Oregon
Oregon’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.
At a glance
- Rate method
- Statewide price
- Case-mix level
- None
- Classification
- None
- Rate updates
- Once a year
- Managed care (LTC)
- Short stays only
- Quality program
- None
- Paid outside the rate
- Small
- Bed hold
- Not paid
- Published rates
- Statewide schedule
- Assisted living
- Covered
- Personal needs allowance
- $81.28 / month
Overview
- Oregon pays every nursing home the same daily rate, with no home-specific rates.
- Each year ODHS ranks homes by audited allowable cost per day (from the Nursing Facility Financial Statement, inflated to the rate year) and sets the statewide 'basic rate' at the 62nd percentile.
- Residents who qualify get a fixed multiple of that rate instead: complex medical 140%, bariatric 185%, ventilator 235%.
- Pediatric units get their own rate.
- As of 7/1/2026 the basic rate is $568.23/day (complex $795.52, bariatric $1,051.23, ventilator $1,335.34, pediatric $1,538.80).
What matters in Oregon
- $568.23/day: one statewide basic rate for every home from 7/1/2026, set at the 62nd percentile of cost.
- No case mix: complex-medical residents get 140% of basic, bariatric 185%, ventilator 235%, all approved by the state.
- CCOs (Oregon's Medicaid managed care plans) do not pay long-stay care; ODHS pays it fee-for-service. CCOs cover only a 20-day post-hospital benefit.
- Rates rebase every July 1: $518.22 (2024), $546.36 (2025, +5.4%), $568.23 (2026, +4.0%).
- Oregon pays no bed holds; the long-term care facility tax runs through June 2032, with only veterans' homes exempt.
- Medicaid assisted living pays services only: $2,040-$4,789/month by level, plus $6,480 for endorsed memory care.
Frequently asked
Does Oregon adjust nursing home Medicaid rates for resident case mix?
No. Oregon pays one statewide basic rate ($568.23 from 7/1/2026) with no MDS case-mix index. Higher pay comes only from state-approved resident classes: complex medical (140%), bariatric (185%) and ventilator (235%).
Do Oregon coordinated care organizations pay for long-term nursing home stays?
No. ORS 414.065(5) leaves Medicaid long-term care payment and contracting with ODHS. CCOs pay only a 20-day post-hospital extended care benefit; a 2025 law extends it to 100 days once CMS approves it.
Why is the Oregon nursing home Medicaid rate so high compared with other states?
The single rate is set at the 62nd percentile of all-in allowable cost per day, including the provider tax and capital. It is paid to every home regardless of its own cost.
How much is paid outside the posted rate in Oregon?
Small: UPL-based workforce supplementals for private homes, funded at $30M state money for 2021-23; current size unconfirmed.
What does Oregon Medicaid pay on Medicare coinsurance days?
Lesser-of: Medicaid allowed amount minus Medicare's payment, capped at the coinsurance, so usually $0.
Does Oregon require a minimum share of spending on care?
No rate-wide spending floor; CNA staffing ratios are set by licensing rule and supplementals are earmarked by MOU.
How is the Oregon nursing home provider tax charged?
A per-patient-day tax on all days, capped at 6% of statewide gross revenue; only the Oregon Veterans' Homes are exempt.
