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Well over a year and a half into an effort to revamp the state’s “backbone” system for funding and delivering behavioral health care, counties are still balking at the Oregon Health Authority’s pitch.
Under Oregon’s fragmented mental health care system, the disputed arrangements, known as County Financial Assistance Agreements, have for decades been the primary way the OHA partners with counties to fund and organize services like case management, substance use disorder treatment, and problem-gambling programs—particularly when those services are not eligible for Medicaid dollars.
The state, which is seeking to finalize revamped agreements in a matter of weeks, describes its plan this way: It would make it easier for counties to shape their plans around regional needs. It would provide them more funding stability. And it would set “clear expectations for counties to ensure transparency around funding, data, and outcomes.”
Multnomah County Commissioner Meghan Moyer is among those who see the new proposal very differently.
In an interview, she listed two core objections: One is the removal of a contract provision that shields counties from liability if they don’t meet certain terms of the contract as a result of inadequate funding. “That is the single biggest issue,” Moyer says. “We’re not willing to take on that liability for something that is still fundamentally a state function that we are taking on for them.”
The OHA counters that the contract has language clarifying that counties will not have to rely on non-state funds to fund the required services, thus ensuring that no “service that OHA is requiring is unfunded.”
But officials like Moyer are skeptical. And she has a second objection: The state wants counties to shift their behavioral health care focus almost entirely toward “aid and assist” patients—people who have been charged with a crime but deemed incapable of aiding in their own defense, and who the state is under serious pressure to process faster. (It’s subject to a court order that exacts near-constant fines.)
The state wants every county to “make that their number one priority,” Moyer says. “And it’s like, ‘Well, actually, that’s your responsibility.’”
The model for County Financial Assistance Agreements was developed long ago, amid a different health landscape, OHA spokeswoman Kim Lippert said in an email. Over time, she said, laws, funding streams, regulations and community needs have evolved.
For that reason, she said, the OHA and the Association of Oregon Community Mental Health Program launched a joint rewrite in April 2024 to “modernize the framework and clarify expectations.”
The revamped agreement, which the OHA is rushing to put into effect by Jan. 1, clarifies shared roles and strengthens partnerships, Lippert said, adding that the revisions “ensure that every dollar spent supports meaningful results while keeping counties central to the delivery of community-based care.”
But county frustrations have been festering for a while now. As The Lund Report has documented, in June the state announced it would push the signing deadline back six months to the end of the year, when a harder deadline kicks in.
And more recently the state has been imposing—and then, out of necessity, adjusting—more immediate-term deadlines as counties refuse to sign. Documents obtained by via a public records request show OHA Behavioral Health Director Ebony Clark twice, since Oct. 28, moving back deadlines for counties to “notify us of your intent” as to whether they would sign the contract.
Moyer has been unimpressed with the moving dates, which she said are completely arbitrary. “They’re posturing in a way that I don’t understand because they’re in contempt of federal court,” she said, referring to the legal albatross regarding getting the “aid and assist” prisoners into care.
“They’re not in a position to be telling other people to fix their problem,” Moyer says. “Like what would happen if Multnomah County didn’t sign it? What would they do? We put local dollars—significant local dollars—into our behavioral health system. Who is going to come in and be our local mental health provider for all of Multnomah County? I don’t think there is even anybody capable of doing that. So their threatening posture is not productive.”
The state’s proposed contract lists a priority system for the services provided by a “coordinated crisis system.” Top goes to the aid and assist population, as well as others held under terms of the legal system, such a those who have been found guilty of a crime exempt for insanity, or are being help under civil commitment.
Second priority would also go to people who have had brushes with the law or courts.
The debate is not whether such populations ought receive care. At issue is civil liability, and the question of where limited resources ought to be deployed.
Multnomah County Commission Chair Jessica Vega Pederson said in a statement that “Multnomah County is aligned with the state on our overall goal: serve people through a well-coordinated behavioral healthcare system that meets individuals where they are at and efficiently uses resources to provide the best care possible. We are negotiating to accomplish that shared goal but also need to ensure that the needs of all counties, and specifically for me, Multnomah County, are addressed in this contract.”
Multnomah County is far from the only jurisdiction that says it is not prepared to accept OHA’s terms. At a meeting last week, for example, Yamhill County commissioner Mary Starrett celebrated a recent Association of Oregon Counties event in which, she said, members came together over the contract debate, not at a matter of right or left, but right or wrong.
“This is such a textbook example of unfunded mandates,” she said, arguing that the state was trying to put its own court-mandated obligations on the backs of counties. It is impossible to comply with the proposed contract without more money, she said.
Starrett reflected on a saying: “‘He who’s got the gold makes the rules.’ And that’s OHA. And we’re saying ‘That might be fine. But we provide the services.’”
