Opinion | Kotek should steer the bus toward Oregon Health Authority fixing Medicaid rules
As Gov. Tina Kotek dives into the future of Portland, she should use her clout to make sure Portland Street Response unlocks federal funding.
Every month this doesn’t get done is a month the city doesn’t receive federal funds, and there are various sticking points to getting it done.
What’s needed is a committed leader to see the process through. That’s where Kotek comes in.
In 2021, Sen. Ron Wyden, D-OR, passed the CAHOOTS Act, which qualified mobile crisis teams for “enhanced Medicaid” — 85% reimbursement.
Oregon was one of the first states to be approved for this funding, but at this point, it’s a ticking clock of lost funds. The legislation is only set up to run through 2027.
You might wonder why I’m connecting these dots. First of all, even though these are federal funds, it’s a state agency — the Oregon Health Authority — that needs to fix the rules, applying for waivers from the Center for Medicare and Medicaid Services.
A major current barrier is crisis workers are expected to document a person's eligibility for Medicaid, but this is, of course, not how crises work. This requirement needs to be fixed by the Oregon Health Authority.
Kotek should direct the Oregon Health Authority to expedite this as part of her focus on actions for Portland’s recovery built into the Portland Central City Task Force she launched Aug. 22. Because these efforts transect multiple jurisdictions, starting with the state, we need a champion who can inject urgency into the efforts until they are complete
Additionally, a fully realized Portland Street Response is a more sustainable, cost-effective and appropriate response to some of the concerns faced by the task force.
At the first meeting, Mayor Ted Wheeler suggested the state send 100 state troopers to bolster the Portland Police Bureau.
This was less than a week after Portland City Council passed an ordinance to double police overtime pay, an up to $1 million cost. While the funds are expected to first come out of the police budget, the ordinance makes clear that PPB can request additional funds in the spring.
Wheeler’s emphasis on hiring police and paying them more overlooks the fact that we can also reduce their workload.
A primary objective of Portland Street Response is to reduce police calls by responding to those coded “unwanted person” and “welfare check.” In its second year of operation, Portland Street Response reduced the police response for these calls by 19% — reducing the total police call load by more than 3% during the daytime hours it was operating, according to the Portland State University evaluation.
That’s a great success, but police could be relieved of many more of these calls should Portland Street Response be built up further. It’s particularly important the program is expanded 24/7, which serves the additional benefit of achieving a necessary facet of obtaining Medicaid funding. Mobile Crisis Teams must operate 24/7 to qualify.
Locking in Medicaid funding will require the state and the city to prioritize this work. As the conduit for Medicaid funds, the Oregon Health Authority needs to fix rules, and City Council needs to expand the program to operate 24/7.
But, hey, the timing is perfect. This Central City Task Force is supposed to be focused on quick action through state and city collaboration, and that is exactly what we need to get this done.
No one seems to be working with a sense of urgency, though. My hope is that Kotek will change that.
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