Lane County health and human services face 'significant uncertainty' from state and federal changes
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Summary
The county's Health & Human Services director told commissioners that changes to Medicaid, potential work requirements, CCO transitions and pulled HUD NOFOs threaten revenue and will increase demand and administrative burden, prompting plans for January briefings.
Eve Gray, the county’s director of health and human services, told the Board of County Commissioners that nearly every division in her department faces significant uncertainty from state and federal shifts.
Gray said Medicaid funding now flows into virtually every division the department oversees and that program design changes and policy shifts increase financial and administrative risk. "We are facing significant uncertainty in every area of health and human services," she told commissioners, citing possible work requirements and reductions in ACA subsidies that could boost the number of uninsured residents and reduce reimbursement.
Gray said community health centers have had years of flat revenue and a post‑COVID spike in operating costs, and flagged the CCO (coordinated care organization) transition as a contractual risk: a local payer stepped up to pay for primary care but added performance‑risk provisions that could reduce funding if measures are missed.
On homelessness and shelter funding, Gray said a HUD Notice of Funding Opportunity (NOFO) that had been expected was pulled back and that the county expects any reissued NOFO to include short timelines and possibly significantly reduced award levels. She said staff will reassess grant projections when the new NOFO is released.
Gray also described relative stability in behavioral-health funding but warned some elements (like case management) have been reduced or transferred by partners. She said the county will brief the board again in January with program-level detail as the state completes a Medicaid‑restructuring committee expected to report in mid-2026.
Why this matters: Health and human services make up a large share of the county's service responsibilities and are highly dependent on state and federal funding streams. Changes in eligibility, reimbursement or competitive grant awards could force service reductions or program redesigns and raise local costs.
Next steps: The director will return with more detail at the board’s January briefing and staff said they will continue tracking CCO negotiations, the NOFO schedule and the state Medicaid restructuring work.