The Oregon Health Authority needs to step up efforts to provide health care for Oregonians who speak different languages and to expand access to behavioral health care treatment, a new state report found.
The report , released the week of July 15 by the authority’s Ombuds Program, scrutinizes shortcomings in the state’s Medicaid program, which provides medical, dental and behavioral health care for low-income Oregonians. It found that people who speak a language other than English can struggle to access services, especially when providers lack staff or interpreters that speak their language.
Other Oregonians faced a lack of residential behavioral health facilities and outpatient clinics, which forces long waits, inadequate care or both.
The Oregon Health Plan, the state’s Medicaid program, covers 1.4 million Oregonians who earn up to 138% of the federal poverty level, or nearly $21,000 per year for one person or more than $43,000 per year for a family of four.
The Ombuds Program operates within the Oregon Health Authority independently of Medicaid and advocates for people to receive better access to health care. In 2023, the program responded to nearly 3,000 concerns, most of them related to the Medicaid program. The concerns encompass a range of issues, including access to care, quality of care or billing problems.
Sarah Dobra, the Ombuds program manager, said in a statement that the health authority needs to act on “solutions for our statewide behavioral health crisis.” The authority also needs to work together with the regional Medicaid insurers that contract with the state to serve patients, Dobra said.
The report, based on state data and the stories of Oregon Health Plan members, also provides a window into the experiences of everyday Oregonians as they struggle to access care.
Struggles in the system
In one account, an immigrant mother took her disabled son to a doctor’s appointment through a medical transportation company. The driver dropped off the mother, who doesn’t speak English, and her son in pouring rain a few blocks from the appointment. The transportation company wouldn’t accept her complaint, the report said.
“This invalidated the member’s experience, failed to elevate his voice and did not account for language or disability accommodations,” the report said.
In another account, a family with a child with complex mental and physical health could not find a residential facility. The Ombuds program worked with the Medicaid insurer to find intensive care so the child could return home from the hospital. Eventually, the home-based care was lined up, but that was not the best outcome.
“The youth never received the originally recommended level of care — placement in a rehab facility,” the report reads.
In another instance, a woman needed a therapist for mental health care. Her Medicaid insurer provided her a 90-page list of 772 providers, but only eight worked in her region and were qualified to serve her. Some worked in other specialties, like addiction treatment and children’s behavioral health. One was deceased and others had moved out of Oregon.
“This caused (the) member to become distressed, anxious and sleepless,” the report reads.
The report recommends higher Medicaid payments for medical and dental providers who have interpretation services. Behavioral health providers already receive higher payments for interpretation services.
The report’s findings reflect ongoing and persistent concerns about the behavioral health system, said Kevin Fitts, president of the Oregon Mental Health Consumers Association. The small Portland-based nonprofit lobbies to give residents a greater voice in the state’s behavioral health system.
In an interview, Fitts said people are frustrated when they try to navigate a system with inadequate access or services. He said policymakers need to keep the voice of consumers who need care at the forefront of efforts to make improvements.
“People are apathetic and numb about the lack of responsiveness to the issue and I think we’ve had plenty of reports and audits that suggest this is a huge challenge,” he said.
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