Oregon Spousal Pay Program

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

Oregon’s Spousal Pay Program is almost unique in the world of Medicaid’s consumer directed programs. As the name implies, the program pays the spouse of an individual that requires significant assistance with their activities of daily living, provided they and their spouse meets all the eligibility requirements. This program is based on the Cash and Counseling model, which allows the participant greater control over who is hired to provide their care.

When a couple qualifies for this program, the spouse becomes an official Homecare Worker and joins the Homecare Workers Union. They receive a salary, pay taxes and 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 might 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.

The administrator of the Spousal Pay program is the Oregon Department of Human Services.


Eligibility Guidelines

The caregiver and spouse must be residents of Oregon, legally married, and residing at home (not in a skilled nursing home or assisted living facility). The individual in need of care must require fairly extensive care, and if not for the Spousal Pay Program, would need nursing home care. The individual must also require full 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. Some examples of qualifying diagnoses include cancer in late stages, seizures that occur frequently and unpredictably, and spinal cord injuries.

As mentioned previously, the Spousal Pay Program is a Medicaid program. Therefore, individuals must financially qualify for this special version of the Oregon Health Plan for seniors. Oregon Medicaid income limits for 2018 for a married applicant whose spouse is not also receiving Medicaid benefits is $2,250. This amount is adjusted annually in accordance with the Federal Cost of Living Adjustment. For 2018, the countable resource limit for an individual applicant is $2,000. The primary home is considered exempt if the applicant lives in the home and it is valued under $572,000. A single vehicle, household goods, personal items, and burial plots are also considered 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 aiding with their spouse’s ADLs, it is expected they manage the home, perform housekeeping, do laundry, do the grocery shopping, provide transportation, manage medications, and prepare meals.


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 as of April 1, 2018, the average hourly rate was $14.65 per hour.

In addition to their wages, the caregiving spouse also receives 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 or 503-947-5162.

Available is a downloadable brochure about the program.