Paying for care

Medicaid and in-home care in Oregon: what it pays for and how to apply

How Oregon pays for in-home care through the K Plan, OPI and OPI-M: who qualifies, what each covers, what the assessment is like and how to apply.

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The short answer

Yes. Oregon Medicaid pays for help at home for people who qualify. That help comes at regularly scheduled times and covers daily activities like bathing, dressing and eating, plus household tasks like meals and housekeeping. The state says the goal is to help a person stay at home with as much independence and dignity as possible.

Medicaid isn't one program here. Oregon pays for care at home through a few programs, and each has its own rules. The three most families run into are the K Plan and OPI-Medicaid (OPI-M), which Medicaid pays for, and Oregon Project Independence (OPI), which the state funds for people who don't have Medicaid long-term care. This page walks through each one, who qualifies, what the assessment is like and how to apply. For other ways to pay, like VA benefits, insurance and private pay, see our guide to paying for in-home care in Oregon.

You don't have to figure out the right program before you call. The Aging and Disability Resource Connection (ADRC) at 1-855-673-2372 can talk through your parent's situation and point you to the right programs.

Pasha Health accepts Medicaid. If you'd like to talk it through, schedule a 15-minute call.

Three programs, side by side

Here's how the three programs compare. Dollar limits change each year. The figures below are the state's 2026 numbers. For updates, check the ODHS OPI-M income and resource standards (opens in a new tab) and the OPI fee schedule (opens in a new tab).

Oregon's K Plan, OPI and OPI-M compared
Topic	K Plan (Medicaid in-home services)	Oregon Project Independence (OPI)	OPI-Medicaid (OPI-M)
Who it's for	People who are eligible for Medicaid and meet the state's level-of-need test	People 60 or older, and people of any age with Alzheimer's or a related disorder, who aren't on Medicaid (food benefits and help with Medicare premiums don't count). In some counties, including Marion, Polk, Multnomah and Washington, adults 19 to 59 with physical disabilities too	Adults 18 or older who need help from another person with personal care. Adults 59 or younger must also meet Social Security or state disability criteria
How it's funded	Medicaid	The state	Medicaid
Income and assets	Based on your income, financial resources and how much help you need	No income or asset limits	Income up to 400% of the federal poverty level ($5,320 a month for one person in 2026). Savings and assets up to $103,645 for one person (July 2026 to June 2027). Married couples have different rules, so ask the ADRC or ODHS
Level of need	Service priority level 1 to 13 on the state assessment	Set during a home assessment by your local Area Agency on Aging	Service priority level 1 to 18 on the state assessment
Cost to you	Ask your case manager what, if anything, you'll owe	A share of the cost on a sliding scale, based on household income minus medical costs. Under the 2026 fee schedule, a person living alone with adjusted income of $1,995 a month or less pays no share	No cost if you qualify, and no estate recovery
What it can cover	Hands-on help, supervision or cueing with daily activities and household tasks, plus emergency response systems, assistive technology, home modifications and home-delivered meals	Personal care, home care, chore services, assistive technology, adult day care, respite, nursing services, home-delivered meals and service coordination	Personal care, housekeeping, meal prep, home-delivered meals, chore services, adult day services, assistive technology, home modifications and support for unpaid family caregivers
Waiting lists	Ask your local office	Some areas have them. People with the highest need and the least support go first	Ask the ADRC whether your area is taking new applications

Sources: ODHS OPI-M income and resource standards (opens in a new tab), ODHS OPI fee schedule 2026 (opens in a new tab), ODHS In-Home Services Overview (opens in a new tab), ODHS Home Care Consumers (opens in a new tab), ODHS Long-term Care Options (opens in a new tab), ADRC: OPI (opens in a new tab), ADRC: OPI-M (opens in a new tab), OPI-M terms approved by CMS (opens in a new tab).

The K Plan, in plain language

The K Plan is Oregon's name for Community First Choice. It's a Medicaid option created under the Affordable Care Act that lets the state pay for care at home and in the community. Oregon's K Plan took effect on July 1, 2013.

At its core, the K Plan pays for attendant care. That means help with daily activities, household tasks and health-related tasks, given as hands-on help, supervision or cueing. Cueing means a reminder or a word of encouragement so your parent can do the task themselves.

What the K Plan can cover

Help with bathing, personal hygiene, dressing, eating, moving around and transfers, toileting, and memory and behavior support
Emergency response systems for people who live alone or are alone for long stretches
Electronic devices and assistive technology, like medication minders, motion sensors and fall sensors
Home modifications tied to daily care needs, generally limited to $5,000 per modification
Home-delivered meals for people who are homebound, can't cook and don't have someone to cook for them
Backup or relief care when the usual caregiver is sick or suddenly unavailable

Care can come from a homecare worker, a personal support worker or an in-home care agency. There's more on those choices below.

