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1155 Chapter 7:Worker guides • Section 7: OSIPM worker guides (07/2026) Note: If the individual has home equity that exceeds $752,000 and causes ineligibility, QPP payments cannot be used to reduce the countable home equity. When excluding all other resources based on the receipt of QPP payments, first always exclude resources that would otherwise be countable. This will allow the individual to become eligible for Medicaid sooner. Assets that are excluded due to the receipt of QPP payments may be gifted without penalty (OAR 461-140-0220). However, if the individual chooses to gift the assets prior to applying for Medicaid, then the amount of the assets excluded in the eligibility determination must be reduced. There could still be a transfer penalty to serve if the individual transfers more assets than are excluded by the QPP payments. Example 1: Nadene gave $40,000 to a son a year ago when the QPP was paying for a nursing facility placement. Nadene has now received a total of $130,000 QPP payments and is applying for Medicaid. The gift to the son is not disqualifying, but the amount of the resources that can be excluded in the eligibility determination is $130,000 QPP payments minus $40,000 gift = $90,000. Example 2: Leroy gave $160,000 to a grandchild a year ago when the QPP was paying for a nursing facility placement. Leroy has now received a total of $130,000 QPP payments and is applying for Medicaid. $130,000 of the gift is not disqualifying due to the QPP payments received, but Leroy’s gifts of $160,000 exceeds the QPP amount by $30,000, so Leroy still needs to serve a disqualification for $30,000 to be eligible for Medicaid. The eligibility worker has the option of using the Resource Calculation when there are QPP Payments (SPD 3404) to help them calculate resources that are excluded and whether the individual’s resources meet the Medicaid limit. If the worker chooses not to use this form, they can narrate the calculation. If the QPP pays benefits in such a small amount that the individual is not able to use the payments prior to applying for Medicaid, then the individual is not eligible for any resource exclusion. Example 3: Helen purchased a QPP that pays benefits of $100 per day. Years later, Helen was in a car accident and suffered injuries that required nursing facility care at the cost of $195 per day. Helen does not have enough income to make up the difference in coverage of $95 per day and applies for Medicaid. At application, Helen is in the 60-day waiting period and has received no QPP payments to date. Even though there is a QPP, Helen is not eligible for any resource exclusion because no QPP payments have been received. The eligibility worker enters a case note that Helen has a QPP, but has received zero payments so there is zero resource exclusion allowed. If the individual has accessed only part of the QPP payments prior to applying for Medicaid, then the individual is eligible for a resource exclusion only for the amount of total benefits received to date. Example 4: Bernie purchased a QPP that pays benefits of $120,000 over 2 years. When Bernie applies for Medicaid, $50,000 in LTC insurance payments have been received. Bernie also has countable resources of $240,000 now, but had $270,000 countable resources when care began. Bernie’s spouse Irene lives in the couple’s home, so it is excluded. When doing the resource assessment, the worker excludes $50,000 due to QPP payments received, so the countable resources are reduced to $190,000. Irene’s community spouse resource allowance (CSRA) is $109,560 because ½ of $270,000 when care began exceeds the maximum. The eligibility worker determines that $190,000 (countable resources after QPP exclusion) - ($2000 individual resources + $109,560 CSRA) = $78,440 that the couple has now that exceeds the resource limit. After the couple has spent down this excess, Bernie will be eligible for Medicaid.