How to Get Paid as a Family Caregiver in Oregon (2026)

Oregon paid family caregiver options include the Spousal Pay Program, which pays a husband or wife to care for their spouse when strict conditions are met.1 For other relatives and friends, the place to start is Medicaid in-home services, where ODHS calls the person receiving care the homecare worker's "consumer-employer."1

Oregon law also requires a criminal records check on every home care worker who registers with the Oregon Home Care Commission or renews that registration.2

This guide lays out every legitimate way to be paid as a family caregiver in Oregon for 2026: who can be hired under each program, how the pay works, and how to pick the route that fits your family.

The Short Version

If you are an adult child, sibling, other relative, or close friend of someone who receives Medicaid in-home services, ask whether you can be paid as that person's homecare worker. The Independent Choices Program's rule says outright that a participant's relative may be employed as a paid provider, but a representative who makes ICP decisions for the participant may not be, whatever their relationship.3

If you are a spouse, the Spousal Pay Program can pay you if every condition is met: your husband or wife qualifies for Medicaid in-home services, needs full help with at least four of six daily activities, has a debilitating medical condition, would otherwise need nursing facility care, and needs more care than one spouse usually gives another; you are able to provide the care and actually provide most of it, including the majority of service plan hours, meet all the requirements to enroll as a homecare worker in the Consumer-Employed Provider Program, and are not designated as your spouse's representative; and ODHS's Central Office approves. A care recipient with excess income contributes to the cost.1 If that bar is not met, ask about the Independent Choices Program, which can pay a spouse if the care recipient meets ICP's eligibility criteria and is approved for it.1 If your spouse is a veteran, look at the VA pathways below too.

If your loved one is a veteran, check the VA programs too. The VA's caregiver stipend can go to a spouse or another family caregiver, and Veteran-Directed Care lets the veteran hire workers who VA says might include a family member.7,8

If your family has enough private assets and is thinking about paying a relative privately, talk to an Oregon elder-law attorney first. Oregon applies a 60-month look-back to asset transfers, and a transfer made in whole or in part to establish or keep Medicaid eligibility can later disqualify the person from Department-paid nursing facility or home and community-based care.9

The rest of this guide walks through each pathway in detail.

Two Features to Know: Homecare Workers and Paid Spouses

Two features shape paid family care in Oregon. The first is the homecare worker model. Under Oregon's Consumer-Employed Provider (CEP) Program, ODHS calls the person receiving care the "consumer-employer" of their homecare worker.1

Homecare workers register with the Oregon Home Care Commission (OHCC). Oregon law requires ODHS or the Oregon Health Authority to complete a criminal records check on a home care worker registering with the Home Care Commission or renewing that registration, and the background check system ODHS uses is called ORCHARDS. ODHS lists the OHCC-SEIU collective bargaining agreements on its homecare workforce pages, most recently the 2025-2027 SEIU OHCC Contract, so confirm the current wage with OHCC when you enroll.2

The second is that Oregon can pay a spouse. Its Spousal Pay Program is one of the hourly service options under Medicaid in-home services, and it pays a spouse to provide care, within tight eligibility limits.1

The Oregon Paid Family Caregiver Pathways

1. Medicaid In-Home Services and the K Plan: The Main Route

Who pays: Medicaid, through the Oregon Department of Human Services, Aging and People with Disabilities (ODHS APD).

Who can be paid: A homecare worker; ODHS calls the person receiving care that worker's "consumer-employer."1 If you are a non-spouse relative or friend, confirm with the local office that you can be hired in that role; the Independent Choices Program (below) is the in-home option whose rule says outright that a relative may be employed, unless that relative is the participant's ICP representative.3 Payment to a spouse is restricted. Within CEP, ODHS names the Spousal Pay Program and the Independent Choices Program as the only in-home service options that allow payment to a spouse provider, and when a care recipient does not meet Spousal Pay eligibility, ODHS guidance is that the spouse cannot continue as the paid homecare worker. One situation sits outside that rule: a homecare worker who marries a consumer-employer who meets all Spousal Pay eligibility requirements is not paid under the Spousal Pay Program; a standard in-home service plan is built on the consumer's needs, with the full IADL hours, without reduction, assigned to that worker.1