Sources: ODHS Waivers and K Plan (opens in a new tab), Oregon K Plan state plan (opens in a new tab).

Who qualifies for Medicaid in-home services

Your parent has to pass three tests:

They're eligible for Medicaid.
They need enough help to reach service priority level 1 to 13 on the state's assessment.
They live in a type of home the state rules allow, such as their own home.

The service priority level is a ranking of how much help someone needs. It's based on age and on physical and cognitive limits, like trouble walking or memory loss. People under 65 may qualify too if they have a documented medical, non-psychiatric diagnosis or a physical disability. It depends on their assessment and a medical determination.

For the money side, the state says it plainly: whether you qualify depends on your income, your financial resources and how much help you need at home. The ADRC or your local office can tell you the current limits.

Sources: ODHS In-Home Services Overview, pp. 3 and 9 (opens in a new tab), ODHS Home Care Consumers (opens in a new tab).

What the assessment looks like

Once you apply, a case manager visits your parent in person, at home or wherever they live now. They complete the state's assessment, called the CA/PS. It looks at what your parent can do on their own and where they need help.

The case manager will also ask who already helps. The state calls these people natural supports: family, friends, neighbors or roommates who pitch in. Before the visit, write down who helps with what and how often. It makes the conversation easier and the plan more accurate.

How many hours will Medicaid pay for?

There's no flat number. Hours are set from the assessment of your parent's needs. Afterward, your parent gets a written notice called a Service Planning and Notice (SPAN) and an Assessment Summary. Together they show which services and hours were approved.

If the standard limits don't cover what your parent needs, the case manager can ask for an exception based on documented need. The case manager starts that request with your parent's consent. The state decides whether to approve it.

After care starts

The case manager stays in touch. A direct or indirect contact each month is required for your parent to keep Medicaid in-home services.

Source: ODHS In-Home Services Overview, pp. 5 to 10 (opens in a new tab).

Who provides the care: your choices

Medicaid lets your parent choose how care is delivered. Here are the main options.

Homecare worker (Consumer Employer Program): your parent hires and manages their own worker, and the program pays the worker directly.
Independent Choices Program: your parent gets a monthly cash benefit and pays workers themselves. They can hire who they want, including a homecare worker, a spouse or other family members.
Agency with Choice: your parent picks and trains a worker, and a partner agency handles hiring, background checks, taxes and pay.
In-home care agency: the agency screens, interviews and hires the caregivers. For Medicaid clients, the state pays the agency directly. Agencies need a contract with the state's Aging and People with Disabilities program to provide Medicaid in-home services.

If your parent is on Medicaid, OPI or OPI-M and wants an agency, ask the case manager. If you'd rather find an individual worker, Carina, an online referral system, helps you search for one.

With an agency, the agency takes on the employer work, like hiring, taxes, background checks and covering vacations.

Sources: ODHS Home Care Consumers (opens in a new tab), ODHS In-Home Services Overview, p. 4 (opens in a new tab), ADRC: Who can help (opens in a new tab).

OPI and OPI-M in more detail

Oregon Project Independence (OPI)

OPI is for people 60 and older, and people of any age with Alzheimer's or a related disorder, who aren't on Medicaid. In some counties, including Marion, Polk, Multnomah and Washington, adults 19 to 59 with physical disabilities can qualify too. The state funds it, and there are no income or asset limits.

Most people pay part of the cost on a sliding scale, based on monthly household income minus monthly medical costs. Under the 2026 fee schedule, a person living alone with adjusted income of $1,995 a month or less pays no share, and someone above $5,320 a month pays the full cost.

Some areas have waiting lists. People who are frail, lack support and are likely to have to leave home for care get priority. After you ask for services, someone from your local Area Agency on Aging calls to set up a home assessment.

OPI-Medicaid (OPI-M)

OPI-M is newer. Federal Medicaid officials approved it in 2024 for adults 60 and older and adults 18 and older with physical disabilities. Its income and asset limits are higher than regular Medicaid's, so more people can qualify. For 2026, income can be up to $5,320 a month for one person. Savings and assets can be up to $103,645 for one person from July 1, 2026 to June 30, 2027. Married couples have different rules, because a spouse's resources count at the start, so ask the ADRC or ODHS.

If your parent qualifies, there's no cost for OPI-M services. There's also no estate recovery. That means the state won't ask your parent's heirs to pay back the cost of OPI-M services after they die.

