OHA presents statewide behavioral-health priorities: workforce, access, state hospital strain

Ebony Clark, Director of the Behavioral Health Division at the Oregon Health Authority, told the Senate Committee on Early Childhood and Behavioral Health on Jan. 23 that Oregon’s behavioral health system faces a mixture of rising demand, workforce shortages and gaps in community capacity.

“Behavioral health refers to a person's emotional and mental health well-being across the lifespan,” Clark said. She framed the division’s work around prevention, early intervention, treatment and recovery supports and stressed the role of social determinants — housing, education, employment, language access and culture — in shaping outcomes.

Clark said the Behavioral Health Division, created in 2024, aims to expand the workforce, increase access to community-based care and improve accountability to outcomes. She told senators the division’s annual budget is “just a little over 6,000,000,000,” that roughly 49% of the 2023–25 budget is state general fund and about 51% federal funds, and that average behavioral-health spending increased about 30% over the last biennium.

She cited specific system pressures: the opioid crisis and fentanyl’s presence in the drug supply, rising numbers of people diagnosed with serious mental illness (SMI), and workforce shortages “at all levels from psychiatry to alcohol and drug counselors” that limit access to timely care. Clark said hospital and peer organizations are also strained and that peers — people with lived experience trained to support others — are critical for engagement and retention in treatment.

On the Oregon State Hospital, Clark said the facility provides the state’s highest level of psychiatric care and has 706 beds. She reported a shift in the patient population, with 98% of admissions now coming through aid-and-assist orders, and noted a federal court order (referenced by staff) that sets requirements for timely discharge for aid-and-assist patients. Clark said discharges have increased but so has the wait list.

Clark reviewed investments and recent progress: funding 465 new treatment beds for youth and adults (target phased in), 25 organizations funded to expand licensed community residential facilities for people with severe persistent mental illness, expansion of peer services and housing supports under Measure 110, and distribution of 279,258 naloxone doses through a harm-reduction clearinghouse (concentrated in Multnomah, Lane and Jackson counties). She said loan-repayment participants showed a 94% retention rate in the behavioral-health workforce in the prior biennium and that the state supported 494 contracts with 59 organizations and nine federally recognized tribes to bolster credentialed providers and peer workforce development.

Cheryl Ramirez, executive director of the Association of Oregon Community Mental Health Programs, described the county-based Community Mental Health Programs (CMHPs) that manage local behavioral-health systems under ORS guidance and contract with Coordinated Care Organizations (CCOs). “CMHPs … manage their local behavioral health system, provide direct services, and contract with other providers and community based organizations for other services,” Ramirez said. She explained the common funding mix for CMHPs is roughly 60% Medicaid, about 30% state general fund, and smaller amounts from county funds, federal grants, private payers and other sources. Ramirez said state general fund is administered through County Financial Assistance Agreements (CFAAs) and described planned updates to those contracts to tie funding to local planning and outcome metrics.

Both presenters highlighted concentrated challenges in crisis and residential care, and in children’s services. Clark and Ramirez told senators they would return with more detailed analyses, including child/youth-specific capacity and the methodology for residential needs for younger populations. Committee members pressed for clearer outcomes metrics to tie spending to results; Clark said OHA intends to strengthen outcome reporting as county contracts and CCO arrangements are revised and as the state moves toward CCO 3.

Ramirez emphasized workforce and funding solutions for CMHPs: incentives and loan forgiveness to recruit and retain qualified mental-health professionals (QMHPs) and peers, targeted provider rate increases for organizations serving highest-acuity clients, and reductions in administrative burden tied to multiple payers and reporting requirements. She referenced a cost study that identified about a $65 million current gap for crisis, aid-and-assist and civil-commitment services and urged continued investment in community-based alternatives and jail diversion programs.

Committee members asked for follow-up materials; Director Clark agreed to supply more detailed breakdowns of federal funding increases and to return with a presentation on the child, youth and young-adult continuum of care. Ramirez said the Association will provide details on CMHP funding flows and how proposed CFAA changes will be structured.

No formal committee action was taken on policy items during the informational session; senators said they will continue follow-up hearings on the state hospital, secure residential treatment facilities, and early-childhood and youth prevention strategies.