How the rate is set
How the method got here
| Effective | From | To | Change | Headline | Source |
|---|---|---|---|---|---|
| 2003-07-01 | Statewide flat basic rate tied to costs through a 'relationship percentage', without required annual rebasing | Provider-tax-funded statewide flat rate rebased every July 1 at a set percentile of allowable costs; relationship percentage dropped (kept only for pediatric) | The 2003 long-term care facility assessment law required annual rebasing, kept the complex medical add-on and pediatric rate, and ended the relationship percentage for the basic rate. | Provider tax funds annual rebasing of flat rate | https://www.oregonlegislature.gov/bills_laws/ors/ors409.html |
| 2013-10-07 | Basic rate at the 63rd percentile of allowable costs | Percentile tied to a 1,500-bed statewide reduction goal (53rd-63rd schedule for 2016-2018) plus a bed-buyback Quality and Efficiency Incentive Program | HB 2216 (2013) linked the rate percentile to closing 1,500 NF beds and paid incentives to homes that bought and retired beds. | Rate percentile tied to statewide bed reduction | https://www.law.cornell.edu/regulations/oregon/Or-Admin-Code-… |
| 2018-07-01 | Bed-reduction-linked percentile schedule (53rd-63rd) | Fixed 62nd percentile of rebased allowable costs through 6/30/2026 | 2018 Oregon Laws ch. 66 set the basic rate at no lower than the 62nd percentile for 7/1/2018-6/30/2026. | Basic rate fixed at 62nd percentile | https://www.oregonlegislature.gov/bills_laws/ors/ors409.html |
| 2020-07-01 | Basic, complex, ventilator and pediatric rate classes | Added a prior-authorized bariatric rate at 185% of basic | Oregon created a bariatric rate class (OAR 411-070-0028, -0087), paid at a fixed 185% multiple of the basic rate. | Bariatric rate class added | https://www.law.cornell.edu/regulations/oregon/Or-Admin-Code-… |
| 2021-10-01 | No supplemental payments for nursing facilities | UPL-based supplemental payments to private NFs in the Oregon Essential Workforce Health Care Program | SPA 21-0022 began quarterly supplemental payments up to the private-NF upper payment limit for homes providing employee health benefits through OEWHCP. | Workforce health care supplemental payments begin | https://www.oregon.gov/oha/HSD/Medicaid-Policy/StatePlans/Med… |
Verified October 11, 2026
Cost basis
- Uses cost reports
Yes
- Cost report
Oregon Nursing Facility Financial Statement (NFFS, Forms SPD 35/35A), state-specific, filed annually for the fiscal period ending June 30 under the Uniform Chart of Accounts (OAR 411-070-0300, -0465).
- Base year and rebasing
Rebased every July 1 (required by ORS 409.815(4)(a)(A) as a condition of the provider tax). The rate uses statements received by October 31 for the period ending June 30 of the prior year; e.g., 7/1/2018 rates used periods ending 6/30/2017. Only homes in operation at least 180 days and open on June 30 are included. Pediatric and ventilator unit costs and days are excluded (OAR 411-070-0442(1); 4.19-D §III.B).
- Components
Component Method Notes basic rate (all costs combined) Statewide price at the 62nd percentile of facility allowable cost per day, with direct, indirect, administrative and property costs combined. Homes are ranked high to low, and the rate is interpolated if no home sits exactly at the percentile. The 62nd percentile applies 7/1/2018-6/30/2026 (ORS 409.815(5); OAR 411-070-0442(5)(c); 4.19-D p.12-13). Not split into component prices or ceilings; one percentile is applied to total cost. The provider tax is an allowable cost (ORS 409.805(2)). complex medical needs rate 140% of the basic rate (the add-on is 40% of basic), paid per authorized resident needing daily skilled medication, treatment or rehab procedures (OAR 411-070-0091, -0442(6); 4.19-D §II.B). $795.52/day from 7/1/2026. bariatric rate 185% of basic, prior-authorized: BMI > 40 plus two-person full assist with ambulation or transfers and full assist in cognition, eating or elimination (OAR 411-070-0028, -0087, -0442(8)). The home must add CNAs above licensing staffing for the 3rd+ bariatric residents. $1,051.23/day from 7/1/2026. Created 7/1/2020. ventilator assisted program rate 235% of basic (OAR 411-070-0092, -0442(7); 4.19-D p.12). $1,335.34/day from 7/1/2026. Was 200% in the 2019 MACPAC entry. pediatric rate Day-weighted average cost of pediatric facilities and self-contained pediatric units, inflated by the DRI index, times a 93% relationship percentage (4.19-D p.13a-13b; OAR 411-070-0452). $1,538.80/day from 7/1/2026. - Inflation
'DRI Index or its successor': IHS Markit (S&P Global) CMS Nursing Home without Capital Market Basket (Healthcare Cost Review Table 6.7), Q4 table before the rate year. Applied from the midpoint of the cost period to the midpoint of the rate year (OAR 411-070-0442(1)(b); 4.19-D p.12 footnote).
