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OHA officials outline workforce investments and review of board-registered associate Medicaid billing
Summary
Oregon Health Authority deputies briefed the Senate committee on workforce investments made since 2022 and described a planned rule review of board-registered associates and Medicaid billing to assess quality and access impacts for pre-licensure clinicians.
John Collins, deputy director for the Behavioral Health Division at the Oregon Health Authority, told the Senate Committee on Early Childhood and Behavioral Health that the agency is following up on feedback from a statewide listening tour and other workforce studies.
Collins summarized major workforce investments from the 2022 behavioral-health workforce bill (House Bill 4,071), saying the program directed about $80 million to a mix of strategies. “About $20,000,000 went directly towards clinical supervision,” Collins said, and the remainder supported loan repayment, tuition assistance, stipends and housing supports intended to recruit and retain workers.
Collins said loan-repayment investments have strong early retention: “90% of the folks that we were able to prepay loans for are still within the behavioral health workforce,” he said. He also said the OHA and partners helped cover fees for roughly 7,900 behavioral-health certifications to ease entry barriers. The agency highlighted targeted investments in child-and-family behavioral health training, apprenticeship programs such as United We Heal, and partnerships with community colleges and OHSU.
Collins and Risha Grinstead, Medicaid policy manager for children and families policies and programs at OHA, described a separate but related effort: a rule-review process focused on board-registered associates. Grinstead defined board-registered associates as people who have completed their education but not yet achieved full licensure; they practice under conditions of required clinical supervision. The OHA said about 1,000 such associates currently exist and that they represent roughly 10% of the behavioral-health workforce.
The OHA is exploring whether board-registered associates should be able to bill Medicaid when they are not working for an organization that holds a Certificate of Approval (COA) with OHA. Collins said the current rules allow associates to render services that are billed to Medicaid, often requiring a supervisor’s sign-off, but the agency is examining whether billing and supervision rules remain appropriate as the associate workforce grows.
Committee members pressed OHA officials for clarity about where associates can practice and what changes might mean for access. Collins and Grinstead said the agency will center community and provider engagement during the review and will not move forward in a way “to disrupt access to services, especially when it comes to culturally, linguistically, and developmentally appropriate services.” Grinstead described a tentative timeline for community outreach and rule revisions and said OHA will post engagement opportunities on its website and provide technical assistance during implementation.
Several committee members said concerns had been raised publicly about possible access barriers from any rule changes. OHA officials acknowledged those concerns and said the rule-review process is intended to identify equity impacts and implementation mitigations before any change is adopted.
