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Local parents and providers warn of service cuts and financial strain as Medicaid rules shift
Summary
Members and providers told the council they are worried that pending Medicaid eligibility changes and implementation (beginning 2026) could reduce services, add reauthorization burdens and force agencies to restructure because of a new three‑month liquid reserve certification requirement.
Parents and provider representatives raised urgent concerns at the Sept. 22 Clackamas County IDD Advisory Council meeting about possible Medicaid changes and new state certification rules that could force agencies to reorganize or close.
A parent representative said she is "hearing it seems like it's changing all the time" and worried about reductions in services and changes to paid parental caregiving if federal or state Medicaid rules change. County staff responded that many details are still in flux and recommended making Medicaid updates a standing agenda item so the council can monitor developments.
Several providers described a new state requirement that certificated agencies hold three months of payroll and operating expenses in liquid funds. One agency owner said the requirement is "impossible for us as a nonprofit," noting a 180-person agency would need roughly $3.5 million in liquid reserves to meet the rule. She added that agencies are already operating on thin margins: "We have about a 4% overhead" and rising costs, including an insurance increase of about 47% this year.
Members also discussed how eligibility and hours can change with assessor reviews, age, or PBSP implementation, and how the state’s approach has produced inconsistent outcomes: "some people... got dropped down to the lower tier for hours" while others later regained maximum hours after appeals.
Workforce and pay disparities also surfaced: members said PSWs (represented by SEIU) and DSPs (agency-employed direct support professionals) are funded differently and that collective bargaining yields different compensation structures. That difference has led to concerns about recruitment, retention and whether the state’s rate setting will deliver equitable outcomes across provider types.
What the council will do: staff said they will continue to monitor Medicaid implementations and provide monthly updates; members asked the council to track impacts to families, eligibility renewal patterns and provider viability.
The meeting did not adopt formal council action on Medicaid items; members asked staff to report back as state rulemaking proceeds.