Verified October 11, 2026
Case mix
- System
None
- Applied at
None
- How it works
No MDS case-mix index. The basic rate is the same for every home and every resident (4.19-D §I.B 'standard, statewide flat rate'). Acuity reaches payment only through state-authorized per-resident rate classes (complex 140%, bariatric 185%, ventilator 235%, pediatric), which are fixed multiples of the basic rate.
- Classification
none (per-resident rate classes based on state criteria: complex medical needs procedures (OAR 411-070-0091), bariatric criteria (OAR 411-070-0087), ventilator program (OAR 411-070-0092), pediatric (OAR 411-070-0452))
- Applies to
Not applicable; the rate classes replace the whole per diem for the authorized resident.
- Acuity measured from
Not applicable
- Updated
Not applicable; a resident's class changes on state authorization (complex add-on start and end dates under OAR 411-070-0035).
- Move to PDPM
Not applicable; Oregon never used RUG-based case mix for NF Medicaid rates.
Verified October 11, 2026
Low-acuity residents
None. No reduced rate exists for low-acuity residents. Every Medicaid resident must meet NF service-priority eligibility (OAR 411-015) and is paid at least the basic rate (OAR 411-070-0025, -0075). A related but different rule: the State may reduce payment for residents where abuse is substantiated, until corrected (OAR 411-070-0045(5)). Checked OAR 411-070 and 4.19-D.
Verified October 11, 2026
Capital
Included in the price. Property costs (interest, rent, depreciation, amortization) are part of the allowable costs ranked for the 62nd-percentile basic rate (OAR 411-070-0359, -0365, -0465; 4.19-D). There is no fair rental value system and no home-specific capital payment.
Verified October 11, 2026
Budget adjustment factor
None found. The percentile itself is the budget lever: the 62nd percentile (7/1/2018-6/30/2026) replaced the 63rd, which from 2016-2018 was tied to bed-reduction goals (53rd-63rd schedule). Temporary increases ended: +10% (4/1-6/30/2020), +5% COVID (1/1/2021-6/30/2023), and a 4% Enhanced Wage Add-on (10/1/2021-6/30/2023).
Verified October 11, 2026
Add-ons and money outside the rate
Paid outside the posted rate
- Level
small
- Estimate
Probably under ~5% of base, by rough estimate. Base: one ~$546-568 rate times Medicaid days, likely ~$600-800M/yr (Medicaid day count not found). The only recurring off-rate program, the OEWHCP supplemental, was capped at $30M state general fund for 2021-23; with federal match that is about $35-40M/yr if funded at the same level. Current funding not confirmed. CareWorks ended 7/31/2024.
- Components
OEWHCP UPL supplemental for private NFs: $30M GF per 2021-23 biennium plus federal match (current amount unknown). CareWorks training supplemental: time-limited (services 1/2023-7/2024), amount not found. CNA training pass-through: small.
Verified October 11, 2026
Payments by owner type
- Applies
yes
- Detail
Reverse of the usual pattern. Both supplemental programs (OEWHCP UPL payments, CareWorks) are limited to 'privately-owned' NFs, defined as not owned by the state or a non-state government. Oregon Veterans' Homes (state-operated, ODVA) are exempt from the LTC facility tax. There is no IGT-funded payment for public homes. The basic rate itself is the same for all owners.
- Funding
State general fund plus federal match (UPL-limited), not IGT.
Verified October 11, 2026
Quality program
- Active
No
- Program
Quality and Efficiency Incentive Program (OAR 411-070-0437; HB 2216 (2013), SB 1585 (2016)). It paid up to $9.75 per Medicaid day for up to four years to qualifying homes that bought and closed beds. Entry closed 6/30/2016, so payments under it should have ended by mid-2020. No current quality or P4P program was found.
