Multnomah County Commissioner Meghan Moyer is asking the state for $1.75 million to fund a task force dedicated to connecting people with severe mental illness to Medicaid-funded treatment.
Moyer said her plan, which she brought before the county board Tuesday, would fill a significant gap in the county’s support services for people with debilitating mental illness and keep people with chronic conditions off the streets, out of hospitals and away from jail.
“How do we stop this?” Moyer said. “We stop this by using Medicaid long-term care for this population. So instead of allowing every interaction point to inevitably result again in homelessness, we go to those interaction points and we intervene.”
Moyer blasted Oregon’s approach to assisting those with long-term conditions, saying that the state and county use Medicaid programs like the Oregon Health Plan for treatment in emergency situations but do little to fund longer-term health care. She wants the county to set a standard for other governments.
“There is no front door to long-term services,” she told the board. “I cannot tell you the number of families who have called the organization I used to work for, Disability Rights Oregon, begging to know how to get their loved one the help they need.”
Moyer went to Salem on Wednesday to pitch the project to lawmakers, who are navigating an uncertain budget and competing priorities in this year’s session.
If lawmakers fund Moyer’s plan, the county would use the money to hire three case managers and six Medicaid eligibility workers who could meet people at the county jail, Unity Health Center, homeless shelters and other locations to screen them to see which Medicaid plans they might qualify for. Her plan also calls on state workers to help county health care and service providers get licensed to accept Medicaid.
As part of the plan, Moyer would want the Oregon Health Authority and the county to research and evaluate the program’s monetary effectiveness. After the county exhausts the one-time state funds, Moyer said the program could shift to being funded through billing revenue from Medicaid.
The pilot project would save the county from spending homeless services tax dollars on long-term care and housing support, Moyer said. The county is currently grappling with a $70 million shortfall in its homeless services budget for the next fiscal year.
Moyer said the county would aim to connect with 150 people in its first year of the pilot program and 250 in its second. She acknowledged that the numbers seem low, but argued it would lay the groundwork for future outreach.
“You may look at that and think ‘that is a really small number,’” Moyer said. “This is intentional. I do not want to over promise and under deliver.”
Moyer wants the county to tap into the Community First Choice Option. This option is reserved for seniors and people with disabilities who need home and community-based nursing home-style care. Once the eligibility workers screen a participant, they could come up with a care plan to connect them with services and help them through the process, Moyer said. The county’s case managers would track the progress and provide help along the way.
The county currently helps older adults and people with physical disabilities enroll in the Oregon Health Plan, officials said. That does not offer the same long-term care coverage the Community First Choice Option does, Moyer said.
Board members expressed support for the plan Tuesday.
“This is a way, I think, of really tying the needs of that population to the right financial resource that would be able to provide (services) in a way that we’re just not currently doing anywhere,” Chair Jessica Vega Pederson said.
The conversation comes at an uncertain time for federally funded health care as Congress mulls cuts to Medicaid spending. Commissioner Julia Brim Edwards questioned how certain the county can be that the resource will be available in the future given the potential rollback.
“With the (federal) administration’s continuing assault on health care, including Medicare and Medicaid, I’m curious about the shift from going from one-time state money into being covered by Medicaid,” she said.
Moyer said the pilot project would be “vulnerable” among the federal uncertainty, but added that the population it’s built to support and the approach the county would take make it “slightly more protected” because the people served would be among the lowest income individuals using Medicaid.
“Therefore under any scenario of income eligibility changes, they won’t be impacted,” she said.
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