I/DD Waivers in Oregon

All states: Medicaid disability services map

Oregon I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in Oregon?

The Office of Developmental Disabilities Services (ODDS), part of the Oregon Department of Human Services (ODHS), runs I/DD home and community services. The Oregon Health Authority (OHA) is the state Medicaid agency and has ODHS operate the I/DD waivers day to day. Families start at their county Community Developmental Disabilities Program (CDDP), and case management comes from CDDPs, support services brokerages or ODDS staff, depending on age and where the person lives.

• Oregon Health Authority (OHA): the single state Medicaid agency. It holds the federal approvals and delegates waiver operation to ODHS.
• ODDS: sets policy, authorizes services, publishes rates and pays providers through its eXPRS payment system.
• Front door: the local CDDP, a county based program that takes applications and decides I/DD eligibility.
• Case management: case management for children comes from CDDP services coordinators, or from ODDS state staff for children in the Children's Intensive In-Home Services (CIIS) programs. Adults who live in their own or a family home choose between a CDDP services coordinator and a personal agent at a support services brokerage. Adults in foster care or 24-hour residential settings are served by the CDDP. A 1915(b)(4) selective contracting waiver limits who can provide waiver case management to these groups.

What Medicaid waivers and programs serve people with I/DD in Oregon?

Oregon uses two kinds of federal approval. The K Plan, Oregon's 1915(k) Community First Choice program, pays for most daily supports such as attendant care, relief care and day support. Six 1915(c) waivers, all amended effective July 1, 2026, mainly add employment services, waiver case management, nursing and home or vehicle modifications, and give the ICF/IID level of care pathway. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care.

• K Plan (1915(k) Community First Choice): serves children and adults with I/DD who have Medicaid, meet an institutional level of care and have an assessed need. Services include attendant care (in the home, in foster care, during day support activities and on the job), relief care, professional behavior services, community nursing, community transportation, assistive devices and technology, chore services, environmental modifications, home delivered meals and transition services, according to the ODDS Expenditure Guidelines.
• Adults' Home and Community-Based Services Waiver (control number OR.0375): formerly the Support Services waiver. It serves adults 18 and older with I/DD at ICF/IID level of care and enrolls all eligible people. Services include Employment Path (prevocational), individual and small group supported employment, Discovery, waiver case management, direct nursing, environmental and vehicle modifications, family training and specialized medical supplies. It estimates 23,655 participants in its first year, rising to 26,541 in year five.
• Children's Home and Community-Based Services Waiver (OR.0117): serves children from birth through age 17 with I/DD at ICF/IID level of care who live with family, in child welfare foster homes or in 24-hour residential settings. Services include waiver case management, employment services, modifications, family training and specialized medical supplies.
• Behavioral (ICF/IDD) Model Waiver (OR.40194): serves children with I/DD and intensive behavioral needs who live at home, through the CIIS Intensive Behavior program. Enrollment is capped. Services include case management by ODDS CIIS staff, family training, individual directed goods and services, modifications and specialized medical supplies.
• Children's Extraordinary Needs (CEN) Waiver (OR.2386): serves children under 18 with very high medical or behavioral needs (ONA service group 5b or 5m) who live in the family home. Its main service is attendant care by a paid parent or guardian, up to 20 hours a week, hired through a provider agency. It can serve 230 children at a time from July 1, 2026.
• Medically Fragile (Hospital) Model Waiver (OR.40193) and Medically Involved Children's Waiver (OR.0565): run by ODDS through the CIIS programs for children with significant medical needs who live at home, at hospital and nursing facility level of care. They serve medical needs rather than I/DD alone, and offer case management, family training, modifications and specialized medical supplies.

Oregon has no Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) in the state, according to the Adults' waiver, even though ICF/IID is the level of care the I/DD waivers use.

Does Oregon pay for I/DD services through managed care?

No. Oregon pays for I/DD services fee-for-service. ODDS authorizes services, and providers bill through the ODHS eXPRS payment system, which pays validated claims directly to providers. Case management comes from public programs, not health plans.