- Funding
State plan rate augmentation (budget appropriation)
- Size
Up to $9.75 per Medicaid resident day per qualifying home (historical)
- Paid as
per-diem augmented rate
- Payment formula
Eligibility gate (licensing and survey compliance, no substantiated abuse in 6 months) plus a bed-reduction acquisition plan; not a scored program.
- Eligibility
Homes acquiring and retiring beds under an acquisition plan submitted 10/7/2013-6/30/2016
- Scores published
No
- Notes
The OEWHCP supplemental (see supplemental_payments) requires homes to 'participate in evidence-based workforce and quality of care improvements' and report quality metrics, but it is paid by Medicaid days, not by quality score.
Verified October 11, 2026
Provider tax
- Charged
per occupied bed day (all occupied days, including Medicaid and Medicare)
- Standard amount
$42.42 per occupied bed day for 7/1/2026-6/30/2027 (ODHS Director's letter of 6/17/2026), up from $42.25 (7/1/2025) and $37.68 (7/1/2024). The Director sets the rate each June for the year starting July 1 (OAR 411-069-0150), capped at 6% of projected gross revenue of non-exempt facilities (ORS 409.802).
- Tiers
Who Test Amount Oregon's two state veterans' homes (operated by the Oregon Department of Veterans' Affairs) public exempt - Lower for high-Medicaid homes
no
- Returned in the rate
Indirectly. The tax is an allowable cost (ORS 409.805(2)) and so enters the 62nd-percentile basic rate. The fund also pays for annual rebasing and the complex medical and pediatric rates (ORS 409.815(3)-(4)). There is no separate add-on, and homes are 'not guaranteed' to get back what they pay (ORS 409.801(4)).
Verified October 11, 2026
Provider tax notes
Long Term Care Facility Assessment (ORS 409.800-409.816; OAR 411-069). Per patient day, all patient days including Medicaid. The rate is set by the ODHS Director each June 15 for the July-June year and capped at 6% of statewide LTC gross revenue; overages are refunded as credits. Revenue goes to the LTC Facility Quality Assurance Fund, which may only be used with the annual-rebase method. Extended by HB 4033 (2024) to assessments before 6/30/2032 (repeal 1/2/2034).
Verified October 11, 2026
Supplemental payments
(1) Oregon Essential Workforce Health Care Program (4.19-D p.15-18, TN 21-0022, effective 10/1/2021). Quarterly UPL-based supplemental payments to privately owned NFs that join the self-insured OEWHCP employee health plan, sign an MOU with OHA on use of funds, and report quality metrics. Paid pro rata by Medicaid days. The pool is the lower of 95% of the private-NF UPL gap or the appropriated general fund plus federal match ($30M GF for 2021-23). Current-biennium funding not confirmed. (2) CareWorks Supplemental Payments (4.19-D p.19-20, TN 24-0004): for private NFs in a labor-management training trust (HB 3396 / SB 1049, 2023), for services 1/1/2023-7/31/2024, paid pro rata by Medicaid days within the appropriation. Time-limited. (3) Nurse aide training and competency evaluation costs reimbursed quarterly as a pass-through (OAR 411-070-0470). (4) One-time 2021 Employee Retention Payment reimbursement, $500 per employee (OAR 411-070-0436). No IGT-funded public-home program or MCO directed payment was found.
Verified October 11, 2026
Other add-ons
(1) Outlier client add-on: home-specific direct-care add-on under an approved outlier care plan for residents with extraordinary medical, behavioral or social needs who cannot otherwise be placed (4.19-D p.9-10). (2) 'Enhanced' rate on the ODHS schedule equal to the complex rate ($795.52), likely for specialized or enhanced care units; criteria not confirmed. (3) CNA staffing standard payment (2008-2009, 4.19-D p.10), long since folded into the basic rate. No COVID-era add-on remains (the 5% ended 6/30/2023).
Verified October 11, 2026
Units paid separately
(1) Ventilator Assisted Program: 235% of basic ($1,335.34). Vent unit costs and days are excluded from the basic-rate array (OAR 411-070-0092, -0442). (2) Pediatric nursing facilities and self-contained pediatric units: separate weighted-average-cost rate x 93% ($1,538.80) (4.19-D p.13a-b). (3) Bariatric: 185% ($1,051.23), prior-authorized. (4) Swing beds: paid the NF Medicaid rate; CAHs with no NF within 30 miles may serve up to 20 Medicaid residents (4.19-D p.8-9). (5) Out-of-state: lesser of the other state's rate or the Oregon rate.
