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515 (07/2026) Chapter 2:Eligibility • Section 10: Long-Term Care (LTC) services Long-term care (LTC) services Introduction Long-term care (LTC) includes a range of services that assist individuals who can no longer complete Activities of Daily Living (ADL) on their own (e.g. moving around their home, using the restroom, or eating). Eligibility for APD LTC services is based on a Service Priority Level (SPL) assessment conducted by an APD/AAA case manager in Oregon ACCESS. The Office of Developmental Disabilities Services (ODDS) determines eligibility for intellectual and developmental disabilities (I/DD) LTC services based on an Individual Support Plan (ISP) assessment conducted by the local Community Developmental Disability Program (CDDP) eligibility specialist in the Express Payment & Reporting System (eXPRS). Assessments are used to identify support needed based upon each individual’s health and safety needs, interests, choices and goals. Each plan established uses a person-centered planning process. Note: ODHS|OHA provides behavioral health focused Home and Community-Based Services to qualified Oregonians age 21 or older who receive OHP Plus benefits and are also determined eligible by local community behavioral health specialists outside of ONE. See Behavioral Health (BH) service eligibility below. These services include nursing facility, in-home and community-based care to assist seniors and people with disabilities to live as independently as possible where they choose to live. This is because Oregon has several waivers related to Medicaid that allow the state to be more flexible by offering a larger variety of services. To receive LTC services, individuals must be eligible for an OHP Plus medical benefit either through HSD’s medical programs or APD’s OSIPM program. OSIPM has income and resource tests while HSD medical programs use tax filing status and income tests to determine who may be eligible. Both HSD medical and OSIPM recipients can be otherwise eligible for Medicaid without services, but there are many who can only qualify for OSIPM if they also meet LTC service eligibility. Note: There are various types of Medicaid benefits that an individual may qualify to receive. For a full list of HSD medical and APD medical programs, refer to the Types of Assistance (TOA) QRG. Evaluations for Medicaid eligibility and LTC services can be done at the same time. Eligibility workers determine the individual’s financial eligibility and case management staff assess their need for assistance with personal care tasks. Eligibility workers and APD case managers or DD eligibility specialists and service coordinators work together to help Oregonians through the application process, coordinate eligibility for long-term care and prevent interruptions in benefits once approved. Note: Some individuals have income too high to receive Medicaid without services. There are special provisions related to OSIPM that allow for higher income limits for LTC and more resources for married individuals. Once determined eligible for services, a service plan is approved and a service eligibility record is created on the SELG screen for the individual. If eligible for LTC, the state will pay for all or part of the individual’s care, which might include a home care worker or services in a foster home, group care home or assisted living facility. Except for care in a nursing home or for children, payment for room and board is normally the responsibility of the individual. However, depending on the income of the individual, they may be responsible to also contribute to the cost of the care, which is referred to as a service or patient liability.