Oregon Health Authority’s 2025 behavioral health proposals are sparking significant concern among mental health professionals and the clients they serve. The proposed reversal of a 2016 decision stands out as a particularly troubling development. This 2016 decision, which allowed board-registered associates to work for OHA-licensed entities, but not require the extra-cumbersome Certificate of Authority, is now under threat. The 2025 proposed policy seeks to force associates to work exclusively in Certificate of Authority (COA) agencies such as Community Mental Health Programs (CMHPs) or hospital-based programs. This move not only restricts employment options and wages for associates but also risks disrupting the quality and continuity of care for Oregon Health Plan (OHP) members. Some have even called it serious prejudice.
A Brief History: “Serious Prejudice” in 2016
In 2016, Oregon Health Authority (OHA) behavioral health system made a pivotal change to address a critical gap in mental health services. By allowing board-registered associates—those who have completed their master’s degree but are not yet fully licensed—to work at non-COA agencies, the state expanded employment opportunities and helped alleviate the severe shortage of mental health providers. According to the Oregon Health Authority (2016), “Behavioral health providers registered by Oregon regulatory boards as interns or licensed as non-clinical providers are eligible for and need to enroll as a provider of services in the Oregon Medicaid program and claim for services rendered to Oregon Medicaid recipients.” OHA went on to assert that not having these providers within the system was a “serious prejudice to the public interest, the Authority, Medicaid recipients and eligible providers.” (Oregon Health Authority, 2016)
This 2016 step further aligned Oregon Administrative Rules (OAR) with Federal Center for Medicare and Medicaid Services (CMS) rules such as 42 CFR § 438.214 which reads:
Nondiscrimination. MCO, PIHP, and PAHP network provider selection policies and procedures, consistent with § 438.12, must not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. (Provider Selection and Credentialing, 2025)
A MCO is equivalent to a CCO, or Coordinated Care Organization, which is the vehicle for healthcare for medicaid recipients in Oregon. Oregon Board registered Clinical Social Worker Associates (CSWA) are “high-risk population serving” providers who often, for the majority, serve the medicaid population within OHA-licensed-entities, within CCO contracts and CCO credentialing. Not to exclude Oregon Board licensed Marriage and Family Therapist Associates (MFTA) and Professional Counseling Associates (PCA) are also of this kind. They are preventing and treating suicide ideation, homicide ideation and domestic violence to just name a few things these hard working providers are actively doing in various settings throughout the State. Still, OHA wants to remove them from the provider network or give them a cumbersome path that will impact their job security, wage security and ability to serve their present populations in the least restrictive environments.
2025 OHA “Serious Prejudice” Proposal: A Restriction on Freedom
The proposed OAR reversion is an about-face from OHA’s assertions in 2016 that it was a “serious prejudice.” It threatens to undo this progress by mandating that associates no longer treat medicaid recipients under the Oregon Board recognized licenses but instead as Quality Mental Health Professionals (QMHP) within a Certificate of Authority (COA) organization. This move could be interpreted as a violation of said Federal law (42 CFR § 438.214) as it will remove the ability of a provider-type (CSWA, MFTA, PCA) to serve medicaid recipients and be reimbursed for their services within the Oregon Board protected titles.
To further contrast (Masters Degree attained, Oregon Board registered) associate mental health providers with QMHPs, the latter can be bachelor degree educated individuals. This includes registered nurses or occupational therapists who are licensed with the state and only have a bachelors degree. All Oregon Counseling Boards (OBLCSW & OBLPCT) would not accept this education type and training but OHA’s COA holders do. This becomes kinda worse when you learn that they also let non-board registered, bachelor degree attained (within a master’s program for counseling) individuals to also be a QMHPs (Oregon Health Authority, 2021). Here too, the Oregon Counseling Boards do not allow this as it could be interpreted as a watering down of the profession and absolutely not to the definition of CSWA, PCA or MFTA.
Legalities and the present watering down system aside, this change also eliminates the freedom of choice for associates. Forcing them into employment at specific programs, regardless of their career aspirations or preferred work environments, is a restriction on freedom. Such a restriction feels like a step backward, ignoring the diverse needs of both providers and clients in Oregon’s behavioral health system.
For associates, this policy is more than an inconvenience; it’s a significant limitation on their professional growth and livelihood. Outpatient Mental Health Agencies often offer a broader range of therapeutic approaches, specialized training, and innovative treatment models. By contrast, CMHPs may not always align with an associate’s career goals or preferred modalities of care. Furthermore, the pay at CMHPs is sometimes half of what associates might earn at Outpatient Mental Health Agencies, and the work hours for full-time positions are often 10 hours longer per week. Removing the option to work in OHA-licensed (non-COA) organizations effectively denies associates the opportunity to choose the path that best suits their professional development and their ability to survive in today's climate.
