This article has been updated and expanded to incorporate additional reporting.
Sejal Hathi’s resignation as director of the Oregon Health Authority on Thursday followed months of increasing speculation about her future.
Having spent more than two years heading the nearly 6,000-employee agency, which oversees the Medicaid-funded Oregon Health Plan that covers 1.4 million lower-income Oregonians, Hathi will be replaced on an interim basis by Fariborz Pakseresht, who did an eight-year stint heading the Oregon Department of Human Services.
Hathi moved to Oregon with a sparkling resumé citing leadership and awards, having spent a few months as a top health bureaucrat in the state of New Jersey and two years as an advisor to the White House Domestic Policy Council.
Upon starting the Oregon job in January 2024, she repeatedly spoke of her ambition to pursue “bold” initiatives to tackle problems in health care in the state. She said she moved to Oregon to raise a family on the same coast where her parents lived and hoped to stay in her job for four to eight years.
However, she has increasingly faced questions about a lack of leadership on health care crises in Oregon even as she has sought to boost her national profile — including as a co-owner of the Portland Trail Blazers with her husband, venture capitalist Sheel Tyle.
Speculation that Hathi was not long for the job had grown over a series of recent incidents:
Hathi’s handling of the health authority budget and layoffs had raised questions from staff in a virtual meeting with Kotek on June 30, sparking the governor to say, in effect, she'd have handled it very differently. The comments were widely interpreted within the agency as public criticism of Hathi’s leadership.
Her May 25 New York Times guest essay concerning deficiencies in post-partum care she faced as a new mother put Kotek in an awkward position and sparked criticism that Hathi was out of touch with the issue in her own state — where she had not only been silent on the issue for two years, but had presided over major funding cuts to the primary care providers tasked with providing the seamless care Hathi called for.
In recent months, two decisions that Hathi and her team had won Kotek’s approval for were reversed at significant cost to the state: firing the agency’s equity director on Juneteenth week of 2024 — leading to a $630,000 settlement —and claiming the federal government had required a decades-old Medicaid cost control program be abolished, only to have federal officials disagree, leading to the need to reboot the program.
Despite publicly emphasizing the need to improve primary care access, Hathi had resisted a call by influential lawmakers to reduce unnecessary administrative overhead for family medicine providers to help combat the state’s primary care provider shortage.
Hathi’s public denial to The Oregonian/OregonLive of knowing about controversial seclusion practices at the Oregon State Hospital was undermined by a records request filed by the Eugene Lookout Local that showed the director had been warned months before an inmate’s controversial death.
The internal announcements of her resignation, obtained under Oregon Public Records Law before the decision was announced publicly, characterized the decision as based on a desire to focus on her family.
“I want to share that Dr. Sejal Hathi has decided to step down from her position as the Director of the Oregon Health Authority effective August 1, 2026, to focus on family, personal priorities and the next chapter of her life and service,” Gov. Tina Kotek wrote in an email to agency staff Thursday morning. “We are grateful for her leadership and her steady work to strengthen health care and Oregon’s public health system during her time with us.”
In her farewell email to staff, Hathi wrote that “I am proud of what we have advanced together: expanding coverage ... establishing the West Coast Health Alliance, expanding residential behavioral health capacity, working to stabilize and prepare Oregon’s Medicaid program amid seismic federal change, strengthening core agency operations, navigating difficult fiscal choices, and continuing the work to build a more equitable and effective health system.”
Rep. Rob Nosse, chair of the House Health Care Committee, works closely with the agency.
“I had heard that maybe this was coming,” he wrote in a text to The Lund Report. “She is super talented and young, and so good for her to take a moment to focus on being a mom and not having to juggle all the things with young motherhood while doing a VERY hard job in state politics.”
Leadership style provoked praise, criticism
Hathi took the Oregon job with a history of promoting social change while cultivating strong connections in politics and business.
Her husband, Tyle, had been among a number of young business leaders that were close with the Obama administration. In 2019, Tyle brought Obama advisor Susan Rice on as a corporate board partner and part-owner at his venture capital firm Amplo Partners, and in 2021, when President Joe Biden appointed Rice to be his Domestic Policy Advisor, Hathi was hired to be part of Rice’s advisory staff for two years, a major entry in her resumé before coming to Oregon.
On podcasts and in public speeches, she has cultivated a personal brand of promoting positive change through defiance of authority, publicly describing how she overcame resistance she faced early in her life from her parents as well as a faculty advisor.
In January 2025 Hathi received a performance evaluation, which was obtained under Oregon Public Records Law. It included anonymous comments submitted by people asked to weigh in that spoke of Hathi’s intelligence and ambition for change, but also her impatience.
One wrote, “She likes to get things done and make an impact, which I know has sometimes ruffled feathers and can be a bit of a journey in state government, but I would hate to lose someone like her that really thinks innovatively and could transform things significantly.”
Another had a more negative spin.
“Sejal is so focused and demanding that she has made staff cry and they really struggle with how to satisfy her requests and demands,” one wrote. “Sejal does not feel very present in meetings with others. Most times she has her camera off and doesn't appear engaged. She appears to be multi-tasking, reading emails or responding to phone calls, etc. It is not very engaging for people meeting with her and they question if she cares.”
Reflections on tenure
Hathi’s supporters say she has moved the massive agency in a positive direction by trying to centralize and formalize decision-making. And, they note, Hathi’s job was among the most challenging assignments in state government.
Hathi’s predecessor in the permanent job, James Schroeder, had resigned after seven weeks, privately calling the agency a “toxic place” in a text.
But some prominent people said Hathi never reached out to forge alliances and push for positive change, or even just introduce herself. State Sen. Sara Gelser Blouin, who has been concerned about a lack of urgency by the agency over deaths at the state hospital, said that as far as Hathi, “despite serving on key committees related to the Oregon Health Authority, I never had a personal interaction with her.”
And critics inside and outside the agency say her leadership style — such as requiring memos be written before any major decision — have slowed the agency’s response to problems, and her attempts to unify the agency have wasted money on redundant efforts rather than making the agency’s existing structure work as intended.
“Hopefully Fariborz can bring a sense of calm and direction,” one health care executive told The Lund Report, speaking on condition of anonymity. There is a sense, they added, that “no one is leading this massive agency, so there's a lot of decisions being made in the different corners of the agency that don't seem coordinated. They care about everything and they can't do anything well, because they've prioritized everything. No one is saying ‘no’ to things.”
Hathi has also faced criticism over her management of the Oregon Health Plan, which had faced major financial and care access concerns even before the effects of federal changes passed by Congress last year hit. Despite Hathi speaking publicly against private equity and health care consolidation, executives with Oregon-based companies like PacificSource and Moda Health have complained of missteps by the agency that hurt their ability to continue providing care.
Former health authority Director Patrick Allen had resigned after Kotek had spoken on the campaign trail of her intent to fire him, instead taking a similar job in New Mexico. Now an executive at Montana’s worker’s comp insurance company, he said he’s been hearing concerns for a year of a leadership void as the problems in the state health care system and industry get worse — and that the state’s leadership is playing the role that “we are a victim of those changes,” as opposed to “exerting influence” to change things.
“I would say that running OHA is a tough job under any circumstances. And being new to the state, being unfamiliar with its health reform history and not having relationship with a lot of key players puts you behind the curve no matter what,” he said. “We've been in a time of post-pandemic turmoil of health care generally in the state that calls out for strong leadership — to engage a lot of voices and a lot of perspective to figure out where the state goes from here. And, for probably a variety of reasons, there's not been anybody, OHA or anybody else, who's been able to step up and convene that conversation.”
