Multnomah County, Portland providers criticize Measure 110 grant process

Portland Business Journal, July 21, 2022

Multnomah County and seven other behavioral health providers expressed disappointment with how Measure 110 grants have been allocated and are asking the Oregon Health Authority to reconsider.

The organizations detail their criticisms — missed opportunities, lack of fairness and innovation and “rushed and poorly developed” application materials — in a June 29 letter to OHA and the Measure 110 Oversight and Accountability Council. The groups are asking for a formal review and redetermination, as first reported by Willamette Week.

Voters in November 2020 passed the measure, which decriminalized small amounts of street drugs and created a new funding stream for low-barrier substance use disorder services, including peer support, harm reduction and supportive housing.

OHA declined to discuss ongoing negotiations in specific county regions, including Multnomah County.

“Measure 110 represents an innovative and first-of-its-kind health-based approach to addiction and overdose,” OHA said in a statement. “We acknowledge that there may be concerns about the funding decisions. We have been, and are continuing to, invite feedback and suggestions for process improvement.”

The 21-member Oversight and Accountability Council, which is made up largely of people who have experienced substance use disorders themselves, and OHA have reviewed 335 provider applications and awarded letters of intent to 242. Behavioral health resource networks, or BHRNS, have now been approved in 29 of Oregon’s 36 counties.

The council devised a formula for awarding $365 million in grants statewide, based on the county’s Medicaid and homeless populations, arrests and drug overdose deaths. Multnomah County was awarded the largest share of funds, at $58.8 million. OHA lists 41 approved service entities in the county, among them Central City Concern, OHSU Addiction and Complex Pain, Cascade AIDS Project, New Avenues for Youth and Outside In.

The June 29 letter is signed by Julie Dodge, interim director of Multnomah County’s behavioral Health Division, and leaders of the following grant applicants: Fora Health, Holistic Healing Behavioral Healthcare, Recovery Works NW, Mental Health & Addiction Association of Oregon, LifeWorks NW, Cascadia Behavioral Healthcare and the City of Portland.

Problems they flagged include a complicated application process and tight deadlines.

“A majority of providers were confused about how to request funding for forming a BHRN,” the letter says. “Organizations were unclear on which sections of the application they needed to complete and the materials they were required to submit in partnership with others.”

Many small, culturally specific organizations that lacked grant writing experience “struggled or were unable to develop applications with just five weeks,” the providers said.

Dodge and the other leaders also said the council “too often made funding decisions using information from outside the scoring rubrics, reviewer recommendations and applications.” Providers were declined funding because they were “perceived as having enough revenue.” Some council members said they were hesitant to fund lesser-known entities, the letter says.

“At other points, reviewers discussed their external knowledge of or relationship with an organization, reflecting a conflict of interest, which then seemed to impact how the panel voted,” the letter says.

The providers cite examples of requests that were declined, including a year-round transitional housing and emergency shelter in downtown Portland for 30 people and land to develop 80 units of permanent supportive housing and culturally specific services.

They further argue that the purpose of the newly created Drug Treatment and Recovery Services Fund under M110 was interpreted too narrowly.

“Agencies were often denied funding for medical staff, intake specialists, program directors, housing specialists and administrative staff,” the letter says. “Requiring agencies to deliver services without funding the very people necessary to provide them sets them up for failure and is one of the reasons the nonprofit sector has had such difficulty in retaining and expanding its workforce.”

This is not the first time that the M110 grant process has stirred controversy. Earlier criticism centered more on funding delays.

Grantees within a county must work together to establish a memorandum of understand among themselves to become a Behavioral Health Resource Network and negotiate final terms of the grant agreement before funds are distributed, which is expected to be ongoing through October.