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Oregon - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Oregon, Respite Care Services are primarily funded through the state's 1115 Medicaid Demonstration Waiver (Oregon Health Plan) and the K Plan (Community First Choice state plan option), rather than traditional 1915(c) waivers. The Oregon Department of Human Services (ODHS) oversees the certification of respite providers through its Aging and People with Disabilities (APD) and Office of Developmental Disabilities Services (ODDS) divisions.

The most significant structural precondition for providing Medicaid-funded respite in Oregon is that in-home respite for K Plan members is typically delivered through the Consumer-Employed Provider Program, where workers are hired directly by the consumer and paid through the Oregon Home Care Commission (OHCC) payroll system, rather than through traditional agency models. For facility-based crisis respite, the Oregon Health Authority (OHA) restricts Medicaid billing exclusively to OHA-licensed Residential Treatment Facilities (RTFs) and Secure Residential Treatment Facilities (SRTFs), explicitly prohibiting Adult Foster Homes (AFHs) from billing for crisis respite.

1. Service Definition and Scope

Respite Care Services in Oregon provide short-term relief to unpaid primary caregivers of children and adults with intellectual/developmental disabilities, chronic conditions, or behavioral health needs. The service is designed to maintain individuals in their community settings and prevent institutionalization.

Under the K Plan, respite is authorized as part of the member's person-centered care plan based on assessed need, rather than a flat statewide limit. For behavioral health populations, Oregon distinguishes between standard Respite Care and Crisis Respite Services, with strict limitations on which facility types can provide the latter.

2. Regulatory and Oversight Agencies

Multiple divisions within the Oregon Department of Human Services (ODHS) and the Oregon Health Authority (OHA) regulate and oversee respite services, depending on the target population and setting.

The Oregon Home Care Commission (OHCC) plays a unique role in managing the workforce for consumer-directed in-home respite.

3. Gatekeeping Prerequisites: Who Can Even Apply

Oregon imposes strict structural prerequisites on who can provide Medicaid-funded respite, heavily favoring consumer-directed models for in-home care and specific licensed facilities for crisis care.

Agencies seeking to provide in-home respite must navigate a system where the state primarily utilizes the Consumer-Employed Provider Program for K Plan members.

4. Licensure and Certification Requirements

Certification requirements depend on the setting. Individual respite providers must be certified under OAR Chapter 411, Division 205.

Facilities providing crisis respite must hold specific OHA licenses.

5. Medicaid Provider Enrollment

Providers must enroll through the Oregon Health Authority (OHA) Provider Portal. The process requires establishing a business entity (for agencies) or registering with the OHCC (for individuals).

Enrollment is contingent upon meeting the specific certification or licensure requirements for the intended service delivery model.

6. Staffing, Training and Background Checks

Oregon requires comprehensive background checks and specific training for all respite providers, whether agency-employed or consumer-directed.

The state mandates administrative and compliance training for new providers.

7. Documentation, Policies and Records

Providers must maintain detailed records to support Medicaid billing and demonstrate compliance with HCBS requirements.

Any limitations on a participant's rights must be documented as an Individual-Based Limitation (IBL).

8. Billing, Rates and Claims

Billing procedures vary significantly between consumer-directed in-home respite and facility-based crisis respite.

In-home workers are paid through the state's payroll system, while facilities bill the MMIS directly.

9. Approval Sequence and Timeline

The approval process involves foundational business setup, mandatory training, certification/licensure, and finally Medicaid enrollment.

Timelines vary based on the provider type and state agency capacity.

10. Common Denials and Survey Findings

Applications and claims are frequently denied when providers misunderstand Oregon's specific structural rules for respite.

Compliance with the HCBS Settings Rule is a major focus of state surveys.

11. Key Contacts and Resources

Prospective providers should utilize state resources and contact the appropriate division based on their intended service model.

The ADRC is the primary point of contact for consumers seeking to add respite to their care plans.

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