Oregon Medicaid pays for in-home personal care and related services through 2 programs, including the K Plan (Community First Choice, 1915(k)) - APD in-home services and the 1915(c) Aged and Physically Disabled (APD) Waiver. ODHS Aging and People with Disabilities operates in-home services; OHA is the Medicaid agency. In-home care is delivered by homecare workers (consumer-employed), licensed in-home care agencies under contract (OAR 411-033), or personal support workers in the Independent Choices Program. The APD 1915(c) and 1915(b)(4) waivers expire 2026-12-31, with renewal for 2027-2031 pending CMS approval. ODDS developmental disability waivers were not researched.
Yes. Oregon covers hands-on attendant care under the K Plan (1915(k) Community First Choice) since 2013-07-01, and also runs State Plan Personal Care (OAR 411-034-0020 to 411-034-0091) through enrolled homecare workers.
Which Oregon waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
K Plan (Community First Choice, 1915(k)) - APD in-home services
Population
Medicaid-eligible people who meet an institutional level of care; for APD in-home services, Service Priority Levels 1-13 on the CA/PS assessment.
Services covered
ADL supports (bathing, dressing, eating, mobility, bowel and bladder care)
In-home care agencies contract with APD; the case manager authorizes hours in the MMIS plan of care, and the agency must verify visits with EVV under OAR 411-033-0020.
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
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