Key takeaway
Oregon is one of the most flexible states for paid family caregiving. Through the K Plan and the Independent Choices Program, family members — including, in many cases, spouses — can be hired and paid via Medicaid.
- Community First Choice (K Plan) lets Oregon Medicaid members hire family caregivers (including spouses in many cases).
- The Independent Choices Program (ICP) gives a flexible cash budget to direct your own care.
- Oregon Project Independence (OPI) is state-funded for older adults who don’t yet qualify for Medicaid.
- Veterans can layer in Aid & Attendance or Veteran Directed Care (VDC also pays spouses).
Overview
Oregon has one of the most robust paid-family-caregiver systems in the U.S. The Oregon Health Authority and the Department of Human Services (DHS) Aging and People with Disabilities (APD) division administer a Medicaid State Plan option called Community First Choice — often called the K Plan in Oregon — which funds personal care, attendant services, and supports for people of any age who meet a nursing-facility level of care. Family members, including spouses in many cases, can be hired as Homecare Workers.
The Independent Choices Program (ICP) is Oregon’s self-directed alternative: instead of an agency-employed Homecare Worker, the participant manages a cash budget and hires their own caregiver. For Oregonians who don’t yet qualify for Medicaid, Oregon Project Independence (OPI) provides state-funded in-home services. Veterans can layer in VA Aid & Attendance or Veteran Directed Care.
Programs that pay family caregivers in Oregon
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| Community First Choice (K Plan) (Medicaid State Plan) | Oregon Medicaid (OHP)-eligible; meets a nursing-facility level of care; available to all ages with no enrollment cap (entitlement). | Funds personal care and attendant services delivered by a Homecare Worker. Family members — including, in many cases, a spouse or parent of an adult child — can be hired as Homecare Workers. |
| Independent Choices Program (ICP) (Medicaid self-directed) | Same as the K Plan; participant (or authorized representative) able to direct their own care. | Converts authorized service hours into a monthly cash budget. The participant hires and pays caregivers, including family, and can purchase approved goods. |
| Oregon Project Independence (OPI) (State-funded) | Oregon residents 60+ (or 18+ with certain disabilities) who do not qualify for Medicaid; assessed functional need. | Sliding-scale personal care, homemaking, and case management; family caregivers can sometimes be hired through participating agencies. |
| Medically Involved Children’s Program / Children’s In-Home Services (Medicaid) | Children with significant medical or developmental needs who meet program criteria. | Funds in-home nursing and attendant care; parents may be paid in limited situations (state rules continue to evolve, especially after recent expansions of parent-as-paid-caregiver options). |
| Aid & Attendance Pension (VA benefit) | Wartime veteran or surviving spouse needing help with ADLs and meeting VA income/asset rules. | Increases monthly pension that the veteran can use to pay a family caregiver such as an adult child. Spouse cannot be paid directly. |
| Veteran Directed Care (VDC) (VA program) | Veteran in VA care needing nursing-facility level of care at a participating VAMC (e.g., Portland VA). | Self-directed monthly budget; family, including spouses, can be paid through a fiscal management service. |
Oregon Medicaid programs
Oregon Medicaid (the Oregon Health Plan, OHP) funds family caregivers primarily through Community First Choice — the K Plan — and the Independent Choices Program. Both are administered by the DHS APD division and offer some of the most flexible spouse and family rules in the country.
Community First Choice — K Plan
The K Plan is Oregon’s Community First Choice State Plan option. It funds personal care, attendant services, skills training, and back-up systems for people who meet a nursing-facility level of care, with no waitlist if eligible.
- Open to OHP-eligible Oregonians of any age who meet the level-of-care criteria.
- Family Homecare Workers — including, in many cases, spouses and parents of adult children — can be paid.
- A Homecare Worker is enrolled with the state, completes orientation, and is paid through the state’s payroll system.
Independent Choices Program (ICP)
ICP is the self-directed alternative to the standard K Plan Homecare Worker arrangement. The participant gets a monthly cash budget equal to the value of authorized hours and uses it to hire and pay caregivers directly.
- Participant — or representative — designs the care plan and manages the budget.
- Family caregivers, including spouses in many situations, can be paid.
- A fiscal intermediary handles tax filings and payroll compliance.
