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Lane County health center reports budget shortfall, says layoffs and revenue changes followed
Summary
Lane County’s Community Health Center director told the board the center faces lower patient revenue, Medicaid payment reassignment and staffing cuts; staff plan fee-schedule changes, a Medicaid rate scope-change request and Medicare billing improvements to close a projected gap.
Director Grama, who led the Community Health Center briefing, told the Lane County Board the center’s new-patient revenue has fallen short of projections and “there are a number of reasons” including patient churn and state-level payment assignments that have affected budget forecasting.
Grama said the county’s shift in Medicaid funding mechanics — in which a coordinated care organization pays about one-third of a Medicaid payment and the state pays roughly two-thirds — has complicated revenue projections and that the Oregon Health Authority’s (OHA) assignment of the state portion has changed the center’s expectations. She warned that federal redetermination rules and new work requirements may add provider workload and create patient-access challenges.
To address the shortfall, Grama described several near- and longer-term steps. She said the center has identified $3,000,000 in one-time revenue sources and $3,500,000 in personnel reductions announced in June; “we identified $3,000,000 in 1 time revenue sources,” she said. The staffing reductions affected 23 positions; Grama said six individuals have received formal layoff notices.
Grama also described revenue-enhancement measures under way: a scope-change request with OHA to renegotiate Medicaid rates (a proposed rate will be submitted this summer, with OHA decisions often taking about a year and any increase paid retroactively to Oct. 1); consulting to optimize Medicare and Medicare Advantage billing; and fee-schedule and self-pay rate adjustments for patients with out-of-network commercial plans.
Board members asked about bumping and recall rights in the collective-bargaining process. Grama described how classifications, bumping rules and recall windows work and said lower-seniority staff are usually most affected by layoffs; she also emphasized efforts to preserve bedside staff where possible and noted non‑represented positions have borne a disproportionate share of recent reductions.
On system-level drivers, Grama warned that parity between behavioral health and physical health has increased utilization and costs, and that state-level review groups are considering large Medicaid reductions as they balance the biennial budget. She urged continued engagement with state and federal partners, and told the board the center will pursue both operational savings and revenue options to remain financially sustainable.
Next steps: staff said they will return with fee-schedule adjustments and further updates on the OHA scope-change process and Medicare billing work. The board did not take a formal vote during the presentation.