• Claims: waiver and K Plan provider billings go to eXPRS. Direct nursing is paid through MMIS, the state's Medicaid claims system, according to the Adults' waiver.
• Case management: CDDPs, support services brokerages and ODDS CIIS staff coordinate services, as described above.
• Selective contracting: the ODDS waivers page lists a Fee-for-Service Selective Contracting Waiver (1915(b)(4)), effective July 1, 2024. It limits who can provide waiver case management. It is not managed care.

Is there a waiting list for I/DD services in Oregon?

For some programs, yes. Oregon's capped children's waivers have limited slots and keep statewide wait lists, and the state does not publish a count of children waiting. The Adults' HCBS Waiver and the K Plan enroll all eligible people, so adults do not wait for a waiver slot.

• Adults' waiver: states that it enrolls all eligible people and does not limit participants at any point in time.
• Children's waiver: enrolls all eligible children but allows a statewide first come, first served wait list, ordered by the date of the completed application, if enrollment reaches its maximum.
• Behavioral waiver: enrollment is capped. When it is full, a child may be reviewed for the Children's waiver or placed on a first come, first served wait list.
• Children's Extraordinary Needs: the CEN program page says the program has a wait list because of limited funds. The waiver used a random number order for the first group of applicants, and children are now added in order of application. It can serve 230 children at a time from July 1, 2026.
• Medically Fragile waiver: the waiver text refers to a wait list.

We did not find a published count for any of these lists. Families can ask their CDDP, or ODDS at ODDS.Questions@odhs.oregon.gov or 503-945-5811.

How do people apply for I/DD services in Oregon, and how are budgets set?

Families fill out Oregon's common application (form SDS 0552) and send it to their county CDDP, which decides I/DD eligibility. Waiver and K Plan services also need Medicaid and an institutional level of care. A case manager then completes the Oregon Needs Assessment (ONA), which sets the hours a person can receive, and writes an Individual Support Plan (ISP).

• Eligibility: under Oregon rule OAR 411-320-0020, a person qualifies with an intellectual disability (IQ of 70 or below with significant adaptive impairment, starting before age 18; an IQ of 71 to 75 may qualify with a psychologist's diagnosis) or a developmental disability (starting before age 22, originating in the brain, expected to continue and significantly limiting adaptive behavior).
• Medicaid and level of care: the person needs Medicaid (OSIPM, an OHA medical program or Healthier Oregon) and must meet ICF/IID level of care for the I/DD waivers, checked with a state level of care tool.
• Oregon Needs Assessment: done at the start of case management and usually every year. It places the person in one of 14 age-based service groups, and each group sets monthly hour ranges for attendant care, skills training and adult day support.
• Foster care rates: set using the Support Needs Assessment Profile (SNAP).

What day and residential services can I/DD providers offer in Oregon?

Day services in Oregon include Day Support Activities under the K Plan and employment services under the waivers, all delivered by ODDS certified and endorsed Medicaid agencies (job coaching can also be self-directed). Residential options include 24-hour group homes, supported living, host homes and developmental disability foster homes, licensed or certified by ODHS. Rates below are from the ODDS Expenditure Guidelines, Version 20, updated July 1, 2026.

Day and employment services

• Day Support Activities (DSA): attendant care during scheduled, structured activities outside the home, focused on community participation and communication, with a measurable ISP goal. Offered to adults in a facility or in the community, in group, 1:1 or 2:1 formats (solo community DSA needs an ODDS exception). Only agencies can provide DSA, not personal support workers, under OAR 411-450. Billed hourly: group community DSA $17.66 to $41.04 an hour and group facility DSA $12.37 to $29.30 an hour, across rate categories 1 to 4. We did not find a general staff ratio; billing codes separate group, 1:1 and 2:1 support.
• Employment Path and small group employment support: prevocational and small group supported employment under the waivers, paid hourly at rates tied to four funding categories. Providers need an ODDS employment endorsement. We did not find a published staff ratio.
• Job coaching, job development and Discovery: job coaching is paid for each hour the person works, at rates that vary by need and by job phase (initial, ongoing, maintenance). Job development and Discovery are paid as outcome payments by level of need. Job coaching can be self-directed. We did not find a published staff ratio.