State-funded option: Oregon Project Independence (OPI)
Oregon Project Independence (OPI) is the state-funded program for Oregonians who don’t yet qualify for Medicaid. It’s administered by DHS APD and Area Agencies on Aging and provides personal care, homemaking, and case management on a sliding scale.
A care manager completes a needs assessment and authorizes hours through a participating provider. Participants pay a sliding-scale cost share.
Family members may be employed through participating agencies. Direct cash payment to family is more common through the K Plan or ICP than through OPI.
Who qualifies
- Oregon residents 60+ (or 18+ with certain disabilities) who do not qualify for Medicaid.
- Assessed functional need for in-home help.
- Income too high for Medicaid but within OPI thresholds; cost share applies.
Veterans’ programs
Oregon veterans and their surviving spouses can use two VA pathways to fund in-home care: Aid & Attendance and Veteran Directed Care.
Aid & Attendance Pension
A&A increases the monthly VA pension for qualifying wartime veterans (or surviving spouses) who need help with daily living. The veteran can use the increase to pay a family caregiver such as an adult child.
- Wartime service, limited income/assets, and documented need for daily care are required.
- Spouses cannot be paid directly through A&A because household income is jointly counted.
Veteran Directed Care (VDC)
VDC provides a flexible VA-funded monthly budget that the veteran directs. Family — including a spouse — can be paid through a fiscal management service. Portland and Roseburg VAMCs typically participate.
- Requires veteran to be in VA health care and need a nursing-facility level of care.
- Spouses, adult children, and other relatives can be paid caregivers.
Long-term care insurance
A long-term care insurance policy can fund payment to a family caregiver if it covers in-home personal care and allows direct payment to the policyholder.
What to check in the policy
- Confirm in-home personal care is a covered service.
- Cash or indemnity policies let the policyholder pay any caregiver, including family.
- Reimbursement-only policies usually require a licensed home care agency to bill.
If the policy reimburses only licensed agencies, an Oregon-licensed in-home care agency can employ the family caregiver and bill the insurer for services delivered.
How to apply in Oregon (step-by-step)
- Identify the most likely path: K Plan, ICP, Oregon Project Independence, VA benefits, or LTC insurance.
- Gather documents: photo ID, Social Security card, proof of income/assets, medical records, medication list, and DD-214 (if applicable).
- Start with the right agency:
- K Plan / ICP: apply for the Oregon Health Plan (OHP) and request a long-term services assessment through your local DHS APD office or Area Agency on Aging.
- OPI: contact your local Area Agency on Aging or DHS APD office.
- VA paths: connect with a VA social worker at the Portland or Roseburg VAMC.
- LTC insurance: call the insurer to confirm how a family caregiver can be paid.
- Complete the level-of-care assessment (Client Assessment and Planning System, or CA/PS) and submit financial documentation.
- Choose Homecare Worker (K Plan) or Independent Choices Program (ICP). Enroll your family caregiver as a Homecare Worker or through the ICP fiscal intermediary.
- Begin services, submit timesheets via the Oregon Provider Time Capture (OR PTC DCI) system, and complete annual reassessments.
Oregon paid caregiver FAQs
How do I become a paid family caregiver in Oregon?
The most common path is the K Plan (Community First Choice). Your loved one applies for OHP and a long-term services assessment. Once approved, you can enroll as a Homecare Worker, complete orientation, and be paid through the state. The Independent Choices Program (ICP) is the self-directed alternative.
Can a spouse be paid as a caregiver in Oregon?
In many cases, yes. Oregon’s K Plan and ICP allow spouses to be paid as Homecare Workers under certain conditions — this is unusually flexible compared with most states. Confirm with your local APD office. VA Veteran Directed Care can also pay spouses.
What is a Homecare Worker in Oregon?
A Homecare Worker is an Oregon Medicaid in-home caregiver who is hired by the Medicaid recipient and paid through the state payroll system. Homecare Workers complete background checks, orientation, and ongoing training; they are represented by SEIU 503.
What is the difference between the K Plan and ICP?
Under the K Plan, you’re hired as a Homecare Worker and paid through the state. Under ICP, the Medicaid recipient gets a cash budget and hires caregivers directly through a fiscal intermediary. Both can pay family members.
How long does it take to be approved for the K Plan?
Approval typically takes 45–90 days from the OHP application and CA/PS assessment to authorization of services and Homecare Worker enrollment.