What the K Plan is: The K Plan is a Medicaid state plan option authorized under the Affordable Care Act. It lets states provide home and community-based services and supports while receiving a six percent increase in federal medical assistance funds for those services, and ODHS says it benefits Oregonians who need assistance with regular activities and want to stay in their home or in a community setting. CMS describes the federal authority in the same terms as the Community First Choice option, implemented through Section 1915(k) State Plan Amendments. CMS has also approved two waivers for APD, which are set to expire Dec. 31, 2026 unless renewed.4

What it covers: Home and community-based attendant services and supports, meaning help with daily activities so the person can keep living at home.4

Eligibility, recipient: Ask the local office whether the care recipient qualifies for Medicaid in-home services; the ADRC (step 1 below) can connect you.

Eligibility, caregiver: Register with the Oregon Home Care Commission; ODHS or the Oregon Health Authority must complete a criminal records check on that registration.2

How you get paid: Ask OHCC for the current homecare worker rate when you register; ODHS lists the OHCC-SEIU collective bargaining agreements, most recently the 2025-2027 SEIU OHCC Contract.2

Best for: A non-spouse relative or friend of someone eligible for Medicaid in-home services, once the local office confirms you can be hired as the homecare worker.

2. The Spousal Pay Program: Paying a Spouse

Who pays: Medicaid in-home services, under OAR 411-030-0080.1

Who can be paid: A husband or wife caring for their spouse.1

The eligibility bar: The Spousal Pay Program is not a general spouse wage; it is reserved for heavy-care situations, and every condition must be met. The care recipient must:

• Meet all the eligibility requirements for Medicaid in-home services.
• Need full assistance in at least four of the six activities of daily living, as determined by ODHS's assessment.
• Have a debilitating medical condition, which ODHS defines as a severe and persistent condition that significantly impairs the person's ability to function and take part in most daily activities. The rule's examples include late-stage cancer and a spinal cord injury or similar disability with permanent impairment, and ODHS says having a medical diagnosis is not required to establish one.
• Require care that would otherwise mean nursing facility services without Medicaid in-home care, and that exceeds in both extent and duration the usual care one spouse provides another.1

What the spouse must do: The spouse must have the capability and health to provide the services and actually provide the principal services, including the majority of the service-plan hours. The spouse must meet all the requirements to enroll as a homecare worker in the Consumer-Employed Provider Program and cannot be designated as the care recipient's representative. ODHS's Central Office must review and approve Spousal Pay eligibility at enrollment and again at each annual re-assessment.1

How the spouse is paid: Authorized spousal-pay hours equal one-half of the assessed IADL hours plus all of the hours for specific ADLs, paid at the hourly homecare worker rates in the rate schedule. A care recipient with excess income must contribute to the cost of services.1

How to start: Call the Aging and Disability Resource Connection at 855-ORE-ADRC (855-673-2372) to reach your local ADRC, and ask specifically about the Spousal Pay Program.10

Best for: A married couple where one spouse needs extensive daily care and would otherwise face a nursing facility.

3. The Independent Choices Program (ICP): The Cash, Self-Directed Option

Who pays: Medicaid in-home services, run by ODHS Aging and People with Disabilities.3

Who can be paid: Family members, a spouse, neighbors and other interested applicants, including homecare workers. A participant's relative may be employed as an employee provider, but a representative who makes ICP decisions for the participant may not be, whatever their relationship.3 ODHS says a spouse can be the paid provider through ICP when the care recipient meets ICP's eligibility criteria and is approved for ICP, so it is the route to ask about when Spousal Pay is out of reach.1