Residential services

• 24-hour residential (group homes): for adults and children, in homes run by agencies that ODHS licenses and certifies. Paid a daily rate by payment category and home size (for adults, $156.30 to $727.98 a day), based on 344 days a year.
• Supported living: supports for adults in their own homes from a supported living agency. From July 2026, paid as a monthly rate by ONA service group when more than 75 percent of authorized hours are delivered, plus a fixed monthly administrative amount, with hourly rates below that.
• Host homes: the person lives with a host home provider through a certified agency. Daily rates run from $137.86 to $345.96 across payment categories 1 to 4.
• Adult and child foster homes: licensed by ODHS. K Plan attendant care is paid in foster care, the rate is set by the person's SNAP assessment, and adult foster home rates are set through collective bargaining.

Agencies can find licensing and certification details on the ODHS I/DD agency licensing page.

How are I/DD provider rates set and how do agencies enroll in Oregon?

ODDS publishes statewide rates in its Expenditure Guidelines. Most agency rates come from rate models built by the consulting firm Burns and Associates, put in place in July 2023 and tied to the ONA service groups, while personal support worker and adult foster home rates are set through collective bargaining. Agencies become ODDS certified and endorsed Medicaid agencies through ODHS licensing.

• Rate models: the ODHS rate models page covers 24-hour residential, attendant care, employment and day support activities. Residential and host homes are paid daily, day support and employment hourly, and supported living monthly by service group.
• Latest rate change: an ODDS memo from July 2025 said that under Senate Bill 5526 (2025), some agency rates rose on July 1, 2025, with a second step scheduled for July 1, 2026, including 2.1 percent for day support activities, 2.8 percent for employment services, 2.0 percent for transportation and 5.0 percent for adult supported living. In-home services got no increase. ODDS confirmed the 2.8 percent job coaching increase in its July 2026 rate table. Check the current Expenditure Guidelines for the other 2026 rates.
• Becoming a provider: agencies apply to ODHS to be licensed or certified and endorsed for each service type (for example 24-hour residential, supported living, host homes or employment). In-home supports can be offered by Standard Model Agencies or, since January 1, 2026, by Employer Model Agencies, a newer agency type that shares employer duties with the family.
• EVV: electronic visit verification applies to in-home attendant care (OR526), daily relief care (OR507) and state plan personal care (OR502). Agencies can use the free eXPRS Mobile-EVV app or their own EVV system that produces a file for import into eXPRS, and personal support workers must use eXPRS to be paid. EVV does not apply to 24-hour residential settings, day support activities or on-the-job attendant care, according to the ODDS EVV agency guidance.

What is changing next for I/DD services in Oregon?

As of October 23, 2026, we did not find a confirmed change with a set date for Oregon's I/DD services. ODHS is building two new systems that will affect providers, but it labels both timelines tentative.

• New provider enrollment and licensing system: ODHS is building PEMS, a provider enrollment and maintenance system. Its tentative timeline shows an agency and foster home module, replacing the current federal ASPEN licensing system, in late 2026, and a module for all provider types in late 2027.
• New case management system: a statewide I/DD case management system, with vendor RSM Public Sector brought on in late 2025, is planned to launch in phases in 2026 and 2027, according to the ODHS project timeline.

Recent changes already in place include the July 1, 2026 amendments to all six waivers, the CEN waiver's capacity of 230 children from that date, the new supported living monthly rate, and Employer Model Agencies from January 1, 2026. For news on rates or rule changes, ask ODDS or check its provider transmittals.

Oregon I/DD sources

• ODHS: I/DD waivers
• ODHS: Adults' Home and Community-Based Services Waiver (OR.0375)
• ODHS: Children's Home and Community-Based Services Waiver (OR.0117)
• ODHS: I/DD eligibility
• ODHS: I/DD case management
• ODHS: Children's Extraordinary Needs program
• ODDS Expenditure Guidelines (Version 20, updated July 1, 2026)
• ODDS Director's message: rate increases (July 16, 2025)
• ODHS: Licensing for I/DD agencies
• ODDS: EVV agency exceptions

Related reading

• Disability Services and Independent Living Guide
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Disability Services DayHab has a dilemma - how to solve it
• Outcome Measures in Disability Services: Measuring what matters
• I/DD services in every state (map)
• Oregon EVV requirements

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.