Verified October 11, 2026
Payment rules
Managed care for long-term care
- Status
short_stay
- Detail
Long-stay nursing facility care is carved out of CCOs (ORS 414.065(5); ORS 414.632) and paid fee-for-service by ODHS APD. CCOs cover only the Oregon Health Plan post-hospital extended care benefit: up to 20 days in a NF after a 3+ day hospital stay, for non-Medicare members (OAR 411-070-0033; OAR 410-120-1210). Oregon Laws 2025 ch. 617 §6 (ORS 414.722) directs OHA to extend this benefit to up to 100 days and put it in CCO contracts once CMS approves (§10). Whether CMS has approved was not confirmed.
Verified October 11, 2026
Who pays
fee_for_service: ODHS Aging and People with Disabilities (APD) sets and pays nursing facility rates directly. ORS 414.065(5) gives ODHS, not the Oregon Health Authority or the CCOs, responsibility for paying for and contracting Medicaid-funded long-term care. ORS 414.632 makes CCOs responsible for dual eligibles' Medicare and Medicaid services 'other than Medicaid-funded long term care services.'
Verified October 11, 2026
Managed care rate floor
Not applicable for long-stay care, which is fee-for-service. For the CCO post-hospital benefit, no rule requiring CCOs to pay at least the ODHS basic rate was found.
Verified October 11, 2026
Included in the daily rate
Bundled rate (OAR 411-070-0085) includes nursing, activities, social services, dietary, consultants, medical director, room and board, laundry, OTC drugs, oxygen up to 1,000 liters/24 hrs, most DME (wheelchairs, beds, lifts, walkers), and incontinence, ostomy, trach and wound supplies. Excluded and billed separately under OHP: therapy by outside providers, physician services, radiology, lab, podiatry, outside medical transport, biologicals and vaccines, hyperalimentation, prescription drugs, and ventilators.
Verified October 11, 2026
Bed hold
- Hospital stays
Not paid.
- Leave days
Not paid.
- Occupancy rule
Not applicable
- Notes
OAR 411-070-0110: 'SPD does not pay for holding a resident's bed.' A resident's personal incidental funds or family may pay to hold a bed if there are no vacancies for same-sex residents and no duplicate payment. Medicaid pays the admission day but not the discharge day (OAR 411-070-0050).
Verified October 11, 2026
Personal needs allowance
- Per month
81.28
- Effective
2026-01-01
- Notes
ODHS 'Personal Incidental Funds' for NF residents: $77.14 (7/2024) -> $79.07 (2025) -> $81.28 (1/1/2026). The steps match the Social Security COLA (2.5%, 2.8%), so it appears COLA-indexed. Community-based care (ALF/RCF) residents keep $221/month.
Verified October 11, 2026
Medicare coinsurance days
- Method
lesser_of
- Rule
For clients with Medicare and full Medicaid, OHA 'limits payment to the Medicaid allowed amount, less the Medicare payment, up to the Medicare co-insurance and deductible, whichever is less' (OAR 410-120-1340(14)). Supplement 1 to 4.19-B marks Part A coinsurance for QMBs and duals 'SP' (limited to State plan rates). The NF-specific text (OAR 411-070-0125; 4.19-D §II.E.1) says the Division 'shall pay the coinsurance rate' for days 21-100. Swing beds pay the 'difference, if any, between the Medicare partial payment and the facility Medicaid rate.' Medicare Advantage cost-sharing treatment was not found.
- Effect
Medicare's PDPM rate is usually above the $568 basic rate, so the home usually gets little or none of the day 21-100 coinsurance ($217/day in 2026). Complex-rate residents ($795.52) may yield a partial payment.
