TMOregon's Agency with Choice Program: What Home Care Agencies Should Know
Oregon now has a fourth way for Medicaid members to get care at home, and it is worth a close look from any agency that serves older adults or people with disabilities. The state's Agency with Choice program lets a person pick and train their own direct support worker while a contracted agency takes on the employer side of the job: hiring paperwork, background checks, taxes and payroll. The Office of Aging and People with Disabilities (APD) launched its version in July 2026, and OPEN MINDS reported on Oct. 25 that the model now spans older adults, people with physical disabilities and people with behavioral health needs through the Oregon Health Authority.
How Agency with Choice works in Oregon
The program sits alongside the options Oregon already offered rather than replacing them. APD members can still be the employer of their own homecare worker, take a cash benefit through the Independent Choices Program, or receive services from a traditional in-home care agency. Agency with Choice is the middle path. The individual decides who provides care, how it is delivered and when visits happen within their authorized hours, and the agency serves as the legal employer. In APD, that agency is GT Independence. APD and the Oregon Health Authority can contract with up to two agencies for the model, and the developmental disabilities side of ODHS launched its own version, called the Employer Model Agency, on Jan. 1, 2026, under Senate Bill 1521 from 2024.
What the referral path tells agencies
Access runs through case managers. A case manager walks the person through every in-home option, and if they choose Agency with Choice, the case manager sends an assessment summary and service details to GT, which reaches out within five business days to start enrollment. For now, the option is limited to people on specific APD benefit plans. That design matters for traditional agencies: when people are offered a side-by-side menu, the differences between options become very visible. Agencies that can clearly explain what they handle, how schedules are set and how a client stays involved will be in a better position when that conversation happens.
Why other states are paying attention
Co-employment models like this are part of a wider push to give Medicaid members more say over their care without making them run payroll themselves. For agencies, the practical lesson is that choice and accountability now travel together. Programs that split responsibilities between a member and an agency depend on clean records of who was scheduled, which visits actually happened and what changed along the way. That is the kind of planned-versus-completed visit visibility CareSync® was built to make easier to see, whichever service model an agency operates under.
If you serve Oregon members, it is worth reading the APD Agency with Choice page and the case manager referral guide so your intake team can answer questions accurately. If you operate elsewhere, keep an eye on your own state's self-direction plans. Oregon's rollout is a useful preview of how the line between agency care and self-directed care is starting to blur.
Sources: OPEN MINDS, Oregon ODHS Agency with Choice, ODHS AwC referral process for case managers.