Self-Direction and FMS in Oregon

All states: self-direction map

Oregon self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in Oregon offer self-direction?

Oregon offers self-direction in several Medicaid in-home programs run by three offices: ODHS Aging and People with Disabilities (APD), the ODHS Office of Developmental Disabilities Services (ODDS) and Oregon Health Authority (OHA) Behavioral Health. In most of them the person who receives services, or a representative, is the employer of the worker. One program, Independent Choices, also gives the person a monthly cash benefit to manage. A newer option, Agency with Choice, started in 2026 and makes an agency the employer while the person still chooses and directs the worker.

• Consumer-Employed Provider (CEP) Program: serves older adults and adults with physical disabilities who qualify for APD Medicaid in-home services. APD runs it with local APD and Area Agency on Aging offices. The consumer, or a Consumer-Employer Representative, hires and manages a homecare worker. The consumer has employer authority. Hours are authorized by the case manager, and we did not find a participant-controlled budget in this program.
• Spousal Pay Program: an option inside the Consumer-Employed Provider program for consumers who need full assistance in at least four of six activities of daily living, have a debilitating medical condition, and are cared for by a legally married spouse. APD runs it, and its Central Office approves every plan at enrollment and each year. The spouse enrolls as a homecare worker. The ODHS guide we read does not say which federal authority the program sits under.
• Independent Choices Program (ICP): serves people eligible for APD Medicaid in-home services who show a stable living situation and can manage money, directly or through a representative. APD runs it as a 1915(j) Medicaid state plan option. The participant has both employer authority and budget authority. A monthly cash benefit is deposited into a separate ICP checking account, and the participant sets wages.
• ODDS in-home supports from Personal Support Workers (PSWs): serves children and adults with intellectual or developmental disabilities who live in their own or family home. ODDS runs it through local case management entities (community developmental disabilities programs and brokerages). The individual, a representative or a designated person is the employer of the personal support worker. Hours are authorized by ODDS.
• Agency with Choice (APD and OHA): serves adults 60 or older and adults 18 or older with a disability who get Medicaid long-term services and supports at home, plus people with mental health conditions who are eligible for Medicaid in-home personal care. APD and OHA Behavioral Health run it through one contracted provider. The provider employs the Direct Support Worker, and the individual chooses the worker and directs the care and schedule. It is not available to Oregon Project Independence Medicaid (OPI-M) clients.
• Employer Model Agency: the ODDS form of agency with choice, for people with intellectual or developmental disabilities who live in their own or family home. ODDS certifies and endorses the agencies. The agency is the employer of the direct support worker, and the individual shares employer duties by choosing and training the worker and directing the care.
• OHA Behavioral Health Personal Care Attendant (PCA) program: serves people with mental health conditions who are eligible for Medicaid in-home personal care. OHA Behavioral Health runs it, and Comagine Health handles referrals and assessments. Under state rule the individual or a representative is the employer of the provider. We did not find a statement on budget authority for this program.

Employer authority means the person recruits, hires, schedules and supervises the worker. Budget authority means the person also manages a set amount of money. Homecare worker and personal support worker services sit under Oregon's 1915(k) Community First Choice state plan. The approved state plan amendment selects the Agency Model for that benefit and does not select the self-directed model with a service budget. ODHS lists its APD in-home options and guides on its in-home services tools page.

Who handles financial management services (FMS) in Oregon?

Oregon does not use one FMS model or one vendor. The state pays homecare workers itself, Public Partnerships, LLC (PPL) runs payroll for I/DD personal support workers, and Acumen is the fiscal intermediary for the Independent Choices Program. In those programs the person or a representative is the employer. In Agency with Choice and Employer Model Agencies, the agency is the employer and shares duties with the person.

Financial management services are the payroll and tax side of being an employer: paying the worker, withholding taxes and filing them. Oregon uses a few different names for the organization that does this. In ODDS services it is the Financial Management Agent Service (FMAS) vendor. In Independent Choices it is the fiscal intermediary.

