Oregon Health Authority proposes rule change restricting associate providers from billing Medicaid

Concerns over proposed changes to the billing practices of associate behavioral health providers dominated the recent Senate Committee on Early Childhood and Behavioral Health meeting in Oregon. The proposed rule change, set to take effect on July 31, 2025, would restrict associate providers from billing Medicaid clients unless they work in community mental health programs, a move critics argue could exacerbate existing mental health care shortages.

Associate providers, often recent graduates working under supervision to complete their clinical hours, are currently allowed to bill for care across various settings. This flexibility was established in 2016 to address workforce shortages, particularly in rural areas. However, the Oregon Health Authority (OHA) now claims that the rule change is necessary to ensure consistent care and quality standards, despite a lack of evidence supporting the assertion that current practices are inadequate.

During the meeting, stakeholders expressed alarm that the change could cut off access to care for an estimated 10,000 Oregon Health Plan members, particularly impacting vulnerable populations such as BIPOC communities, LGBTQ+ individuals, and families in rural areas. The Health Equity Committee unanimously opposed the rule change, citing concerns that it would deepen health inequities and undermine ongoing efforts to improve access to mental health services.

Critics also highlighted that the rule change fails to address the root causes of workforce shortages in community mental health settings. Many associate providers are already employed in private practices with robust supervision, and the proposed restrictions could drive them to seek opportunities in neighboring states like Washington, where they can bill Medicaid in all settings.

As the OHA moves forward with the rulemaking process, the urgency of addressing the mental health crisis in Oregon remains paramount. Stakeholders are calling for a more collaborative approach that includes input from affected providers and communities to ensure that any changes enhance, rather than hinder, access to essential mental health care.