Health care access is top complaint to Oregon Medicaid Ombuds Program

Oregon’s regional Medicaid insurers spent vastly different amounts on behavioral health services for their low-income members, with one organization spending just 3% of all its benefits payments on mental health and substance use treatment, according to a government watchdog. 

The 16 coordinated care organizations — known as CCOs — that are contracted to oversee the Medicaid-funded Oregon Health Plan on average paid about 14% of benefit spending in the first half of 2022 on behavioral health services, according to the most recent report from the Oregon Health Authority Ombuds Program. 

On the upper end, one coordinated care organization spent nearly 21% on behavioral health services with another on the lower end spending just a sliver of that. The findings from the Ombuds Program, which advocates for Oregon Health Plan patients, are the latest snapshot of the challenges the state’s ongoing shortage of behavioral health services pose.

The report noted that the percentages don’t speak to the number of Oregon Health Plan members served “since the costs of services can differ by region.” But the finding left one member of the Oregon Health Policy Board, which oversees the Oregon Health Authority, rattled. 

“It was just disturbing,” Dr. John Santa said during a presentation of the report during the board’s Tuesday meeting. 

Santa said that there are bound to be variations between coordinated care organizations. But he said the only way to account for a variation that large is for one coordinated care organization to “select patient populations that hardly have any mental health problems” or throw up barriers that prevent patients from accessing services.

The report analyzed 1,732 concerns from Oregon Health Plan patients in 2022 that directly related to Medicaid plans or providers. Nearly 40% of concerns involved a problem of access to care, the report found. 

The report also used state data to spot other barriers facing recipients of the low-income health plan. One of those concerns was Oregon Health Plan patients accessing substance use disorder treatment. 

There are 47 licensed residential substance use disorder facilities in Oregon, 36 of which provide services to Oregon Health Plan members. But on average, each coordinated care organization contracts with only nine of these facilities, according to the report. Six coordinate care organizations contract with five or fewer. 

In fact, every single coordinated care organization lacks contracts with a majority of residential substance use disorder facilities in the state, according to the report. 

“This may reduce timely entry into treatment for some members,” reads the report. 

Sara Dobra, a manager for the agency’s ombuds program, told the board that the report’s analysis is “imperfect” and doesn’t reveal how many treatment beds are available to each region or coordinated care organization’s members. But she said it is evidence that some Oregon Health Plan patients face “disproportionately additional barriers” to beds based on network availability or “lack of care coordination and support to really advocate and get someone into care.”

Ombudsperson Ellen Pinney told the board there are “some pretty low-hanging fruit” to improve access for Oregon Health Plan patients to substance use disorder treatment.  

“Why does the Oregon Health Authority not require all CCOs to contract with all substance use disorder facilities to maximize the chance that any client in any CCO has equal access to immediate substance use disorder treatment?” she said. 

Pinney also reviewed figures showing that in 2022, only 13% of Oregon Health Plan patients in a substance use-caused crisis were admitted to hospitals after coming to emergency departments. Of the roughly 9,000 Oregon Health Plan patients in 2022 who showed up at emergency departments with a psychiatric crisis, only 12% were admitted to the hospital. She explained that hospitals have to coordinate care for admitted patients when they are discharged. However, hospitals have fewer obligations to coordinate care for patients who are only treated at an emergency department. 

“What we have observed is that sometimes hospitals don’t want to admit patients in psychiatric crisis because, I’m sure you’ve seen the reports, it’s very hard for them to find placement,” she said. 

She said these patients might be in the hospital a long time before a bed in a residential treatment facility or program opens up. In the meantime, she said emergency department visits are a “missed opportunity” to connect Oregon Health Plan patients in a psychiatric or substance use disorder crisis with services the coordinated care organization provides.

The report noted that “members who visit the ED during a behavioral health crisis often do not know the name of their CCO.”

You can reach Jake Thomas at [email protected] or via Twitter @jakethomas2009.