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Oregon selects vendor to run Agency with Choice program; lawmakers press agencies on private-equity concerns and rate-setting
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Summary
APD, OHA and ODDS told the subcommittee that CMS approved state plan amendments and a waiver for Agency with Choice, that Guardian Track Independence (GTI) scored highest in the procurement and is in contract negotiations, and that agencies will execute separate identical contracts and begin enrollment in 2026; lawmakers asked for follow-up on vetting, rates and workforce impacts.
Oregon agencies updated a legislative subcommittee Feb. 9 on implementation of Agency with Choice, an in-home care co-employment model established in the 2024 session. Officials said federal approvals are in hand, a vendor was selected through a competitive process, and agencies are negotiating contracts that they expect to finalize in 2026 before phased enrollment.
APD and the Oregon Health Authority (OHA) said House Bill 4,129 directed the agencies to create an Agency with Choice option, limit licensing of providers under the model, set rates so direct support worker pay is comparable to existing home-care and personal-care attendant pay, and develop rules that ensure financial transparency and caps on administrative overhead. Shawna McDermott, deputy director for Medicaid services and engagement, reported that CMS approved the state plan amendments and waivers (including 1915(k) and 1915(i) components) in December 2025 and that a 1915(b)(4) waiver was approved to limit Agency with Choice providers to two vendors.
APD said it posted an RFP (slide text referenced the state procurement page) and received five proposals; Guardian Track Independence (GTI) received the highest score and was selected to proceed to contract negotiations. APD described GTI’s operational features: experience as an employer-of-record and fiscal employer agent, payroll/timekeeping systems, onboarding and training infrastructure, and capacity for benefits administration. APD said the contract and licensing language require audited financial statements, reporting and checks tied to licensing renewal; noncompliance could result in fines, suspension or revocation.
Officials said contract negotiations are taking longer than anticipated; open negotiation items include final rate levels and ensuring GTI provides health coverage and benefits comparable to those of current program workers. APD indicated it hopes to execute separate but identical contracts with GTI for APD and OHA in 2026 and begin APD enrollment as early as April 2026. APD also said the program requires electronic visit verification (EVV) systems that comply with federal standards under the 21st Century Cures Act.
Caseload projections were a focal point. APD cited an internal forecast that roughly 50 percent of consumers who receive services through a home-care worker could move to Agency with Choice; OHA estimated a higher migration from its personal-care attendant population (the presentation cited a 90 percent migration figure and an enrollment timeline tied to an assumed 100 consumers per month sequencing). Officials said projections will be adjusted over time as actual enrollment is observed.
Committee members pressed the agencies on vendor vetting and oversight. One senator raised concerns that GTI is private equity–backed and that the company has had complaints in other states about worker conditions and timeliness of pay; lawmakers asked whether the agency review included examination of those complaints and how audited financials would show profit flows to investors. APD told the committee it would follow up with written responses to those questions.
Why it matters: Agency with Choice changes employer responsibilities and could shift workforce patterns and costs across home-care and personal-care systems. Committee members and staff emphasized the program’s fiscal significance and the need to manage workforce transitions and accountability for vendors operating under Medicaid funding.
What’s next: Agencies are negotiating contracts with GTI and expect to report back to the committee with written answers on vendor vetting, fiscal assumptions, final rates and other outstanding questions. Enrollment timelines and caseload projections may be updated once contractual terms and rate levels are finalized.