What it is: The Independent Choices Program is a self-directed option. Instead of the usual service-provider plan, the participant receives a cash benefit at the beginning of each month, calculated from the ADL and IADL task hours in their assessment, and the participant or their representative carries full responsibility for locating, screening, interviewing, hiring, training, paying and terminating employee providers. They must set an hourly rate no lower than the federal or state minimum wage, whichever is greater. Up to 10 percent of the cash benefit can go into a case-manager-approved discretionary fund for items that support health, safety and independence, and a participant who cannot manage payroll and tax duties and has no representative must hire a fiscal intermediary, such as an accountant or bookkeeper. The cash benefit may not be used to buy services from an Adult Day Service provider or a licensed care setting.3

The key caveat: ICP has requirements of its own under OAR 411-030-0100, including evidence of a stable living situation for the past three months and a demonstrated ability to manage money, shown by timely, current utility and housing payments for the past three months or a payment history from before a hospital, community-based care or nursing facility stay. The cash benefit is terminated if the participant is away from home for longer than 30 calendar days due to illness or medical treatment, and may resume on their return if they still meet ICP's criteria. Someone disenrolled from ICP cannot reapply for six months.3

Best for: A care recipient who wants maximum control over hiring, scheduling, and pay, and who is willing to take on more of the employer role themselves.

4. VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

Who can be paid: A designated Primary Family Caregiver of an eligible veteran. The caregiver must be at least 18 and either a spouse, son, daughter, parent, stepfamily member or extended family member of the veteran, or someone who lives full time with the veteran or is willing to if VA designates them.7

2026 stipend: The PCAFC stipend starts from the federal General Schedule GS-4, Step 1 annual rate for the locality pay area where the veteran lives, divided by 12, so the dollar amount varies by locality. That monthly base is then multiplied by a factor set in 38 CFR 71.40(c)(4)(i), and which one applies turns on whether the veteran is in the current program or is a legacy participant or legacy applicant:7

• Current program (veteran meeting 38 CFR 71.20(a)): the factor is 0.625, or 1.00 if VA determines the veteran is "unable to self-sustain in the community."7
• Legacy participant or legacy applicant (veteran meeting 38 CFR 71.20(b) or (c)): the factor comes from the sum of the veteran's 2019 clinical ratings instead. A sum of 21 or higher pays 1.00, a sum of 13 to 20 pays 0.625, and a sum of 1 to 12 pays 0.25. The legacy schedule runs eight years from October 1, 2020 and lapses October 1, 2028.7

A veteran who meets both sets of criteria is paid whichever of the two amounts is higher. If your household enrolled before October 2020, ask your VA Caregiver Support Coordinator which schedule you are on when you confirm your exact stipend.7

Veteran eligibility: VA lists four requirements that must all be true: a VA disability rating of 70 percent or higher, a discharge or medical discharge date, a need for at least six months of continuous, in-person personal care, and enrollment in VA health care. Those are a first screen, not a decision: the veteran and caregiver apply together and go through an application process to determine eligibility.7

Why it stands out: It can pay a spouse or another family caregiver. To get the monthly stipend, the caregiver must be enrolled in direct deposit through the VA customer engagement portal.7

Best for: Families of an eligible veteran where one person provides substantial daily care.

5. VA Veteran-Directed Care (VDC)

Who can be paid: Workers the veteran hires with a counselor's help, who VA says might include their own family member or neighbor. If you are the veteran's spouse, ask the VA site serving you whether you can be one of those workers.8

How it works: Under VA's Veteran-Directed Care program, the veteran receives a budget for services, managed by the veteran or their representative, and with a counselor's help hires their own workers. Through an options counselor, an Aging and Disability Network Agency arranges fiscal management services. Eligibility is conditional: an enrolled veteran qualifies if they are eligible for community care, meet the clinical criteria for the service, and it is available, and VA says services may vary by location. In Oregon, ACL's Veteran-Directed Care directory lists sites at the Portland VA Medical Center, the Southern Oregon Rehabilitation Center & Clinics, the VA Roseburg Health Care System, and the White City VA Medical Center.8

Best for: An Oregon veteran with daily-living needs who wants to pick their own worker and manage their own budget for services.

