Oregon's Oregon Health Plan is delivered through Coordinated Care Organizations — not the MCOs you've encountered in other states. EVV runs through eXPRS, Oregon's own state-built system — not HHAeXchange or Sandata. And 2026 is bringing something genuinely new: the Agency with Choice program, which creates a hybrid care model between agency-directed and consumer-directed care, with GTI selected as the single vendor. Here's what Oregon operators need to understand about each of these before assuming what worked elsewhere applies here.
Oregon's Medicaid home care runs through ODHS (Oregon Department of Human Services) and its APD (Aging and People with Disabilities) program for most older adults and adults with physical disabilities. OHA (Oregon Health Authority) administers the overall Oregon Health Plan. Both agencies are involved in different aspects of home care — ODHS/APD for waiver services and assessments, OHA for the managed care CCO system and behavioral health programs.
Oregon's APD Waiver provides personal care, homemaker, adult foster care, respite, and other HCBS for adults who meet nursing facility level of care criteria. It is administered by ODHS/APD. The waiver has approximately 44,600 annual enrollment slots — when capacity is full, applicants are waitlisted.
In-home assessments are conducted by ODHS/APD case managers. Service authorizations come from the APD case manager, who develops the service plan with the client. Home care agencies contracting for APD Waiver services work directly with ODHS/APD, not through CCOs for waiver services.
Oregon's K Plan is a Section 1915(k) state plan option providing attendant care services with an enhanced federal matching rate. Like the APD Waiver, K Plan services are administered by ODHS/APD and target individuals who need NF level of care. The K Plan allows coverage of attendant care for a broader range of people than may be covered under the waiver alone.
K Plan billing follows the same ODHS/APD structure as the APD Waiver. Agencies authorized for APD Waiver services are typically also able to serve K Plan clients through the same ODHS/APD contracting relationship.
Oregon's ICP provides a healthcare budget that allows OHP members to choose their own caregivers and purchase approved services. ICP participants direct their own care and may hire family members or friends as paid caregivers. The program includes care management through ODHS/APD case managers.
For home care agencies, ICP is less directly relevant than the APD Waiver — the participant directs their own care rather than using an agency. However, understanding ICP helps agencies explain the full service continuum to prospective clients and case managers.
The PCA program through OHA supports people with behavioral or mental health needs — administered separately from ODHS/APD's physical disability programs. PCA workers are enrolled through OHA and use eXPRS for EVV and timekeeping like other Oregon home care workers.
Agencies serving OHA PCA program participants bill through CCOs for managed care members or OHA MMIS for FFS members. The enrollment and authorization pathway is OHA, not ODHS/APD.
Coordinated Care Organizations (CCOs) are regional entities that coordinate and deliver all Oregon Health Plan services in a defined geographic area — physical health, behavioral health, and certain community-based services. Unlike traditional statewide MCOs you may have encountered in other states, CCOs are regional. The CCO serving your clients depends on where those clients live, not which health plan they enrolled with statewide.
Oregon currently has 16 CCOs organized by region. For home care agencies, this means your billing relationship with "managed care" in Oregon is with a regional CCO, not a single statewide insurer. If you serve clients in multiple regions, you may have billing relationships with multiple different CCOs, each with their own prior authorization workflows and claims submission processes.
For APD Waiver services specifically: billing flows through ODHS/APD and OHA MMIS for most FFS members. CCOs handle physical and behavioral health managed care, but the APD Waiver itself operates largely outside the CCO managed care structure — verify the billing pathway for each specific service type and member population with ODHS/APD.
Oregon uses eXPRS (Express Payment and Reporting System) as the state-built platform for EVV, timekeeping, and Medicaid claims for in-home services. eXPRS is not HHAeXchange. It is not Sandata. It is Oregon's own system, developed and maintained by ODHS and OHA, and it is the documentation basis for Medicaid payment for covered services.
| EVV Role | System / Method | Who Uses It | Key Requirement |
|---|---|---|---|
| Primary EVV and timekeeping | eXPRS Mobile-EVV app | All Homecare Workers (HCWs) and Personal Support Workers (PSWs) | Workers must be enrolled in eXPRS before delivering services. Enrollment handled through ODHS and Oregon Home Care Commission (OHCC) |
| Manual EVV data submission | Monthly email submission to eXPRS | Providers unable to use mobile app | Monthly deadline. Manual submission accepted but should not be primary method — consistent manual entry creates audit exposure |
| Worker enrollment and background checks | ORCHARDS system (ODHS Background Check Unit) | All workers before service delivery | Background check must be initiated through ORCHARDS before worker begins providing services. Workers needing to disclose history must do so during the ORCHARDS process |
| Billing (FFS members) | OHA MMIS (payer ID: ORDHS) | Agency providers for FFS OHP members | eXPRS records support the billing submission. Claims without matching eXPRS EVV records are unsupported |
| Billing (managed care CCO members) | CCO directly | Agency providers for CCO-enrolled members | Bill the member's regional CCO. Each CCO has its own prior authorization and claims process. Verify CCO enrollment before billing OHA MMIS |
Worker enrollment in eXPRS is a prerequisite to service delivery — workers cannot submit EVV records without an active eXPRS account. The OHCC (Oregon Home Care Commission) provides support for worker enrollment and eXPRS training. Agencies should build worker eXPRS enrollment into their onboarding process rather than treating it as an afterthought.
