Oregonians enrolled in the state鈥檚 Medicaid program face a maze of red tape and shortage of residential facilities to treat them for drug addiction or mental health care.
The problems manifest in different ways: One Oregon family had to pay out-of-pocket for their child鈥檚 residential drug addiction treatment program because they couldn鈥檛 find one after calling every listed facility. In another case, an Oregonian on Medicaid with schizophrenia went to two hospital emergency rooms seeking treatment for back pain. In both cases, security guards escorted them out without treatment. A homeless advocate drove the person to a third hospital, where they received surgery for a spinal infection.
The findings 鈥� and patient accounts 鈥� are within a that analyzed problems and concerns of people in the Medicaid-funded Oregon Health Plan, which covers medical, dental and behavioral health for nearly 1.5 million low-income Oregonians.
The authority鈥檚 Ombuds Program annual report, released in May, details the most frequent problems that Oregon Health Plan participants faced. The Ombuds Program advocates for people enrolled in Medicaid and recommends improvements to the agency.
In its response, Oregon Health Authority officials said they take all the findings in the 44-page report seriously and are working on plans to address the gaps in service and provide people with the care they need.
鈥淭his report highlights long-standing gaps in care coordination and links to critical supports, especially for Oregonians facing challenges with mental health and substance use who utilize emergency departments,鈥� OHA behavioral health Director Ebony Clarke said in a statement. 鈥淚t is critical that we work towards more flexible and collaborative solutions with our partners in the health system.鈥�
Ombuds report highlights problems
The report flagged problems that include:
- A low residential capacity for people who need to enter facilities for addiction treatment. Oregon has 47 addiction treatment residential facilities statewide, and 36 of those have state contracts as Oregon Health Plan providers.
- People who receive emergency room treatment for mental health or addiction issues are not connected to opportunities for follow-up care. Oregon Health Plan members with mental health and addiction treatment needs visited emergency departments an average of two times during 2022.
- People with mental health conditions face barriers when they seek Medicaid-funded home and community-based services, which can include in-home personal care to maintain their independence. Often, people are not referred to those services or struggle to qualify and obtain services from providers.
Advocates told state officials that facilities and beds that were once an option for Oregon Health Plan members are no longer available, partly because residential providers have 鈥減oor perceptions鈥� of the health authority鈥檚 system used to provide care, the report said.
Oregon Health Authority鈥檚 response
Oregon Health Authority Medicaid officials, in a to the agency鈥檚 Ombuds Program, outlined steps they are taking to address the issues.
Those include:
- The agency is conducting a statewide assessment of residential mental health and addiction care options. Officials will develop a plan that takes into account needs of each part of the state and the development of new facilities. By the end of 2023, that assessment is due to be finished.
- The agency officials have a team set up to look for ways to improve access to home and community services, including meals, medical transportation and in-home care.
- State officials are reviewing and revising rules for how Oregon Health Plan members can coordinate their care and set up treatment.
Dana Hittle, Oregon鈥檚 Medicaid director, said the Ombuds Program plays a critical role in identifying problems.
鈥淎s part of OHA鈥檚 commitment to eliminating health inequities, it鈥檚 essential for OHA to listen and learn from individual concerns,鈥� Hittle said in a statement.
The authority鈥檚 Ombuds Program manager said the steps are good, but far from where Oregon needs to be.
鈥淚t鈥檚 great to see forward progress, but we鈥檙e still a long way from where we need to be, particularly with community-based supports,鈥� Sarah Dobra, OHA鈥檚 Ombuds Program manager, said in a statement. 鈥淪ignificant, transformative, person-centered work 鈥� including member outreach and support for our providers who work with high-risk populations 鈥� is needed to connect people with vital supports that will help them live independently and reduce risk of being unhoused.鈥�
Advocates say much work remains
The report comes two years after the Legislature made an historic $1.1 billion investment into behavioral health in the 2021 session. In the past two years, much of that money has gradually been distributed as health authority officials have set up new programs and sought contractors to run new programs and open new residential facilities.
Advocates say the state report鈥檚 findings are unsurprising and show the need for Oregon to continue to build up a behavioral health system that can meet the needs of Oregonians.
鈥淲e鈥檙e hopeful because the governor and the Legislature keep making strides and investments 鈥� both policy and money investments 鈥� that will incrementally improve the system over time,鈥� said Heather Jefferis, executive director of the Oregon Council for Behavioral Health. 鈥淭hat鈥檚 very exciting because we have a lot more to do.鈥�
Mike Marshall, executive director of advocacy group Oregon Recovers said Oregon has a long way to go.
鈥淲e can鈥檛 fix this problem without dramatically increasing access,鈥� he said.
The state needs to expand its capacity in the long-term, and have a short-term plan for people, he said.
鈥淭he issue is how do we create short-term large capacity as we buy ourselves time to build the long-term capacity,鈥� Marshall said.
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