Why Medicaid Matters—and Why Most Families Shouldn’t Count Themselves Out
Written by: Connor Kavanaugh, Special Needs Planner
December 4th, 2025
A common misconception in special needs planning is that Medicaid is only for individuals with extremely low income or assets. Many families assume they won’t qualify and stop exploring it altogether. That assumption is almost usually wrong.
With the right planning tools, most individuals with disabilities can qualify for Medicaid—and Medicaid is often one of the most valuable benefits available.
Before diving into what Medicaid offers, it’s essential to understand the difference between Medicaid and Medicare. They sound similar, they both come from government programs, and they both serve individuals with disabilities—but beyond that, they function very differently.
Medicare and Medicaid: Two Programs, Two Purposes
Many families mix these programs up. You’re not alone! Here’s the simplest way to understand the difference:
Medicare: Health Insurance for Age 65 and Older or Individuals With Disabilities
Medicare is federal health insurance. It covers:
• Hospital care
• Medical appointments
• Short-term rehabilitation
• Certain therapies
People under age 65 who receive disability benefits through Social Security automatically receive Medicare Parts A and B after a 24-month waiting period.
Medicare is excellent for medical coverage—but it does not cover most long-term care, in-home support, or personal care needs.
Medicaid: Comprehensive Coverage and Long-Term Support
Medicaid is jointly funded by federal, state, and local governments. It's not just health insurance. For individuals with disabilities, Medicaid is the gateway to long-term services and supports that Medicare does not cover.
Depending on eligibility, Medicaid can cover:
• Medical costs not paid by Medicare
• Long-term care
• Support with activities of daily living (bathing, dressing, toileting)
• Transportation
• Personal care services
• Day programs
• Therapy and employment supports
• Residential and community-based services
Because of these programs, Medicaid is one of the most important long-term supports available for individuals with disabilities.
One of Oregon’s Most Powerful Medicaid Programs: The K Plan
Oregon offers an especially valuable Medicaid option called the K Plan, created under the Affordable Care Act. It allows the state to provide home-and community-based services—while receiving additional federal funding to do so.
The K Plan helps individuals:
• Live at home safely
• Avoid institutional care
• Access personal support workers
• Obtain behavioral supports
• Receive community inclusion and skill-building services
The program is designed to keep people healthy, independent, connected, and living in the least restrictive environment possible.
Who Qualifies for Oregon’s K Plan?
To be eligible, an individual must:
• Be an Oregon resident
• Qualify for Medicaid
• Require long-term services or supports
• Have a diagnosed developmental disability
Income limits follow the Medicaid long-term care standard. For 2025, individuals typically qualify if their income is below 300% of the current Federal Benefit Rate. (This figure adjusts annually.) As with most Medicaid programs, the asset limit for an individual is $2,000.
Applications are handled through the local Community Developmental Disabilities Program (CDDP). Every county uses the same application form.
Medicaid Eligibility Is More Achievable Than You Think
Medicaid can feel confusing—complex rules, unfamiliar terms, and federal and state-level requirements. But it is one of the most valuable programs available to individuals with disabilities, especially in Oregon.
Medicaid offers:
• Long-term care
• Employment supports
• Home-based services
• Transportation
• Behavioral support
• Access to personal care workers
• Medical coverage Medicare won’t pay for
• And so much more
Don’t Let Confusion Keep You From Benefits You Deserve
Medicaid and K-Plan services can dramatically improve quality of life, independence, and long-term stability. If you or your family member may be eligible, it’s worth understanding these programs and applying.
If you’d like help navigating Medicaid eligibility, Oregon’s K Plan, or other benefits, your case worker or county developmental disability office can help. And if you'd like support integrating Medicaid planning into your broader financial and long-term plan, Palladio Consulting LLC is here to guide you.
To apply, you can click here to access the state of Oregon’s page on the application process! All CDDPs use the same application for Developmental Disability services. Your local CDDP office can give you the form and help you complete it.
Medicaid can seem daunting but don’t let the confusing definitions and legal jargon intimidate you and scare you out of getting the benefits that you and your family deserve. If you’d like to learn more about Oregon K Plan, Medicaid, or how to apply, you can click here. Please contact your county case worker or if you’re not receiving county DD services, call your local county DD services office! You can view and find the one closest to you by clicking here!