Oregon Spousal Pay Program

Page Reviewed / Updated - Mar. 2014

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services.

Waiver Description

Almost unique in the world of Medicaid’s consumer direction programs, Oregon’s Spousal Pay Program, as the name implies, will pay the spouse of an individual that requires significant assistance with their activities of daily living provided they and their spouse meet all the eligibility requirements. This program is based on the Cash and Counseling model which allows an individual greater control over whom is hired to provide care.

A spouse becomes an official Homecare Worker and joins the Homecare Workers Union. They receive a salary, pay taxes, union fees and are eligible for unemployment insurance. It should be noted that since it is expected that spouses care for each other, the number of hours for which an individual is authorized to receive care can be lower when participating in the Spousal Pay program than were the individual to receive care under other Oregon Medicaid programs such as the Client-Employed Provider Program.


Eligibility Guidelines

The caregiver and spouse must be legally married and residing at home (not in a skilled nursing home). In addition, the individual in need of care must require assistance with at least 4 of the following activities of daily living, bathing, dressing, grooming, eating, toileting and mobility and have a diagnosed, progressive and debilitating condition.

The Spousal Pay Program is a Medicaid program and therefore individuals must be financially qualified to receive Medicaid. Oregon Medicaid income limits for 2014 for a married applicant whose spouse is not also receiving Medicaid benefits is $2,163. The countable resource limit is $2,000. Their home and primary vehicle are exempt assets, meaning their value is not included in their countable resources.

The caregiving spouse must pass a criminal history check and meet the other Oregon Department of Human Services requirements for providing care. In addition to providing assistance with activities of daily living, it is expected they will manage the home, perform housekeeping, laundry, do the grocery shopping and meal preparation.


Benefits and Services

The caregiving spouse receives payment for providing care services. Typically this is an hourly wage agreed upon by the Homecare Workers Union and the state of Oregon.  The exact amount changes annually, but one can expect it to be near the average hourly rate for the state or approximately $20 / hour.  

In addition to their wages, the caregiving spouse also receives the other benefits of union participation such as unemployment insurance, paid vacation time and disability benefits should they themselves become disabled.


How to Apply / Learn More

To apply for the Spousal Pay Program, interested couples should contact the local Area Agency on Aging / Senior and Persons Disabilities Office.  Alternatively they can call 1-800-282-8096.

Some limited information is available on the Oregon.gov webpage.   Also available is a downloadable brochure about the program.