• Consumer-Employed Provider and Spousal Pay: there is no outside FMS vendor. The consumer is the employer of the homecare worker. ODHS pays the worker on the consumer's behalf and withholds taxes, and APD handles wage and payroll problems. An optional service called the Employer Resource Connection offers support with the employer role.
• ODDS personal support workers: the individual, a representative or a designated person is the common law employer. ODDS authorizes hours and processes claims in its eXPRS system, then sends them to the contracted FMAS vendor, Public Partnerships, LLC (PPL), which issues paychecks and handles employment taxes. There is one contracted vendor for this work.
• Independent Choices Program: the participant is a household employer and is responsible for payroll and taxes. The State contracts Acumen as fiscal intermediary for bookkeeping, payroll and EVV at no cost to the participant. Acumen withdraws the budgeted amount from the ICP account each month and pays the workers.
• Agency with Choice (APD and OHA): GT Independence is the contracted provider. ODHS describes the model as shared employer responsibilities. The provider employs the Direct Support Worker and handles payroll, benefits, training and billing. State law allows up to two providers, and one was selected through a competitive process.
• Employer Model Agencies (ODDS): the ODDS in-home agency provider list dated June 18, 2026 shows five: CK Community Supports, LLC; Hildah And Kay's, LLC; LNDT Services, LLC; PMB Homes, LLC; and Rural Oregon Support Solutions, LLC. ODDS says the list is not updated in real time, so check the current list.
• OHA Personal Care Attendants: under state rule the Authority pays the provider on the individual's behalf. We did not find an outside FMS vendor for this program.

One point could not be confirmed for Independent Choices. We did not find a clear statement on whether participants must use Acumen for payroll. ODHS also publishes a list of bookkeepers and an Acumen schedule for EVV only, and its consumer overview says a participant may buy a payroll service with discretionary funds. Ask the Independent Choices Program at icp.spd@odhsoha.oregon.gov.

Pay rates also differ by program. Homecare worker and personal support worker pay rates and mileage are collectively bargained with SEIU. Independent Choices participants set the hourly wage themselves and are told not to pay less than minimum wage. In Agency with Choice the provider sets wages and benefits.

Who can be a paid caregiver under self-direction in Oregon?

Relatives can be paid in Oregon, but the rules depend on the program. In APD services a spouse can be paid only through the Spousal Pay Program, the Independent Choices Program or Agency with Choice. Across the APD programs, the person's representative cannot also be the paid worker.

• Consumer-Employed Provider: a Consumer-Employer Representative may not be the paid homecare worker. A homecare worker who marries the consumer can keep being paid only if the consumer meets all Spousal Pay criteria. We did not find a published answer on whether a parent of a minor child or a legal guardian can be a paid homecare worker. Ask the local APD or Area Agency on Aging office.
• Spousal Pay Program: the ODHS Spousal Pay guide says the spouse is paid for all authorized hours for activities of daily living but only half of the assessed hours for instrumental activities such as housekeeping. The spouse must provide at least 51 percent of the care and cannot be the Consumer-Employer Representative.
• Independent Choices Program: participants may hire family members, their spouse, neighbors and others. The ICP representative may not be a paid provider, whatever the relationship.
• Agency with Choice: a spouse may apply and be hired as a Direct Support Worker if they meet the hiring and background requirements.
• ODDS personal support workers: see the note above. For a guardian of an adult who wants to act as personal support worker or employer, ODDS points to its conflict of interest policy.
• Parents of children with very high needs: the ODDS Children's Extraordinary Needs Program pays parents and guardians of enrolled children under 18 for up to 20 hours a week. The parent is hired by a provider agency, so this is not self-direction. The program serves 230 children at a time and has a long waitlist.

