Oregon Spends $392 Million Farming Out Its Behavioral Health Care

Now, the state wants accountability.

5045 The Big Number: $392 Million (Sophia Mick)
By Lucas Manfield

Oregon has some of the worst mental health outcomes in the country, and it’s not for lack of spending. The Oregon Health Authority is giving out $392 million in grants this biennium to counties and local nonprofits to provide behavioral health services.

The reason for the dismal results, the chair of Oregon Health & Science University’s Department of Psychiatry told WW earlier this year: a siloed system that divides responsibility between officials in state and local governments (“Hotseat: George Keepers,” Jan. 17).

Now Oregon is trying to fix that divide by retooling the contracts outlining who’s responsible for what. They’re known as County Financial Assistance Agreements, and they’re badly in need of a makeover.

The contracts, which are hundreds of pages long, cover over 40 “service elements,” from rental assistance to seniors’ mental health treatment. But they lack accountability for how the hundreds of millions of dollars are spent. The contracts currently require “financial reporting” for only seven of the elements, according to Timothy Heider, an OHA spokesperson.

Meanwhile, county lobbyists say the contracts are unwieldy and riddled with red tape. And most concerning, in many circumstances they don’t pay per client, leaving counties to either make up the difference or leave people underserved.

So the latest version of the contracts, which are scheduled to be finalized by next summer, will reduce “administrative burden” and introduce brand-new “financial reporting documentation,” according to OHA’s Christa Jones.

It’s been a long time coming. Legislators first began pushing for an overhaul in 2021. But, WW is told, progress was slowed by staff turnover at OHA. And it’s still unclear exactly how the state will measure whether its reform has worked.

The state convened a behavioral health committee in 2021 to come up with metrics to be incorporated in the 2023 version of the contracts, but the task remains incomplete. “The BHC will be one source for potential outcomes. But the metrics are still in development,” Heider says.

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