving care

• If married, the at-home spouse may be entitled to a spousal income allowance to prevent impoverishment — the range in 2026 is $2,643.75 to $4,066.50 per month depending on housing costs

ODHS does not draft Miller Trusts on behalf of applicants. The trust must be established by an attorney before or during the Medicaid application process.

Medicaid Asset Protection Trusts (MAPTs)

Income is only half the picture. For families with significant assets — particularly a home — the Medicaid Asset Protection Trust is the primary planning tool.

A MAPT is an irrevocable trust into which assets are transferred. Once inside the trust, those assets are no longer considered the applicant's property for Medicaid eligibility purposes. They're also protected from Oregon's Medicaid estate recovery program after death — as covered in the Oregon Medicaid estate recovery post, Oregon can otherwise reach assets that avoid probate, including homes in living trusts and jointly held property.

Timing is everything. Oregon enforces a 60-month look-back period on asset transfers. If assets are transferred into a MAPT within five years of applying for Medicaid, ODHS treats them as still belonging to the applicant and imposes a penalty period — a stretch of ineligibility calculated based on the value transferred.

MAPTs are long-term planning tools. They work best when created while the applicant is healthy, years before care is anticipated. Once assets are inside the trust, the grantor cannot pull them back for personal use — that's the mechanism that makes the protection work. In some cases the grantor can continue to receive income generated by trust assets, though that income may later need to flow through a Miller Trust to preserve eligibility.

Crisis Planning

What if planning wasn't done in advance and the need for care is immediate? All isn't lost. Attorneys can use other tools — spousal transfers, Medicaid-compliant annuities, or strategic spend-downs on exempt assets — 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 or more per month until the money runs out.

How the Pieces Fit Together

For families doing advance planning, the typical sequence looks like this:

While healthy and years before care is anticipated, create and fund a MAPT if asset protection is a priority — particularly for a family home.

When care becomes necessary, obtain the medical determination confirming Nursing Facility Level of Care.

If gross monthly income exceeds $2,982, establish a Miller Trust with an attorney before or during the application process.

Address any remaining countable assets through legitimate spend-down or repositioning strategies.

File the Medicaid application with ODHS.

The process has multiple moving parts, but with proper planning and legal guidance, Oregon families can access Medicaid long-term care coverage while protecting meaningful assets for a surviving spouse or heirs.

Bottom Line

Medicaid planning isn't about gaming the system. It's about protecting middle-class Oregon families from financial devastation while ensuring care is still available. The families with the most options are the ones who had the conversation before a crisis forced it.

At Track Town Law, I offer flat-fee estate planning that includes guidance on long-term care planning and the tools that can protect what you've built. Schedule a consultation here.

This post is for general informational purposes only and does not constitute legal advice. Medicaid eligibility rules are complex and change annually — figures in this post reflect 2026 standards. Contact a licensed Oregon elder law attorney before making any planning decisions.