6. VA Aid and Attendance Pension

Who is paid: The veteran or surviving spouse who claims the pension.11

2026 maximums (effective December 1, 2025 through November 30, 2026): VA sets these as yearly Maximum Annual Pension Rates, and a MAPR is a ceiling, not a flat payout. VA pays the difference between the claimant's income for VA purposes and the MAPR, computed monthly as that remainder divided by 12. A single veteran with Aid and Attendance has a MAPR of $29,093 per year, a veteran with one dependent $34,488, and a surviving spouse with no dependents $18,697. Income for VA purposes is not gross income: non-reimbursable medical expenses above 5% of the MAPR can reduce it. Confirm current figures on the VA pension rate page before applying.11

Financial limit: The 2026 net worth limit is $163,699, counting the claimant's and dependents' assets and income for VA purposes.11 Check VA's Aid and Attendance page for the rest of the eligibility rules before applying.

Best for: A veteran or surviving spouse who meets VA's Aid and Attendance rules, including its income and net worth limits.

7. Private Personal Services Contract

Who can be paid: Any family member, including an adult child, sibling, or other relative, under a written contract. Spouses are generally not paid this way for Medicaid-planning purposes, because transfers between spouses are treated differently.

What it is: A written, arm's-length contract between the care recipient (or their legal representative) and the caregiver, signed before care begins. It should spell out the services, the schedule, a reasonable and customary hourly rate documented against local agency quotes, how and when the caregiver is paid, and a requirement that the caregiver keep daily logs and report the income on their taxes.

The look-back: Oregon applies a 60-month look-back to asset transfers. A transfer made in whole or in part to establish or keep Medicaid eligibility disqualifies the person from Department-paid nursing facility services or home and community-based care, for a number of months equal to the uncompensated value of the transfer divided by a dollar amount set by rule. That divisor is $16,760 when the penalty's initial month is on or after October 1, 2026, and $14,585 when the initial month is from October 1, 2024 through September 30, 2026. For a new applicant, the initial month is the month they would have been eligible if not for the transfer. For someone already receiving these services, it is the month the transfer was made. Because the penalty is measured by the uncompensated value of a transfer, ask an Oregon elder-law attorney how payments to a family caregiver would be treated before money changes hands.9

Exceptions: Any asset can go to a spouse, or to a child who is blind or has a disability, without a penalty, as long as only that spouse or child can ever benefit from it. A home can also go to a child under 21, to a sibling with an equity interest who lived there for at least a year before the parent entered long-term care, or to a caregiver son or daughter. The caregiver-child exception is narrow. The child must have lived in the parent's home continuously for at least two years before the parent's admission (absences of 30 days or less are allowed), give convincing evidence that their care kept the parent out of a facility. They must also have provided at least 20 hours a week of care made up of daily help with both personal tasks (like eating, dressing or bathing) and household tasks (like meals, medications or shopping). That care must have been given without payment from the Department, so care the Department paid you for does not count toward the test. Confirm your situation with ODHS or an Oregon elder-law attorney.9

Best for: Families with enough assets to private-pay a caregiver. Work with an Oregon elder-law attorney before any money changes hands.

How to Apply as an Oregon Homecare Worker (the Main Route)

For a non-spouse relative or friend, the Medicaid route starts with getting your loved one into Medicaid in-home services and confirming that you can be hired as their homecare worker. Here is the sequence.

Comparing the Oregon Pathways

How to Choose an Oregon Pathway

Start with the care recipient's situation:

