APD 1915(c) and 1915(b)(4) waivers
Two waivers are approved by the Centers for Medicare and Medicaid Services (CMS) for APD. Both are approved to be in place through 2026.
1915(c) #0185 Aging and Physically Disabled Waiver includes:
- Waiver Case Management services for eligible individuals
- Community Transition Services for one-time set-up expenses for individuals transitioning from an institutional or other provider-operated living arrangement to in-home care
- Housing Support Services to help individuals who receive, or want to receive, services in an in-home setting to maintain or find housing
Once a year, APD provides quality assurance reviews to CMS. View the most recent 1915(c) Waiver Assurances and Findings.
1915(b)(4) Case Management Freedom of Choice Waiver allows:
- Area Agencies on Aging (AAA's), APD offices and interested federally recognized Tribes in Oregon to provide Waiver Case Management.
K Plan
The K Plan is a Medicaid state plan option authorized under the Affordable Care Act. It allows states to provide home and community-based services and supports while receiving a six percent increase in federal medical assistance funds for those services.
These services benefit Oregonians who need assistance with regular activities and want to stay in their home or in a community setting and remain as independent, healthy and safe as possible. At the same time, the services save both state and federal money because they provide more extensive home and community-based long-term services and supports in place of more expensive institutional care.
Key facts about Oregon's Approved K Plan:
- The K Plan provides for reinvestment of dollars back into our system by the federal government which allows Oregon to offer additional important services to individuals who normally would not be able to access them.
- It allows Oregon to continue to serve people in their own homes or a community setting.
- The services help people to be independent, safe and healthy.
- The K Plan allows Oregon to better serve individuals transitioning to less institutional levels of care in the community.
The Oregon Department of Human Services (ODHS) is proposing changes to its Oregon 1915(k) Community First Choice and Oregon 1915(b)(4) Fee-For-Service Selective Contracting Program.
The public comment period for these changes closed on Sep. 1, 2025.
These amendments will allow ODHS to implement an Agency with Choice service option for in-home consumers and will update the APD rate methodology for Adult Foster Homes and Residential Care Facilities. These amendments are proposed with an effective date of Jan. 1, 2026.
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Draft of proposed amendments to 1915(k) Community First Choice and
Public Notice
- APD was directed by House Bill 4129 (2024) to create an
Agency with Choice (AwC) service model for in-home service options. This model will be added to APD’s in-home service options in January 2026. The detailed requirements for AwC will be in Oregon Administrative Rules. The 1915(k) language will be amended to reference those rules. The 1915(k) will also include a description of how the AwC rates will be developed. Because HB 4129 limits the number of AwC providers to two, APD will specify that limit in the 1915(k). APD will also add AwC to APD’s 1915(b)(4) for case management services.
- APD is also proposing a new
rate methodology for APD Adult Foster Homes and Residential Care Facilities. The rate methodology for these providers was created in the 1980s and no longer captures the complexity of individuals served in these settings. The new rate methodology will more accurately account for individuals’ needs. Individuals will be assigned to one of five tiers, with Tier 1 assigned to individuals with the lowest need and Tier 5 assigned to individuals with the highest need. Each Activity of Daily Living and Instrumental Activity of Daily Living will receive points, with low needs receiving one point and high needs receiving six points. Individuals with cognitive needs will receive additional points. The sum of all points will place individuals in their specific tier, which will require specific services and supports. The 1915(k) will define the methodology and provider requirements.