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The state’s largest Medicaid provider abruptly announced a policy change last week that some mental health professionals say will leave thousands of patients searching for therapists.
WHAT HAPPENED?
CareOregon, the state’s largest Medicaid provider, said in a Dec. 5 letter to therapists and social workers that it would cease reimbursing patients for appointments with associate therapists and social workers who work independently of an in-network group.
The health insurer, whose revenue comes almost exclusively from public sources, including Medicaid, wrote that it would cease reimbursements for services provided by such clinicians on July 31, 2025. It asked providers to accept no further CareOregon patients with the expectation they would be reimbursed for their services.
“It is with regret that we must inform you that effective July 31, 2025, we will be closing our network to unlicensed board registered associate providers who do not have a contract with CareOregon to provide outpatient behavioral health services or worked under a non-contracted group providers without a Certificate of Approval,” CareOregon wrote in a letter dated Dec. 5. “This was a difficult decision to make and ultimately, this decision aligns with our mission to ensure quality of care and service to our valued members.”
Associate therapists and social workers are working mental health professionals who are still under supervision because they’ve not yet completed enough hours to work independently. Associates have completed their master’s degree but are not yet fully licensed by the state. It takes most associate therapists and social workers between one and five years to get fully licensed.
WHO’S UPSET ABOUT IT?
The Dec. 5 letter sent mental health professionals in Oregon into a panic.
Most associates serve almost exclusively Medicaid patients, many of whom are insured under CareOregon. Without the ability to bill Medicaid for visits, it’s unlikely that associates will retain any of their existing clients. Without Medicaid clients, associates have no business left.
Clients will suffer too, say three licensed therapists WW spoke to.
“Medicaid recipients, already among the most vulnerable populations, will bear the brunt of these cuts. This decision disproportionately impacts those with the least access to alternative care options,” wrote Portland-area licensed therapist Jules Allison on a therapists’ Facebook group. “CareOregon isn’t just cutting costs; they’re cutting access to critical mental health services, raising serious ethical questions about whether they’re truly committed to equity.”
Another looming question is where CareOregon clients will go to find new providers, especially since finding a therapist in Oregon is already such a challenge.
Rainer Rivenburgh is a licensed therapist who currently supervises 13 associate therapists, each of whom has anywhere between 10 and 25 clients and operates their own practice. Over 95% of those clients, Rivenburgh says, are CareOregon patients.
“That’s 100 to 200 clients who are just being asked to close their relationship with their therapist,” Rivenburgh says. “This will cause absolute chaos in outpatient mental health in the Portland area.”
WHAT DOES CAREOREGON SAY?
CareOregon did not respond to WW’s specific questions about the looming policy change. The insurer did not answer questions about how many of its clients it believed would have to find a new provider, nor did it say how many associates would be affected by the change.
“We are making a change in our contracting that will go into effect in July 2025 and stipulate that all care provided to our members must be delivered by a licensed care provider,” CareOregon spokeswoman Cori Schleiffer wrote in an email. “Our team will use the time between now and the contracting change to ensure that providers who want to be contracted have the opportunity to do so, and to ensure that members accessing services will have continuity of care.”
In its Dec. 5 letter, CareOregon wrote that individual associates could try and work with in-network groups to set up an agreement by which they could still bill CareOregon. The insurer also wrote that it may carve out exceptions for certain patients to continue care with associates past the cutoff date.
The state’s Board of Licensed Professional Counselors and Therapists, which regulates mental health professionals, declined to comment on CareOregon’s new policy. The state board that regulates social workers did not respond to a request for comment.