Mental health providers upset over Oregon’s funding formula

From the Salem Statesman Journal, June 21, 2014

When Oregon Senate President Peter Courtney, D-Salem, pushed for increased spending on mental health care in 2013, the one thing he feared might happen was the money wouldn’t make it to the people and places it was needed.

Lawmakers allocated $65.1 million to the Oregon Health Authority in the 2013 session for investments in mental health services. Then, they came back and added an additional $20 million during the September 2013 special session through an increase in the state’s cigarette tax.

OHA decided to eschew its traditional funding formula. Instead, the agency used a grant application process designed to give smaller counties and mental health providers a chance at larger awards.

Instead, the new approach upset some providers who felt forced to compete against each other for resources. And it frustrated rural communities that lacked the time and resources to apply.

“We are a very tiny, rural county,” said Chris Siegner, who runs Harney County’s private mental health provider called Symmetry Care. “We don’t have grant writers who manage all the documentation that go along with it.”

Symmetry Care didn’t apply for any of the 12 grants OHA made available.

“The frustrating part is we have to provide the crisis services anyway,” Siegner said.

In the early 2000s, the state and county health departments hashed out an agreement on how to distribute mental health dollars across the state. It was called the Kessler formula, and it used information such as population and risk factors to determine how much money each local mental health authority received for each two-year budget.

The idea was to create a system of mental health care that provided comparable services whether a person lived in Portland or Burns.

That system has some drawbacks, which is why OHA decided to try doling out some of its funds for 2013-15 budget using grants.

“Some programs require a large start-up amount,” said Pam Martin, the director of addictions and mental health for OHA. “If we had sent this money out using the Kessler formula, it would have distributed limited amounts of money across all organizations, but they wouldn’t have been able to dig in or start new programs.”

The hiccup was that writing the grants to secure those larger-than-average allocations is also a costly, time consuming process.

Marion County, which successfully applied for seven grants totaling $2.1 million, had “teams of people writing constantly,” said Rod Caulkins, the administrator for the Marion County Health Department. “It was a lot of work.”

The major complaint OHA heard when talking with people about the new approach was that the process was complicated and time consuming, Martin said.

Some rural counties did manage to successfully apply for grants.

For example: Wallowa County was awarded $137,500 to provide mental health services in area schools.

OHA plans to continue to use both the Kessler formula and a grant-based system to fund community mental health programs, but the agency is open to modifying how the grant process works.

“We asked for feedback about the process in our newsletter,” Martin said. “We are really interested in people have had to say about how we can make it easier and what support people can provide.”