Measure 110 Funds For Addiction Services Roll Out Belatedly As Auditors Spotlight Problems

Measure 110 OAC celebrates on May 18 2022 after approving first BHRN contract .png

After nearly six months of delays, funds are closer to reaching addiction services providers in Oregon as the council overseeing Measure 110’s rollout finished approving grant applications on Thursday.

The milestone comes one day after the Oregon Secretary of State’s Office sent a letter to Oregon Health Authority calling out “areas of risk” it has so far pinpointed as it conducts an audit of the program’s implementation.

When voters passed Oregon’s landmark drug decriminalization law in November 2020, they diverted about $300 million in marijuana tax dollars to pay for drug and alcohol treatment and recovery services every two years. The bulk of this biennium’s Measure 110 funding, about $276 million, was initially stalled as the inexperienced community council tasked with distributing the funds struggled to design and execute a complicated grant program with little assistance from the state. Then, after more than 130 Oregon Health Authority staff stepped in to take over application reviews, bureaucratic processes further delayed the release of funds.

Oregon Health Authority Director Patrick Allen noted his agency’s “missteps” on Measure 110 in presentations to legislative committees on Wednesday and Thursday.

“There’s been some challenges, and not least of which we’ve certainly made some mistakes as we’ve done this work,” he told the Senate Judiciary and Ballot Measure 110 Committee on June 1. He said the agency “vastly underestimated the complexity” of reinventing the behavioral health system and that the pandemic has placed additional stresses on the agency’s workforce, which led to competing priorities.

This morning, however, the Measure 110 Oversight and Accountability Council voted on the last of 236 applications representing 326 entities across the state during a subcommittee meeting. Now, Oregon Health Authority is negotiating contracts with grant winners, a process that the state estimates will take until late July or early August to complete. After the agency writes up the contracts, the council votes on whether or not to approve them.

“We feel tremendous,” Council Tri-Chair Ron Williams told The Lund Report. “We’re hopeful and optimistic that the county review process will continue on schedule. We plan to have half the counties done within the next couple weeks.”

As of this writing, two contracts totaling about $2.8 million, for Harney and Jefferson counties, were completed and funded. Those contracts, obtained by The Lund Report, offer few details about what the money will be spent on and how. Reporting requirements included in the contracts require tracking of whether people struggling with substance use disorder are able to access services more quickly after the networks receive funding. But it’s unclear how the efficacy of specific programs that receive funding, such as rewards-based programs, will be tracked.

Under the measure, providers applying for funds in different regions of the state, in many cases by county, must jointly form “Behavioral Health Resource Networks.” Each network must provide a range of services that includes needs screening, intervention planning, low-barrier substance use treatment, peer support, housing services, harm reduction and supported employment. And, providers must provide services in a way that aligns with the spirit of Measure 110. For example, services must be culturally competent, inclusive and low barrier. This means that programs can’t eject a patient for a single relapse, and that harm reduction services — such as overdose reversing drugs, fentanyl testing strips and clean syringes — should be available for people who are not ready to abstain from substance use. In some regions, a single provider serves as the entire network.

Grant applicants sought more than $400 million, which is at least $65 million more than is available for distribution. So not all were fully funded, if at all. Providers working together in Harney County requested $4.6 million, but were only allocated $857,711, for instance. Each county’s allocation is based on factors such as the number of people on Medicaid, number of people experiencing homelessness, number of drug overdose deaths and the number of arrests.

Oregon Health Authority was not able to say by press time when tribes will get their set-aside of the funding, which amounts to $11.2 million.

During Wednesday’s meeting of the oversight council, the health authority’s Behavioral Health Director Steve Allen congratulated its members.

“These decisions are really hard. And you’ve done a great job of making difficult decisions to support your communities,” he said.

While providers, politicians and observers have balked at the length of time it’s taken to get funds out the door, state officials and the oversight council have contended the task at hand has been an arduous one. The number of applications was “unprecedented,” according to Oregon Health Authority, and never before has a community council made up of those harmed most by the war on drugs — including people who’ve been incarcerated and who are in recovery — been tasked with designing and implementing a grant program that doles out hundreds of millions of dollars.

In a letter sent to Oregon Health Authority Director Pat Allen on June 1, state auditors issued a list of recommendations that they said “should mitigate risks that could further delay implementation,” and noted there are “promising signs” that Measure 110 “is back on track.”

Issues pinpointed by auditors through conversations with the council mirrored problems The Lund Report identified in its coverage of Measure 110 starting in February. Their findings and recommendations include:

  • The Oversight and Accountability Council did not receive information about individual grantee performance and did not receive public comments from meetings, despite asking the health authority for these items.
  • Measure 110 does not provide clarity around the roles and of the health authority and the council, therefore the Legislature should provide that clarity.
  • The Oregon Health Authority “has not always provided adequate support” to the council and has experienced staffing issues. That has contributed to delays in funding. Therefore auditors recommend that sufficient and dedicated staff support the council and that the authority provide timely and clear responses to the council’s questions.
  • The council “developed an inefficient grant evaluation process, due in part to a lack of support and guidance.” Again, more support from the health authority is recommended.
  • “Insufficient grant management and monitoring pose a risk that providers will not use funding in alignment with the equity and treatment support goals” of Measure 110. Auditors recommend the health authority “develop robust grant management and monitoring processes, including ensuring sufficient data is collected to enable those processes,” and that it give the oversight council sufficient support “while developing and voting on rules for data collection and reporting.”
  • Ongoing ethics and conflict of interest training was also recommended for the council.

In its coverage of Measure 110, The Lund Report has often not received clear, timely answers from Oregon Health Authority to questions about numbers, staffing and other aspects of Measure 110 implementation.

Williams, who serves as council tri-chair and is a prominent community organizer in Portland, said the council has learned valuable lessons, such as to ask for expert advice early on in the process and that the health authority needs to play a more strategic role. He expects the next round of Measure 110 grant funding to go smoother, he said.

To what extent access to treatment and recovery services will expand due to the funding will become more clear as contracts are negotiated and money is spent. In the meantime, Williams said he is excited to see the investments being made.

“I’m really excited about the expansion of peers, harm reduction and housing, in particular, because the emergency, supportive, transitional and recovery housing is a tremendous need,” Williams said. “I’m also excited about — there are some proposals that we’ve approved to increase detox and sobering, and there are some proposals that actually make it possible for folks who are categorically ineligible for Medicaid or uninsured to be to get inpatient treatment. So just the whole array of services I’m excited about.”

The council will begin to accept applications for the next round in the fall of 2023.

You can read the state auditor’s letter PDF iconhere.

The Lund Report is tracking the implementation of Measure 110 as part of a reporting fellowship sponsored by the Association of Health Care Journalists and The Commonwealth Fund. If you have a tip or comment that you think would be helpful, please contact Emily Green at [email protected].

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