'Administrative collapse:' Advocates blame evictions on new Oregon Health Authority housing program

This article has been expanded to incorporate additional reporting. 

Low-income people and their families in the greater Portland area are getting evicted or losing access to needed treatment instead of getting help from a new Oregon Health Authority program, advocates and others said Wednesday.

The new state housing assistance program is intended to help people be healthy by averting homelessness, among other things. But in its first six months it has become a bureaucratic nightmare for many people as well as the social workers trying to help them, according to a coalition of 30 groups that testified at a public meeting of the state Medicaid Advisory Committee.

When the program launched in November, providers submitted applications for rent assistance “hoping for a solution”, said Solara Salazar, who heads Cielo Treatment Center and West Coast Sober Housing, in testimony on behalf of the coalition. “Instead, we encountered an administrative collapse.”

The problems with the program, which had been heavily touted by health officials, affects an indeterminate number of people — many of whom lost the apartments used by them and their children.

The public outcry comes at a time when the agency, which oversees care to more than 1.4 million low-income people, is dealing with potential federal scrutiny, unexpected costs and sudden cuts in funding. It also is contemplating possibly huge additional cuts, as well as new federal barriers to care.

Asked for comment on the problems, an Oregon Health Authority spokesperson provided a statement that stressed the agency’s role is one of “high level” oversight, while working with the regional entities that administer the program, known as coordinated care organizations. 

The temporary housing assistance is limited to low-income people “who are experiencing complex health conditions and short-term disruptions in their ability to pay their rent,” they noted, adding that the program is “not intended to be an imminent eviction prevention resource.”

CareOregon, which oversees much of the program's administration in the greater Portland area, issued its own statement. “The challenges shared at the Medicaid Advisory Committee meeting are heartbreaking—and they reflect real gaps in a program that was launched with urgency but without adequate infrastructure to meet the enormous need.” The statement added that stable housing is essential to its mission. “The fact that some members are unable to access the innovative care they deserve is unacceptable.”

Missing paperwork, lack of help created ‘a nightmare’

An earlier health authority program supporting housing had provided crucial bed funding to treatment providers helping people in the early stages of recovery. Its sudden closure led to widespread systematic denials, Salazar said, and “we were told to wait for a new program.”

But the process for the new program, known as health-related social needs, or HRSN, has been unmanageable. Applications that used to run six pages, she said, now take hours to prepare “50 to 90 pages of documentation, sent via fax at significant cost ... only to be denied or ignored without clear justification.”

The state ombuds office, which helps members of the public with problems accessing care under the Oregon Health Plan, has received 145 complaints about the housing program since January and those complaints likely represent only the “tip of the proverbial iceberg,” according to Ellen Pinney, a principal ombudsperson for the state, in a presentation Wednesday. She called it a “well-intended program ... but in the tri-county area, specifically, it is turning into a nightmare for a number of people.”

Pinney, who helped found the client assistance office in 2010, said “These are the worst cases I've worked in my time here. People holding HRSN approval letters saying six months of rent and utilities are covered are being evicted because providers, payers are not able to be found, because the paperwork that they have submitted and was received and allows them to be determined eligible has been lost over and over again. People who are coming back from crisis, people In domestic violence, people who are coming out of rehab, people who qualify for this program as a result of their disabilities and challenges, are being walked out of the doors of homes they have lived in, in some cases, for many years with only what they can carry on their backs, with four to six months of rent past due owed hanging over their head as debt in the future.”

She called for “courageous” and immediate action to address the problem, including an “all-hands-on-deck action plan.”

In 11 cases, people reported to the ombuds office that they lost their housing despite having obtained an approval letter for state assistance. More than two dozen adults and a dozen children — four of them considered medically fragile — were affected.

Health authority officials, according to the agency statement, are working to clarify the rules and guidance around the program as well as bringing on more housing providers, workers and additional organizations on board to help people with the enrollment process.

‘Hamster wheel’ leading to evictions

Shelly Latini, a community advocate, likened the situation to a “hamster wheel” in which applicants never get the help they were promised and were hoping for. “We're seeing the fallout from a program that that rushed and under-resourced during the rollout. There's also never been a consistent workflow for submitting necessary documents, no case numbers, no IDs, just chaotic floods of emails with no ways to match documents to clients,” Latini said. “Advocates, landlords and attorneys send documents repeatedly, often with no acknowledgment. It's chaos. Just yesterday, I sent the same lease for a member that I've sent six times since February.”

“Why is it so hard to access this funding? Clients and advocates alike sit three to five hours on hold just to hear, ‘we have no updates, we're doing the best we can, and your case has been escalated.’  Court cases are piling up. Weeks and months pass without a payer, without funding. Despite countless calls and rescheduled hearings, there's no support from CareOregon, no housing mediation with landlords and legal aid, no navigation, no intervention when housing is at risk.” 

Latini added, “These are our most vulnerable Oregonians in crisis. They're not getting answers. My clients might only have two minutes to tell you today their story, but I assure you, there's thousands of them like that out there.”

One woman described herself as a single mother of three children with special needs who herself has disabilities, adding that she applied for the rental benefit in February with an eviction pending for March. The stress of trying to get help and failing contributed to estrangement from one of her children.

“For months from when I applied and when we lost our home, I never even received a phone call,” she said. “It's now been over 60 days since I applied. I also lost my job shortly after losing my housing due to all the stress this has caused. So now I'm unemployed, estranged from one of my children, sleeping in the basement of a church, and my kids and I are in a complete mental and emotional wreck.”