Verified October 11, 2026
Required care spending
- Applies
no
- Rule
No rule requires homes to spend a share of Medicaid revenue or the rate on care, and no recoupment for underspending was found. Related rules: (1) OEWHCP and CareWorks supplementals require an MOU with OHA on how the money is used (employee health benefits; training). (2) Licensing CNA ratios (OAR 411-086-0100): day 1:7, evening 1:9.5, night 1:17 residents per nursing assistant since 3/31/2014 (from the 2.46 HPRD standard), reported quarterly. At least 1 RN hour per resident per week and an RN charge nurse 8 consecutive hours daily. (3) The 4% Enhanced Wage Add-on (10/2021-6/2023) required a $17-$17.50 CNA starting wage; it has ended.
Verified October 11, 2026
Occupancy rules
- Applies
no
- Rule
None. Allowable cost per day uses actual resident days (OAR 411-070-0442(1)(c); 4.19-D p.12). Occupancy policy instead worked through the 2013-2018 statewide bed-reduction percentile schedule and the bed-buyback incentive.
Verified October 11, 2026
MDS accuracy penalties
None. No case mix means no MDS-based rate audits. Complex, bariatric and ventilator classes are subject to documentation review and overpayment recoupment if criteria or documentation were not met (OAR 411-070-0028(8), -0035).
Verified October 11, 2026
Published rates and changes
How often rates change
- A home's rate changes
annual
- When
July 1 each year: the basic rate is rebased from new cost statements and all class rates move with it as fixed multiples. A resident's class (basic/complex/bariatric/vent) can change any day with state authorization. The 7/1/2026 schedule was updated July 9, 2026.
Verified October 11, 2026
When rates change
July 1 (state fiscal year). Complex, bariatric and ventilator rates start on the authorization date (OAR 411-070-0028, -0035).
Verified October 11, 2026
Posted rates
- Home-level rates published
No
- Format
pdf
- Cadence
Annual (July 1), with interim updates (e.g., a January 1 schedule for HCBS and PNA changes)
- History
Only the current schedule is posted. Prior versions (7/1/2024, 7/1/2025, 1/1/2026) are available via the Internet Archive.
- Home identifier
None; one statewide rate for all homes
Verified October 11, 2026
Rate build-ups
- Published
No
- Where
No rate-setting array (facility costs per day, percentile ranking) was found posted.
- What they show
Rate schedule only: Basic, Bariatric, Complex, Enhanced, Pediatric, Ventilator daily rates and monthly equivalents.
- Format
pdf
Verified October 11, 2026
Recent changes
| Effective | Change | Headline | Direction | Size | Source |
|---|---|---|---|---|---|
| 2024-01-01 | SPA 24-0004 created CareWorks supplemental payments for private NFs in a labor-management training trust, covering services 1/1/2023-7/31/2024. | CareWorks training supplemental payments approved | increase | https://www.oregon.gov/oha/HSD/Medicaid-Policy/StatePlans/Med… | |
| 2025-01-01 | HB 4033 (2024) extended the long-term care facility assessment from 7/1/2026 to 6/30/2032 (repeal moved to 1/2/2034). | Provider tax extended through June 2032 | structural | https://www.oregonlegislature.gov/bills_laws/lawsstatutes/202… | |
| 2024-07-01 | Annual rebase set the statewide basic rate at $518.22/day (complex $725.51, bariatric $958.71, ventilator $1,217.82). | Basic rate rebased to $518.22 | increase | $518.22/day basic | https://web.archive.org/web/20241114075800/https://www.oregon… |
| 2025-07-01 | Annual rebase raised the basic rate from $518.22 to $546.36/day. | Basic rate rebased to $546.36 | increase | $518.22 -> $546.36/day (+5.4%) | https://web.archive.org/web/20250901101140/https://www.oregon… |
| 2025-07-01 | Oregon Laws 2025 ch. 617 directs OHA to extend the CCO post-hospital extended care benefit from 20 to up to 100 days, operative on CMS approval. | CCO post-hospital nursing benefit extended to 100 days | structural | 20 -> 100 days | https://www.oregonlegislature.gov/bills_laws/ors/ors414.html |
| 2026-01-01 | The NF personal incidental funds allowance rose from $79.07 to $81.28 per month (in line with the 2.8% Social Security COLA). | Personal needs allowance raised to $81.28 | structural | $79.07 -> $81.28/month | https://web.archive.org/web/20260417212315/https://www.oregon… |
| 2026-07-01 | Annual rebase raised the basic rate to $568.23/day (complex $795.52, bariatric $1,051.23, ventilator $1,335.34). The statutory 62nd-percentile floor expired 6/30/2026; the percentile used for this rebase was not confirmed. | Basic rate rebased to $568.23 | increase | $546.36 -> $568.23/day (+4.0%) | https://www.oregon.gov/odhs/providers-partners/seniors-disabi… |
Verified October 11, 2026
Assisted living
Medicaid assisted living
- Covered
yes
- Program
ODHS APD community-based care under Oregon's 1915(k) Community First Choice 'K Plan' state plan option, with the 1915(c) Aged and Physically Disabled Waiver and 1915(b)(4) waiver for case management. Covers assisted living facilities, residential care facilities (RCF), memory care and adult foster homes. Oregon is a large Medicaid ALF/RCF payer.
