Well over a year and a half into an effort to revamp the state\u2019s \u201cbackbone\u201d system for funding and delivering behavioral health care, counties are still balking at the Oregon Health Authority\u2019s pitch. <\/p>\n
Under Oregon\u2019s fragmented mental health care system, the disputed arrangements, known as County Financial Assistance Agreements, have for decades been the primary way the OHA partners with counties to fund and organize services like case management, substance use disorder treatment, and problem-gambling programs\u2014particularly when those services are not eligible for Medicaid dollars. <\/p>\n
The state, which is seeking to finalize revamped agreements in a matter of weeks, describes its plan this way: It would make it easier for counties to shape their plans around regional needs. It would provide them more funding stability. And it would set \u201cclear expectations for counties to ensure transparency around funding, data, and outcomes.\u201d <\/p>\n
Multnomah County Commissioner Meghan Moyer is among those who see the new proposal very differently. <\/p>\n
In an interview, she listed two core objections: One is the removal of a contract provision that shields counties from liability if they don\u2019t meet certain terms of the contract as a result of inadequate funding. \u201cThat is the single biggest issue,\u201d Moyer says. \u201cWe\u2019re not willing to take on that liability for something that is still fundamentally a state function that we are taking on for them.\u201d <\/p>\n
The OHA counters that the contract has language clarifying that counties will not have to rely on non-state funds to fund the required services, thus ensuring that no \u201cservice that OHA is requiring is unfunded.\u201d <\/p>\n
But officials like Moyer are skeptical. And she has a second objection: The state wants counties to shift their behavioral health care focus almost entirely toward \u201caid and assist\u201d patients\u2014people who have been charged with a crime but deemed incapable of aiding in their own defense, and who the state is under serious pressure to process faster. (It\u2019s subject to a court order that exacts near-constant fines.) <\/p>\n
The state wants every county to \u201cmake that their number one priority,\u201d Moyer says. \u201cAnd it\u2019s like, \u2018Well, actually, that\u2019s your responsibility.\u2019\u201d<\/p>\n
The model for County Financial Assistance Agreements was developed long ago, amid a different health landscape, OHA spokeswoman Kim Lippert said in an email. Over time, she said, laws, funding streams, regulations and community needs have evolved.<\/p>\n
For that reason, she said, the OHA and the Association of Oregon Community Mental Health Program launched a joint rewrite in April 2024 to \u201cmodernize the framework and clarify expectations.\u201d<\/p>\n
The revamped agreement, which the OHA is rushing to put into effect by Jan. 1, clarifies shared roles and strengthens partnerships, Lippert said, adding that the revisions \u201censure that every dollar spent supports meaningful results while keeping counties central to the delivery of community-based care.\u201d<\/p>\n