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Name: 2025–27 Agency Budget Request
Attachment: Policy Option Package Form
Title: 560 – Ensuring access to services for individuals with mental health conditions
Author: Oregon Department of Human Services
Submitted: Aug. 30, 2024
Buried deep inside the 1,000-page doorstop that is the Oregon Department of Human Services’ requested budget for the next biennium is a striking admission: For years, the agency has been flouting federal rules.
More alarmingly, the error has fueled one of the state’s worst ongoing crises. In hundreds of instances, the state has denied help to Oregonians with mental illness, despite a federal mandate to provide it.
“They know they’re discriminating against people with mental illness, and yet they are making the conscious effort to continue to do it,” says Chris Bouneff, executive director of NAMI Oregon. “It’s mind-boggling that a state agency would take the most vulnerable people and pretty much guarantee their failure.”
The problem goes back to the 1980s, when DHS began using Medicaid funding to provide care for the elderly and people with disabilities in the community rather than in institutions. But they excluded people with mental illness, leaving other entities to pick up the slack.
This was, at the time, apparently legal. But when the state expanded the community-based care program under the Affordable Care Act a decade ago, it ignored a new provision requiring it to offer similar services to people regardless of diagnosis. (“We are not in compliance,” the agency’s budget request now notes dryly.)
In other words, DHS ignored its federal obligation mandated by Obamacare to provide the same community-based care to people with mental illness that it does to people with other disabilities.
Under such a program, the state leverages Medicaid funding to pay caregivers to help with everyday tasks like taking medication or going to doctor’s appointments. It’s designed for people who would otherwise need to be institutionalized. Oregon uses such a program to assist people with cognitive disabilities, and was supposed to set up similar infrastructure for those with mental illness.
Instead, the state denied people whose only diagnosis was mental illness, and instead referred them to other government agencies, a largely pointless exercise.
Of the 500 people referred by DHS in recent years to community mental health programs for services under the Affordable Care Act, only 3% actually got them, according to a recent presentation by Jane-ellen Weidanz, deputy policy director of the agency’s Office of Aging and People with Disabilities. (A spokesperson for Multnomah County, which operates the community mental health program in Portland, blames the “very limited number” of services available to the sort of very sick patients who would be eligible.)
The upshot is this: “We have people who meet nursing facility level of care [in the aging and people with disabilities program]—they need daily assistance with support—those individuals are not receiving the services for which they’re entitled,” Weidanz says.
Instead, such patients enter what’s known as the “revolving door.” They arrive at emergency rooms in crisis. They’re stabilized, then discharged. But without assistance, they soon regress, reappearing in the emergency room—or jail.
Disability Rights Oregon, and other advocates have long called on the state to fix the oversight. “I have been crying: This population is the people who cycle, who are repeatedly hospitalized,” says DRO policy director Meghan Moyer. “The costs are astronomical.”
This year, the state finally listened. DHS is asking Gov. Tina Kotek and the Legislature for $10 million from the general fund to hire staff with the necessary expertise to operate the program. It’s not clear the agency will get it. Behavioral health is one of Kotek’s top priorities, but this year’s budget is tight.
Moyer says the program will pay for itself by reducing costs elsewhere. “I think this can be, if implemented well, a game changer,” she says.