Commissioner Moyer proposes county pilot using Medicaid long-term care to keep people with severe mental illness housed

Commissioner Moyer presented a proposal asking the board to pursue a state-funded pilot that would use Medicaid long-term care eligibility and case management to help people with severe persistent mental illness (SPMI) remain housed and reduce costly use of hospitals, jails and state psychiatric beds.

"I am proposing that we seize on this moment of opportunity and do strategic field based eligibility work and case management so that we're maximizing Medicaid long term care services to help people stay successfully well in community," Moyer said. The commissioner framed the pilot as targeted, field-focused outreach to enroll people who are currently unhoused and who meet the disability and impairment thresholds for Medicaid long-term services.

Why this matters: Moyer and staff argued that many people with severe behavioral-health disabilities are cycling through expensive public systems—emergency departments, jails, inpatient psychiatric facilities and the Oregon State Hospital—because the county lacks an effective front door for long-term supports. Staff said targeted Medicaid enrollment and sustained case management could avert repeated crises and preserve placements that would otherwise be lost.

Proposal details presented to the board: - Funding request and match: Moyer said the county will request $1,750,000 in state general fund in the upcoming biennium; those dollars would be matched by Medicaid (50/50) as eligible services are billed. "Their $1,750,000 of general fund gets doubled," Moyer said in the briefing. - Initial staffing and incentives: the pilot would fund six field-based eligibility workers to meet people where they are (emergency departments, psychiatric emergency rooms, jails, shelters and mobile crisis response teams), three ODHS-provided licensors to support providers in becoming Medicaid-enrolled, and a small county case-management team initially of three case managers. The plan includes technical assistance or incentives to encourage suitable providers to enroll as Medicaid providers. - Goals and scale: Year 1 would enroll about 150 individuals into Medicaid long-term care services; year 2 would add roughly 250 more individuals. Moyer said the county will be cautious in the first years to ensure adequate provider capacity and durable supports. - Downstream expectations and evaluation: the proposal asks the Oregon Health Authority to study whether the pilot reduces use of expensive services (inpatient psychiatric stays, emergency use, jail bookings and transfers to the state hospital). Moyer also told the board he expects county and state savings from reduced acute care and criminal-justice use.

The briefing described how the pilot would operate: field-based eligibility workers would perform income and impairment assessments on-site, build individualized care plans, identify or support licensing of appropriate residential or community providers, and then transition each person to a case manager who would follow them through interventions, hospitalizations and recoveries to preserve housing placements.

Board discussion touched on implementation questions, legislative timing and geographic scope. Commissioners generally supported the idea and asked staff for more detail on outcomes, district-level impact and coordination with police, hospitals, shelters and providers. Staff said they will coordinate with state partners, the county's Office of Homeless Services and behavioral-health providers as the pilot is refined and as legislation is pursued.

Ending: Commissioners expressed support and asked staff to return with implementation details and outcomes metrics. Moyer said the request will be part of legislative outreach and that the pilot aims to prove a model that could scale regionally or statewide.