OPI-M can't be combined with K Plan services. If your parent later chooses the K Plan, OPI-M ends.

When OPI-M was approved in 2024, the state said it would start with people already on OPI waiting lists. Ask the ADRC whether your area is taking new applications now.

Sources: ADRC: OPI (opens in a new tab), ODHS OPI fee schedule 2026 (opens in a new tab), ADRC: OPI-M (opens in a new tab), ODHS OPI-M income and resource standards (opens in a new tab), ODHS Long-term Care Options (opens in a new tab), ODHS Home Care Consumers (opens in a new tab), OPI-M terms approved by CMS (opens in a new tab), ODHS news release, July 3, 2024 (opens in a new tab).

How to apply, step by step

Step 1: Call the ADRC at 1-855-673-2372 (1-855-ORE-ADRC). They'll talk through your parent's situation and point you to the right programs.
Step 2: Apply for Medicaid. Go to ONE.Oregon.gov (opens in a new tab) and choose Apply Now, call ONE Customer Service at 1-800-699-9075, contact a local ODHS office or use the paper form. Medical benefits through ONE can include in-home long-term services and supports. You can apply any time of year.
Step 3: Find your local office with the ODHS office finder (opens in a new tab) or the ADRC county map (opens in a new tab).
Step 4: Get ready for the in-person assessment. Have a list of who helps your parent now and what they do.
Step 5: Watch for the Service Planning and Notice (SPAN). It tells you which services and hours were approved. Then your parent picks a provider.

Local offices in the Salem area and Portland metro

Marion and Polk counties: NorthWest Senior and Disability Services (NWSDS), an Area Agency on Aging that also runs the local Medicaid in-home programs. Offices in Salem, Woodburn and Dallas. Call 503-304-3420 or toll free 1-866-206-4799.
Multnomah County: Multnomah County Aging, Disability and Veterans Services runs both the aging programs and the local Medicaid in-home programs.
Washington and Clackamas counties: the county runs OPI and other aging programs. Medicaid in-home services go through the local state APD office.

Not sure which county applies? The ADRC county map (opens in a new tab) will show you.

Sources: ODHS Long-term Care Options (opens in a new tab), ADRC Connect (opens in a new tab), OHA: Ways to apply (opens in a new tab), ONE.Oregon.gov (opens in a new tab), ODHS AAA service delivery models (June 2026) (opens in a new tab), NWSDS 2025 to 2029 Area Plan (ODHS) (opens in a new tab), ODHS In-Home Services Overview, pp. 9 and 10 (opens in a new tab).

Questions families ask

How many hours will Medicaid pay for home care in Oregon?

There's no set number. A case manager assesses your parent's needs in person, and hours are approved based on that assessment. Your parent then gets a written notice (the SPAN) showing the approved services and hours. If the standard limits aren't enough, the case manager can ask for an exception based on documented need.

Can a family member be paid to care for my parent?

Sometimes, yes. People on Medicaid long-term services can choose the Independent Choices Program. It gives a monthly cash benefit, and your parent can hire who they want, including a spouse or other family members. Oregon also has a Spousal Pay Program, which has stricter rules. Ask your case manager which options fit your parent.

Will the state take my parent's house?

It depends on the program. OPI-M has no estate recovery, so nothing has to be paid back. For other Medicaid long-term care, including in-home care, the state can ask to be paid back from your parent's estate for services they got at 55 or older. The state won't require the family to sell the home, but the home is usually part of the estate, and a sale may be needed if it's the only way to pay the claim. In most cases the state waits until a surviving spouse has died, and it won't seek repayment if there's a child under 21 or a child of any age who is blind or disabled. Ask the ADRC or an elder-law attorney about your parent's situation.

Is there a waiting list?

For OPI, some areas have one, and people with the highest need and the least support go first. For other programs, ask the ADRC at 1-855-673-2372 or your local office what's open in your area right now.

Can Medicaid pay a home care agency?

Yes, if the agency has a contract with the state's Aging and People with Disabilities program. Your parent asks their case manager for agency services, and the state pays the agency directly. The agency handles the employer work, like hiring, taxes and background checks.

Does Medicare pay for this kind of care instead?

Usually not. Medicare doesn't pay for personal care, like help bathing or dressing, when that's the only care someone needs. It also doesn't cover 24-hour care or homemaker services unrelated to a care plan. Our guide to home care vs. home health in Oregon explains the difference.

Sources

Everything on this page comes from official Oregon and federal sources. Dollar limits change each year, so check the source before you rely on a number.