Multnomah County reports improved billing and data on school-based mental health as budget uncertainty looms

Anthony Jordan, interim behavioral health director for Multnomah County, and his team gave commissioners a quarterly report on the county's school-based mental health program, saying evaluation work and new billing practices are improving program transparency while questions about long-term funding remain.

The report, delivered by Jordan and Jessica Jacobson, interim deputy director, and Julia Dilly, an epidemiologist with Program Design and Evaluation Services, summarized an ecosystem assessment, key performance indicators (KPIs) and early financial signals. Staff reported 1,753 encounters for 449 individual youth in the first two quarters of the current reporting period, and said the share of client records missing insurance information had fallen from roughly 41—5% last year to about 11% so far this year. "More complete information about client insurance means more client services can be billed," Jacobson said.

Why it matters: commissioners pressed staff on whether improved billing will reduce reliance on county general fund dollars and how any projected revenue shortfall could affect services. Anthony Jordan said county projections for insurance receipts are preliminary and that the health department expects to have better figures in May. The county's presentation indicated general fund provided a sizable share of program support in FY26 and that projected reimbursable revenue (insurance receipts) of about $1.1 million for the year is an estimate pending later billing.

What the report found: Dilly described evaluation methods including interviews with partner districts, mapping of complementary school and community resources, and application of KPIs to administrative data. Staff emphasized that the program is one part of a broader system of student supports and cannot meet all needs alone. They also highlighted results from the Oregon Student Health Survey (fall 2024) for Multnomah County: among the roughly 6,500 students surveyed, reported depression rose with grade level (about 27% of sixth-graders, 30% of eighth-graders and 37% of 11th-graders), and certain groups reported substantially higher rates.

Commissioner questions and staff responses: The board's discussion focused on three areas:

- EPIC and billing: Yolanda Gonzalez, senior manager for direct clinical services, said training on the county's new EPIC electronic health record began Sept. 16 and that claims submitted in the first two quarters have not been denied. "We're seeing less and less errors every day," Gonzalez said. Commissioners asked whether the county could pursue enhanced Medicaid billing mechanisms such as FQHC designations; staff said the county previously operated within an FQHC structure but was untangled years ago and that re-entering such a structure would be administratively complex and not guaranteed to secure enhanced rates.

- Workforce and access: Commissioners pressed staff about clinician shortages, especially for Spanish-speaking therapists, and about the limits of billing-focused approaches for services that are non-billable but essential (for example, outreach, prevention and relationship-building in schools). Staff described tools used to capture non-billable work (monthly provider reporting and a spreadsheet) and cautioned that prioritizing billing could erode low-barrier access if not managed carefully.

- Budget timing and risk: Several commissioners noted positive KPI trends yet questioned proposed budget reductions in related proposals. County staff reiterated that no cuts to school-based services had been implemented for the current fiscal year, but that proposed budgets reflect projected revenue shortfalls and that the evaluation and May billing projections will inform final decisions.

What officials said next: Jordan and his team said the evaluation will continue through a third quarter that focuses on establishing performance standards, financial sustainability measures and opportunities to align school and county resources. No formal motions or votes were taken during the discussion.

Context and limitations: Staff repeatedly cautioned that some figures are provisional. Where the report used survey or administrative data (for example, counts of encounters or diagnostic prevalence), presenters noted the measurement method and that estimates will be refined as EPIC data quality improves. The county's presentation also referenced changes to the county financial assistance agreement with the Oregon Health Authority; staff emphasized it does not mandate continued state funding for the program under the new terms.

Next steps: Health department staff will return with refined revenue figures in May and continue to apply the evaluation's KPIs to guide placement, billing and program design decisions. The board signaled interest in continued reporting on both billable revenue trends and the scope of non-billable activities that support access and continuity of care.