name: FY 2025-27 Agency Budget Request
Attachments: Policy option package form
title: 560 – Ensuring access to services for individuals with mental health conditions
author: Oregon Department of Human Services
Submitted: August 30, 2024
Buried deep within the 1,000-page doorstop that is the Oregon Department of Human Services’ requested budget for the next two years is a shocking admission that the department has ignored federal rules for years.
What’s even more alarming is that this mistake precipitated one of the state’s worst ongoing crises. There are hundreds of cases in which the state has denied assistance to Oregonians with mental illness, despite a federal obligation to provide assistance.
“They know they’re discriminating against people with mental illness, but they’re consciously trying to continue that discrimination,” said Chris Boonev, executive director of NAMI Oregon. “It is astonishing that state institutions embrace the most vulnerable people and almost guarantee their failure.”
The problem dates back to the 1980s, when DHS began using Medicaid funds to provide care for the elderly and disabled in the community rather than in facilities. However, they excluded people with mental illnesses, leaving other organizations to fill that role.
This was clearly legal at the time. But when the state expanded its community-based care program under the Affordable Care Act a decade ago, it ignored a new provision requiring it to provide similar services to people regardless of their diagnosis. (“We are not in compliance,” the agency’s budget request now says bitterly.)
In other words, DHS ignored the federal obligation mandated by Obamacare to provide people with mental illness with the same community-based care it provides for people with other disabilities. .
Under these programs, states use Medicaid funds to pay caregivers who help with daily tasks such as taking medications and attending doctor’s appointments. It is designed for people who need to be institutionalized. Oregon uses programs like this to help people with cognitive disabilities, and was planning to create similar infrastructure for people with mental illnesses.
Instead, the state refused to admit people with only a diagnosis of mental illness and referred them instead to other government agencies, a largely pointless move.
Of the 500 people DHS has referred to community mental health programs for Affordable Care Act services in recent years, fewer than 500 people actually received them, according to a recent presentation by Jane Ellen Wydantz, deputy director for policy in the agency’s Office on Aging. Only 3% received it. people with disabilities. (A spokesperson for Multnomah County, which runs a community mental health program in Portland, blames the “very limited” services available to eligible seriously ill patients.)
The conclusion is: “We have people who fill the nursing home level of care.” [in the aging and people with disabilities program]- They need support every day, and these people are not getting the services they deserve,” Weydantz said.
Instead, such patients enter what is known as a “revolving door.” They arrive at the emergency room in crisis. You will be discharged from the hospital after your condition stabilizes. But without help, they quickly regress and reappear in the emergency room or prison.
Disability rights groups in Oregon have been calling on the state to correct this oversight for years. “I was crying the whole time. These are people who ride bikes and end up in the hospital,” says DRO Policy Director Megan Moyer. “The cost is astronomical.”
This year, the state finally listened. DHS is asking Governor Tina Kotek and the Legislature for $10 million in General Fund funding to hire staff with the expertise needed to administer the program. It’s not clear whether the agency will receive it. Behavioral health is one of Kotek’s top priorities, but this year’s budget is tight.
Moyer said the program will pay for itself by cutting costs elsewhere. “I think this has the potential to be transformative if implemented well,” she says.