Hours are capped. Homecare workers, spouse providers included, are limited to 60 hours a week and 16 hours in a 24 hour period, and exceptions above 60 hours are limited to 90 days. Personal support workers are paid overtime for authorized hours over 40 in a Sunday to Saturday week and can work up to 60 hours a week without an exception.

Does EVV apply to self-directed workers in Oregon?

Yes. Electronic visit verification (EVV) applies to self-directed workers in Oregon, and each program has its own system. Homecare workers use the state's OR PTC DCI system, personal support workers use the state's eXPRS Mobile-EVV, Independent Choices workers use Acumen's DCI system, and Agency with Choice workers use the provider's own tool. For homecare workers and personal support workers, pay runs through those state systems.

• Homecare workers (Consumer-Employed Provider and Spousal Pay): workers record time in OR PTC DCI by mobile app, the consumer's verified landline or a fob. The ODHS in-home overview says the system checks each claim, and only valid claims are made available for entry into the state payment system.
• Personal support workers (ODDS): the PSW FAQ says workers must use eXPRS to be paid. EVV applies to attendant care, daily relief care and state plan personal care. Exceptions and manual entries with a reason code are allowed. Family members who live with the person get no live-in exemption and must clock in and out for the time they work.
• Independent Choices Program: participants and their providers must meet EVV requirements, and workers clock in and out through Acumen's DCI system by mobile app, landline or fob. Participants who are not EVV compliant are involuntarily disenrolled. We did not find a statement that wages are held when time is not EVV compliant.
• Agency with Choice: GT Independence tracks Direct Support Worker hours through its own EVV tool, and the provider is responsible for EVV compliance.
• OHA Personal Care Attendants: attendants enter time in the state's OR PTC DCI system.
• Employer Model Agencies: we did not find which EVV system these agencies use. Ask ODDS at odds.questions@odhs.oregon.gov.

We also did not find a published live-in exemption for homecare workers or for Independent Choices workers. For homecare worker questions, contact APD Medicaid Services and Supports at apd.ltss@odhs.oregon.gov or 503-945-5600.

What is changing next for self-direction in Oregon?

We did not find an announced upcoming change to self-direction in Oregon as of the last check on October 13, 2026. Most of the recent change has already taken effect, because 2026 was the year Oregon added agency with choice options. One open item is the federal approval that lets Oregon limit how many Agency with Choice providers it contracts with.

• Agency with Choice is new in 2026. CMS approved state plan amendment OR-25-0023 on December 17, 2025, effective January 1, 2026, adding Agency with Choice to Oregon's 1915(k) Community First Choice benefit. The ODHS Agency with Choice page says the APD option launched in July 2026, and ODHS issued a news release on the launch dated October 5, 2026 naming GT Independence.
• Employer Model Agencies are new in 2026. ODDS set January 1, 2026 as the launch of this provider type.
• The Children's Extraordinary Needs Program grew. Its page says the program expanded on July 1, 2026 to serve 230 children at a time.

The item to watch is a 1915(b)(4) selective contracting waiver, which is the federal permission that lets Oregon limit Agency with Choice to two providers. It was approved for January 1, 2026 through December 31, 2026, with a renewal request due to CMS by October 2, 2026. We did not find confirmation that the renewal was submitted or approved, so we cannot say what happens after that date. For the current status, ask the Agency with Choice team at awc.info@odhsoha.oregon.gov.

Oregon self-direction sources

• ODHS Aging and People with Disabilities: In-home services tools
• ODHS: In-home services overview
• ODHS: In-home options comparison chart
• ODHS: Independent Choices Program outline
• ODHS: Spousal Pay Program guide
• ODDS eXPRS: Personal Support Worker FAQ
• ODHS: Agency with Choice
• CMS: Oregon state plan amendment OR-25-0023 (Agency with Choice in 1915(k))
• ODDS: In-home agency providers list

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
• Self-direction in every state (map)
• Oregon EVV requirements

Page history

• October 13, 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 FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.