Serious Prejudice “Strengthening”
Beyond not aligning with many of its ideals, goals and values, OHA has not fully done the “Community Engagement” part of its rule change process. The OHA Director’s Listening Tour was broad and largely consisted of CCOs, CMHPs, Hospitals and Special Interest Groups with no mention of this specific proposal on any agenda or advertisements. Hardly sounds like a transparent community engagement process for a rule change. Surely providers and OHP members would have attended if it meant decisions could be made that could lead to loosing their jobs and/or providers. Instead the idea jumps over this OHA supposed procedural step and is presented as inevitable with strong pressure to adopt an un-established and potentially unlawful OAR.
There are contradictions aplenty. For example the OHA Director’s Listening Tour Report (2024, December) also plans to “Meaningfully addressing administrative burden in behavioral health.” Yet, OHA’s other listening report proposal, “Strengthening the community mental health workforce” (aka force all associate mental health providers into COA organizations), is the epitome of administrative burden and is also not the recommendation of the HB2235 legislative committee setup to address workforce shortages. It appears that OHA is misrepresenting the HB2235 committee on two fronts. Even the use of the word “Strengthening” is an further example of Orwellian doublespeak as seen by who can be a QMHP and as you will further read about with the impact on clients, schools and communities beyond the workforce themselves.
The Impact on Clients
Clients are the ones who will bear the brunt of this policy change. Many OHP members have formed strong bonds with their associate-level providers, who have been integral to their mental health journey. Forcing associates to leave OHA licensed agencies likely will result in clients losing their trusted providers, a disruption that can set back progress, erode trust in the system and cause significant mental/emotional damage.
Additionally, the quality of care may vary between organizations. Clients may find that the care they receive at CMHPs does not meet their specific needs such as specializations or competencies. They could face longer wait times due to staffing shortages or sparse treatment like monthly appointments. They might have to travel even further for care which is a burden of time and money on a weekly basis. This could lead to a decline in overall satisfaction, deterioration of mental health and outcomes for OHP members.
This policy change could also have profound implications for schools across the state. Stronger Oregon, a program present in more than 10 school districts, relies on associates and licensed providers to serve students. These professionals are critical in addressing the mental health needs of young people in a school setting, where early intervention can be most effective. If the proposed rule is passed, schools might lose these essential providers, forcing them to rely on fewer resources or less specialized staff. This could leave many students without access to timely and appropriate care, compounding the challenges faced by schools and families alike.
Why This Matters
Oregon’s behavioral health system is already strained, with too few providers to meet the growing demand for services. The 2016 decision to expand associate employment opportunities was a forward-thinking solution that addressed this challenge while supporting the increase of mental health providers serving OHP covered Oregonians. OHA-Licensed Agencies, without a COA, have also introduced innovative models that help retain the workforce by reducing burnout. Associates working in these settings often benefit from manageable caseloads, the ability to offer the quality of services that clients need, and a supportive environment. Reversing this decision not only removes vital employment options but also risks exacerbating provider shortages through burnout, restrictions on freedoms, forced relocation, decreases in compensation and disrupting care for some of Oregon’s most vulnerable populations.
A Call to Action
Oregonians are encouraged to take action by contacting their Oregon legislative representatives in the Senate and the House. You can use the COPACT’s (Coalition of Oregon Professional Associations for Counseling and Therapy) online system for electronically submitting a letter to your Oregon representative. There is a link for patients and providers.
Patient Action Alert
Provider Action Alert
You can also sign the petition via google forms: https://forms.gle/Ekcj5sXanNq5GHbT7
Associate’s deserve freedom of choice.
References:
Oregon Health Authority. (2024, December). OHA Director 2024 Statewide Listening Tour. https://www.oregon.gov/oha/Documents/OHA-2024-Listening-Tour-Report_12.2024.pdf
Oregon Health Authority. (2021). Specific staff qualifications and competencies (OAR 309-019-0125). Oregon Secretary of State. https://secure.sos.state.or.us/oard/view.action?ruleNumber=309-019-0125
Oregon Health Authority. (2016). DMAP 50-2016(T). Oregon Secretary of State. https://records.sos.state.or.us/ORSOSWebDrawer/Recordhtml/8023687
Provider Selection and Credentialing, 42 C.F.R. § 438.214 (2025). https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.214