Oregon Spousal Pay Program: Who Qualifies and What It Pays (2026)

Oregon's Spousal Pay Program pays a husband or wife to care at home for a spouse who needs full help with at least four of six daily activities and meets the program's other conditions.1 Spousal Pay is one of Oregon's Medicaid in-home services for people who would otherwise need nursing facility care, and its providers are paid at Oregon's hourly homecare worker rates.1 The first step is a call to 855-ORE-ADRC (855-673-2372).2

Who Qualifies for Oregon's Spousal Pay Program

Spousal Pay is for couples where one spouse's care needs go far beyond the help partners usually give each other. If that sounds like your home, these are the tests to check.

First, your spouse has to qualify for Oregon's Medicaid in-home services. Among the requirements for Oregon's Medicaid in-home services, a person must be 18 or older, eligible for the Oregon Health Plan Plus benefit package, and assessed at service priority level 1 through 13.4

On the financial side, Oregon Medicaid covers long-term care through the Oregon Supplemental Income Program Medical (OSIPM), and its resource limit is $2,000 for a one-person need group.5 Because you're married, ask the case manager how Oregon's spousal impoverishment rules apply to your spouse's case. Brevy's guides to Oregon Medicaid income and asset limits and Oregon spousal impoverishment rules explain the income rules and the allowances for the spouse at home.

Then, under the Spousal Pay Program rule, OAR 411-030-0080, all of these must also be true:1

• Your spouse needs full assistance in at least four of the six activities of daily living (ADLs) Oregon assesses, as found by the state's assessment.
• Your spouse has a debilitating medical condition. The rule's examples include late-stage cancer and a spinal cord injury or similar disability with permanent impairment, and the list is not limited to those.
• Without Medicaid in-home services, your spouse would otherwise need nursing facility care.
• Your spouse's needs exceed, in both extent and duration, the usual help one spouse gives another.

ODHS defines a debilitating medical condition as a severe and persistent condition that significantly impairs a person's ability to function and take part in most ADLs, and says a medical diagnosis is not required to show one.1

ODHS Central Office must review and approve Spousal Pay eligibility when your spouse first enrolls and again at each annual re-assessment.1

Who Can Be the Paid Spouse

Oregon's Consumer-Employed Provider Program is the in-home services model where the person receiving care employs their own homecare worker.1 Under Spousal Pay, the paid spouse must:1

• Show the capability and health to provide the care.
• Actually provide the principal care, including the majority of the hours in the service plan.
• Meet all the requirements to enroll as a homecare worker in the Consumer-Employed Provider Program.
• Not be your spouse's designated representative.
• Not act as the consumer-employer.

This matters if your spouse needs a representative to make care decisions. The paid spouse cannot be the designated representative, so ask the case manager who else could serve as the representative.1

You may not have to cover every hour yourself. The rule asks the paid spouse for the majority of the service plan hours, not all of them, and Oregon lets the person receiving care, or their representative, employ any person who meets the provider enrollment standards, subject to case manager approval. Ask the case manager about a second homecare worker for the remaining hours.1,6

For a break, Oregon's family caregiver support program includes respite care for family members and friends caring for an adult 60 or older who needs in-home care, or for someone of any age with Alzheimer's disease or a related disorder. The way in is the ADRC at 855-ORE-ADRC (855-673-2372). See Brevy's guide to respite care in Oregon.7

How Many Hours Does Oregon's Spousal Pay Program Pay, and at What Rate?

Hours. Your spouse's assessment sets the service plan. The rule says the hours authorized to a spousal pay provider "must consist of one-half of the assessed hours for IADLs and all of the hours for specific ADLs based on the service needs of the individual."1 IADLs are the instrumental activities of daily living, the household tasks, so you're paid for half of your spouse's assessed IADL hours, even if you do all of that household work yourself. That's worth knowing before you plan around the income.1

Weekly limits. Spousal pay providers are Oregon homecare workers, and Oregon's hour limits cover all homecare workers.3,6 For new service plans created since Sept. 1, 2016, a homecare worker is limited to 40 hours a week unless your spouse has received a Weekly Cap exception, or unless the worker averaged 40 or more paid hours a week in March, April and May 2016 (then the limit is 50). One homecare worker can provide no more than 16 hours of awake care in a 24-hour work period.6

A worked example. These numbers are made up to show the math; they don't come from any real plan. Say your spouse's assessment finds 100 hours a month of ADL tasks and 40 hours a month of IADL tasks. You'd be authorized all 100 ADL hours plus half of the 40 IADL hours, or 120 hours a month. At the 2026 step 1 rate of $21.25 an hour, that's $2,550 a month before any add-ons.1,3

Pay. Spousal pay providers are paid at hourly homecare worker rates, so this is a real hourly wage for care you may already be giving.1 The 2025-2027 contract between the State of Oregon and SEIU Local 503 sets a five-step pay scale for non-legacy providers, and your step depends on hours worked since Jan. 1, 2023. Steps 2 through 4 fall between the two rows below.3

• What can raise your rate: the ODHS rate schedule effective July 1, 2026 lists earned add-ons to the homecare worker hourly rate, from $0.25 for CPR/first aid up to $3.00 for the highest listed add-on.3
• When your step changes: step placements are recalculated on the first payroll periods after each Jan. 1 and July 1.3

Cost share. If your spouse has excess income, they'll have to contribute to the cost of Spousal Pay services, so ask the case manager what that share would be.1

If Your Spouse Does Not Qualify

Hearing "not eligible" is hard, and it does not have to end the conversation. ODHS says Spousal Pay and the Independent Choices Program are the only in-home options in the Consumer-Employed Provider Program that allow paying a spouse.1

If your spouse does not meet the Spousal Pay tests, ODHS guidance says you cannot continue as the paid homecare worker. Your spouse can hire a different homecare worker, or pursue having you paid through Independent Choices if they meet its criteria and are approved.1

If you think the decision is wrong, your spouse can ask for a fair hearing. Federal Medicaid rules require the state agency to offer a hearing to anyone who believes it acted wrongly or denied their claim for covered benefits or services, and a state may allow no more than 90 days from the date the notice is mailed to ask.8,9 A state can set a shorter deadline, so go by the deadline on your spouse's notice and ask the case manager how to file.9

One case works differently. A homecare worker who marries the consumer-employer they already care for, when that consumer meets all Spousal Pay eligibility requirements, is not paid under Spousal Pay and is not subject to its payment limits; the full household-task (IADL) hours are authorized to that worker.1

How to Start With Spousal Pay in Oregon

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Get personalized help with Oregon's Spousal Pay Program 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.