Oregon Spousal Pay Program: who qualifies and how the hours work

Oregon's Spousal Pay Program lets a spouse be paid as the homecare worker when the person receiving care meets strict conditions. ODHS says it and the Independent Choices Program are the only consumer-employed in-home options that allow payment to a spouse. Spousal pay hours are capped at 60 per week.

What it is

ODHS's Spousal Pay Program Guide, updated April 17, 2026, says the program is one of the consumer-employed provider in-home service options described in Oregon Administrative Rule 411-030. The spouse provider is a homecare worker legally married to the eligible person. The eligible person must carry out the consumer-employer duties or, if unable to, name a Consumer-Employer Representative. The spouse cannot be that representative.

For the wider picture of Oregon in-home options, see the Oregon program overview.

Who qualifies

ODHS's rule, OAR 411-030-0080, says all of the following must be met.

• The person meets the eligibility requirements for in-home services.
• The person needs full assistance in at least four of the six activities of daily living, as assessed.
• The person has a debilitating medical condition. The rule lists examples including cachexia, severe neuropathy, coma, persistent or recurring stage three or four wounds, late stage cancer, frequent and unpredictable seizures, debilitating muscle spasms, and a spinal cord injury or similar disability with permanent impairment. ODHS's guide says that list is not complete, and a diagnosis is not required.
• The person would otherwise need nursing facility services without Medicaid in-home services.
• Their service needs exceed in both extent and duration the usual and customary services one spouse gives another.
• The spouse shows the capability and health to provide the services and actually provides the principal services, including the majority of service plan hours.
• The spouse meets the enrollment requirements for a homecare worker and is not designated as the representative.
• ODHS has reviewed the request and approved eligibility at enrollment and annually at reassessment.

ODHS's guide says a Central Office policy analyst decides whether a debilitating medical condition exists. The case manager submits the request.

How the hours work

The rule says the hours authorized to the spousal pay provider consist of one-half of the assessed hours for instrumental daily living tasks, such as housework, and all of the hours for specific daily living tasks. ODHS's guide gives an example: with 40 hours of daily living tasks and 20 hours of instrumental tasks, a spouse assigned all the hours gets 50 hours in the pay period.

ODHS says the cap of 60 hours per week, or 120 or more hours per 14-day service period, applies to spouse providers on hourly or shift plans, and a single worker may not work more than 16 hours in a 24-hour period. Spousal pay providers are paid at hourly homecare worker rates, according to the rule, and cannot claim payment for hours they did not work. We did not read the rate schedule, so we state no rate.

People with excess income must contribute to the cost of services under the rule's cross-referenced income rules. Ask your case manager what applies.

If your spouse was already your worker

ODHS says homecare workers who marry their consumer-employer are not paid under the Spousal Pay Program. Their service plan is based on the person's needs with no hour reduction, and the person does not need to meet the spousal pay criteria.

How to start

1. Call the ADRC at 855-673-2372 or your local APD or Area Agency on Aging office, the contacts ODHS lists, and ask for an in-home services assessment.
2. Ask your case manager whether Spousal Pay or Independent Choices fits, and whether Independent Choices is open to you.
3. If your spouse will be paid, ask who will be your representative if you cannot manage the employer duties.

See paid family caregiver in Oregon, home care in Oregon, home health in Oregon, nursing homes in Oregon and developmental disability services in Oregon.

Carevo is a connection platform and directory. We do not run the program, decide eligibility or set hours.

More about care in Oregon

• All Oregon Medicaid programs for care at home
• Paid family caregiver in Oregon
• Home care providers in Oregon