House Bill 4129 (2024 Legislative Session) created the Agency with Choice provider type in Oregon. The model gives individuals more control than traditional agency-directed care — they supervise their own workers and direct their care — while the Agency with Choice vendor manages employment responsibilities (payroll, benefits, compliance, EVV). It's a middle ground between fully consumer-directed and fully agency-directed.
GTI (Guardian Track Independence) was selected as the vendor through a competitive RFP process. CMS approved the required state plan amendments and waivers (including 1915(k) and 1915(i) components, and a 1915(b)(4) waiver limiting Agency with Choice to two vendors) in December 2025. Contract negotiations with GTI were ongoing as of February 2026. APD enrollment is expected as early as April 2026 — but final rates and contract terms had not been finalized as of that date. Monitor ODHS announcements before building business plans around Agency with Choice referrals. Projections suggest 50% of current APD Waiver consumers could migrate to Agency with Choice; OHA estimated up to 90% migration from its PCA population.
For existing Oregon home care agencies, Agency with Choice will primarily affect the consumer-directed population. Agencies serving traditional agency-directed APD Waiver clients under existing ODHS/APD contracts are not directly displaced by the Agency with Choice launch — but agencies competing for consumer-directed market share may find that population shifting toward GTI over time if the launch goes well.
The program requires EVV systems that comply with federal 21st Century Cures Act standards. GTI's EVV approach under the Agency with Choice structure has not been publicly specified as of early 2026 — agencies interested in Agency with Choice operations should monitor ODHS for provider enrollment and EVV requirements once the program fully launches.
CCOs (Coordinated Care Organizations) are regional entities — the CCO serving your clients depends on their county or region, not which statewide plan they enrolled in. They coordinate all OHP services including physical health, behavioral health, and certain community services. Unlike statewide MCOs, CCOs are locally accountable and have broader community health responsibility. For billing, this means your managed care billing relationships are with regional CCOs, not a single statewide payer. APD Waiver services specifically may flow through OHA MMIS for FFS rather than through CCOs — verify the billing pathway for each specific service type.
eXPRS (Express Payment and Reporting System) is Oregon's own state-built system for EVV, timekeeping, and Medicaid billing for in-home services. It is not HHAeXchange and not Sandata. Workers use the eXPRS Mobile-EVV app to clock in and out. Workers must be enrolled in eXPRS through ODHS before they can submit EVV records — build this enrollment into your worker onboarding process, not as a last step. The Oregon Home Care Commission (OHCC) provides training and support for eXPRS. Contact OHCC for worker enrollment guidance. All background checks run through a separate system called ORCHARDS, administered by ODHS's Background Check Unit.
With caution. Agency with Choice is a new provider type — GTI is the selected vendor, CMS approved the waivers in December 2025, but contract negotiations were still ongoing as of February 2026. APD enrollment was projected for as early as April 2026, but final rates and contract terms hadn't been finalized. The program model limits Agency with Choice to two vendors under a 1915(b)(4) waiver — not all agencies will be Agency with Choice providers. Traditional agency-directed ODHS/APD contracts continue under the existing framework. Monitor ODHS's Agency with Choice webpage for launch announcements before building referral projections around it.
Worker enrollment in eXPRS begins with a background check through ORCHARDS (ODHS Background Check Unit) — this must be initiated before the worker begins providing services. Workers complete the ORCHARDS authorization and disclosure process online. After background check approval, workers complete the Homecare Worker (HCW) or PSW enrollment application through the appropriate process for their role type. The OHCC (Oregon Home Care Commission) provides free one-on-one help with enrollment. For HCW enrollment, use the online application through DocuSign. Workers receive a provider number by email from OHA once background check and orientation are complete, and then must complete core training within 120 days.
eXPRS, regional CCOs, ORCHARDS background checks, and a launching Agency with Choice program — Oregon's home care infrastructure requires Oregon-specific knowledge to navigate correctly. The CareDrain Diagnostic shows what operational gaps are costing your agency monthly — wherever you are in building that knowledge base.