- What is paid
Services only. The resident pays room and board from their income (standard room and board $773/month from 1/1/2026) and keeps $221/month in personal incidental funds.
- Rate
Effective 7/1/2026 (monthly): Assisted Living Level 1 $2,040, Level 2 $2,528, Level 3 $3,172, Level 4 $3,982, Level 5 $4,789, ECOS (enhanced) $5,229. Endorsed memory care $6,480. Residential Care Facility Tiers 1-5 $3,482-$6,290. Adult foster homes Tiers 1-5 $2,332-$7,773.
- Limits
Available to people meeting ODHS service-priority (NF-equivalent) eligibility under OAR 411-015. No enrollment cap was found (K Plan is a state plan option, not a capped waiver); provider capacity and Medicaid contract acceptance by facilities limit access in practice.
Verified October 11, 2026
Sources
- ODHS APD Medicaid Services and Supports Rate Schedule, effective July 1, 2026 (updated July 9, 2026) · rate file
- ODHS rate schedules effective 7/1/2024, 7/1/2025, 1/1/2026 (Internet Archive copies) · rate file
- Oregon Medicaid State Plan (full), Attachment 4.19-D Part 1 (TN 18-0008, 20-0016, 21-0019, 21-0021, 21-0022, 23-0028, 23-0040, 24-0004) and Supplement 1 to 4.19-B · state plan
- OAR 411-070-0442 Calculation of the Basic Rate, Complex Medical Rate, Bariatric Rate and Ventilator Assisted Program Rate (LII copy) · regulation
- OAR 411-070 Division 70 Nursing Facilities/Medicaid Generally and Reimbursement (0025, 0028, 0033, 0045, 0050, 0075, 0085, 0110, 0125, 0436, 0437, 0438, 0359) (LII copies) · regulation
- OAR 411-069 Long Term Care Facility Assessment (0030, 0150) (LII copies) · regulation
- ORS chapter 409 (2025 ed.): 409.800-409.816 Long Term Care Facility Assessment and Quality Assurance Fund · statute
- Oregon Laws 2024 ch. 74 (HB 4033): LTC facility assessment extended to 6/30/2032 · statute
- ORS chapter 414 (2025 ed.): 414.065(5) DHS pays Medicaid-funded LTC; 414.632 CCO duals exclusion; 414.722 post-hospital extended care benefit (2025 c.617) · statute
- ORS chapter 410 (2025 ed.): 410.555 LTC reimbursement changes require advisory council review and legislative approval · statute
- OAR 410-120-1340 Payment (Medicare/Medicaid dual payment limit) (LII copy) · regulation
- OAR 411-086-0100 Nursing Services: Staffing (CNA ratios) (LII copy) · regulation
- ODHS Nursing Assistant Staffing Program page · agency page
- ODHS Medicaid Waivers and K Plan for APD Services · agency page
- MACPAC 2019 compendium, Oregon tab (baseline only) · secondary
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