1. Is your loved one a veteran? Check the VA pathways. PCAFC pays a monthly stipend to a Primary Family Caregiver who may be the spouse, Veteran-Directed Care lets the veteran hire their own workers, and Aid and Attendance raises the pension ceiling for a veteran who qualifies.7,8,11
2. Are you a spouse? Look at the Spousal Pay Program. If your husband or wife qualifies for Medicaid in-home services and meets its heavy-care tests (full help with at least four of six daily activities, a debilitating medical condition, needs that would otherwise mean nursing facility care and that go beyond the usual care one spouse gives another), and you are able to provide the care and actually provide most of it, including the majority of service plan hours, Oregon can pay you once ODHS's Central Office approves. A care recipient with excess income contributes to the cost.1 If that bar is not met, ask about the Independent Choices Program, which can pay a spouse if the care recipient meets ICP's eligibility criteria and is approved.1 If your spouse is a veteran, also ask about Veteran-Directed Care, whose workers VA says might include a family member.8
3. Are you a non-spouse relative or friend of someone eligible for Medicaid in-home services? Ask whether you can be hired as their homecare worker, and ask about the Independent Choices Program, whose rule lets a participant employ a relative who is not also their ICP representative.3 Start by calling the ADRC at 855-ORE-ADRC (855-673-2372).10
4. Does the recipient want maximum control over hiring and pay? Ask about the Independent Choices Program, keeping in mind its own entry requirements.3
5. Do you have substantial private assets and want to plan ahead? Talk to an Oregon elder-law attorney about a personal services contract.

Tax Considerations

Talk to a tax preparer about how your caregiver pay is taxed before you file, and ask whether IRS Notice 2014-7 applies to your situation.

Under ICP, the participant or their representative carries full responsibility for hiring and paying employee providers, and a participant who cannot manage the ICP cash payment accounting, tax or payroll responsibilities and has no representative must arrange a fiscal intermediary, such as an accountant or bookkeeper, paid from discretionary or other non-ICP funds.3

Common Misconceptions

"Oregon won't pay me to care for my husband." Oregon can, through the Spousal Pay Program, when every condition is met: the care recipient qualifies for Medicaid in-home services, needs full help with at least four of six daily activities, has a debilitating medical condition, would otherwise need nursing facility care, and needs more than the usual care one spouse gives another; the spouse is able to provide the care and actually provides most of it, including the majority of service plan hours, meets all the requirements to enroll as a homecare worker in the Consumer-Employed Provider Program, and is not designated as the care recipient's representative; and ODHS's Central Office approves. A care recipient with excess income contributes to the cost.1 Independent Choices is the other route ODHS names for paying a spouse, if the care recipient meets ICP's criteria and is approved.1

"If Mom has Medicare, I can get paid through Medicare." Medicare does not pay family caregivers. It only covers short-term skilled home health through certified agencies. The paid pathways in this guide run through Medicaid, the VA, or private funds.

"The state caseworker hires me." In the Consumer-Employed Provider Program, ODHS calls the person receiving care the homecare worker's "consumer-employer."1 A homecare worker registers with the Home Care Commission, and Oregon law requires a criminal records check on that registration.2

"The Family Caregiver Support Program will pay me a wage." Its services are support, not a wage: the federal program behind it funds information, help gaining access to services, counseling, support groups and training, respite care, and limited supplemental services.5 Oregon Project Independence provides limited in-home services to people who need a little help to continue living independently, not a caregiver wage.6 To ask about OPI where you live, call the ADRC at 855-ORE-ADRC (855-673-2372).10

"I can just start getting paid out of Dad's bank account." Talk to an Oregon elder-law attorney before any money changes hands. Oregon's 60-month look-back covers asset transfers, and a transfer made in whole or in part to establish or keep eligibility can disqualify the parent from Department-paid nursing facility or home and community-based care later.9

Related Terms

• Consumer Directed Services (CDS): The national term for self-directed programs. In Oregon's Consumer-Employed Provider Program, ODHS calls the person receiving care the homecare worker's "consumer-employer."1
• HCBS waiver: The federal authority behind Oregon's Aged and Physically Disabled waiver; the K Plan, by contrast, is a Medicaid state plan option, not a waiver.
• Activities of Daily Living (ADLs): The functional basis for in-home service hours and for the Spousal Pay Program's four-of-six test.
• Nursing Facility Level of Care: Related to the Spousal Pay Program's requirement that the care recipient would otherwise need nursing facility services.

Learn More

Find personalized help getting paid as a family caregiver in Oregon at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.