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House Bill Would Bolster Behavioral Health Workforce

The state would provide incentives to retain and recruit employees in the behavioral health care industry as policymakers seek a long-term solution.
Clouds hover over the Oregon Capitol building.
Oregon State Capitol in Salem. | BEN BOTKIN/THE LUND REPORT
February 3, 2022

Oregon behavioral health care providers may get state grants to recruit and retain employees through a bill aimed at providing relief for the industry’s workforce struggles. 

House Bill 4004, heard Thursday in the House Behavioral Health Committee, would provide grants to behavioral health care providers across Oregon. The measure is intended to provide short-term relief and keep the system from collapsing as the state works on a long-term solution that likely will entail raising Medicaid reimbursement rates for providers. 

“The workforce crisis is ongoing,” said Rep. Rob Nosse, D-Portland and chairman of the House Behavioral Health Committee. “We can’t afford to ignore it. If we don’t address this, we’re going to look at the closure of programs.”

The industry’s 24,000 employees face headwinds on multiple fronts. Low Medicaid rates make it difficult for providers to pay competitive wages, particularly for entry-level positions that routinely pay less than $20 an hour. Meanwhile, the pandemic has exacerbated problems in the behavioral health system over the last two years. Residential facilities were forced to reduce beds to comply with capacity restrictions. Outpatient programs and group therapies switched to online instead of in-person communication. Staff have grown exhausted and providers have competed against each other for the same employees. 

Twenty percent of behavioral health providers reported it takes six months or longer to fill a position on average, according to a June 2021 survey by the Oregon Council for Behavioral Health, a trade group for the industry. Another 18% reported they had perpetual job openings due to a lack of candidates.

The bill comes after the Legislature in 2021 approved a range of historic investments into the behavioral health system, including more capacity for residential programs, workforce incentives to diversify the workforce and money to set up programs for Measure 110, which decriminalizes low-level drug possession. Including federal matching dollars, the price of those items was $1 billion.

The catch: Those programs take time to set up and largely aren’t in place yet, even as the pandemic continues to drive up the overall demand for behavioral health care systems.

“I don’t want doors to be shut because we don’t provide the resources that these programs need,” Nosse said.

Unlike the legislation of 2021, this bill turns on a tighter timeline. The Oregon Health Authority would be required to distribute the funding by May 31. Providers would have to use the money by June 30, 2023, or return it. 

Under the bill, providers would have to put 75% of the grants directly toward worker salaries. The remaining 25% would have to go toward other recruitment and retention efforts, such as child care stipends for employees.

The health authority and lawmakers are still working to determine the cost of the bill. The current estimates range from a low of $54 million to a high of $132 million. That’s based on providing an extra $2,000 to $4,000 average to each worker in salary. However, the bill doesn’t dictate how much each individual employee gets.

Due to lack of staffing, Oregon’s residential systems that serve children and adults have lost 383 beds statewide, said David Baden, chief financial officer of the Oregon Health Authority. 

That includes homes that provide a range of different treatments and options, including psychiatric, substance use disorder and adult foster homes.

“It is a true crisis,” Baden said.

Providers and advocates encouraged lawmakers to pass the measure.

Amy Baker, executive director of Clatsop Behavioral Healthcare, said she has three positions she’s been trying to fill for more than a year.

When she tells potential employees the starting salaries, she said, “they often laugh at us.”

It’s a picture that holds true across the industry. Colleagues are concerned, especially after two challenging years, Baker said.

“I hear fear in their voices,” Baker said. “None of us have ever seen anything like this before.”

She said she would put the money toward raises while lawmakers work on a long-term fix.

“I’m willing to take that chance to raise salaries for employees in my organization,” Baker said.

“You are extending a lifeline,” Baker said to the committee members. “You are providing a sense of hope for every behavioral health care provider.”

The bill also requires the health authority to contract with emergency nurses and health care workers to help residential programs impacted during the pandemic. Currently, there are 77 emergency nursing staff at facilities statewide. It costs $700,000 a week for that service, Baden said. Officials anticipate that the Federal Emergency Management Agency will reimburse those costs. If not, the health authority will seek financial help from the Centers for Medicare & Medicaid Services with the costs of the contracts.

As those funds go out to providers, state officials plan to work on higher Medicaid reimbursement rates, which this bill doesn’t provide. That’s in part because it’s a complex process that requires approval from the federal government, which provides matching dollars.

It’s uncertain how the rate structure may change. Current state estimates have scenarios for 10%, 20% and 30% increases to rates.

A 10% increase would cost the state an estimated $18 million and provide $68 million total in state and federal matching dollars. 

A 20% increase would cost $39 million in state funding and $106 million in federal funding — $145 million total. On the high end, a 30% increase would cost an estimated $61 million in state dollars and $169 million in federal dollars — $230 million total.

Those estimates include combined increases to the fee-for-service model and for coordinated care organizations.

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.