A Step Backward for Providers, Clients and Oregon

Oregon’s 2025 behavioral health legislative 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 decision, which allowed board-registered associates to work for state-licensed entities such as Outpatient Mental Health Agencies is now under threat. The proposed policy seeks to force associates to work exclusively in Community Mental Health Agencies (CMHAs), such as county-operated or hospital-based programs. This move not only restricts employment options for associates but also risks disrupting the quality and continuity of care for Oregon Health Plan (OHP) members.

A Brief History: Progress Made in 2016

In 2016, Oregon’s 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 Outpatient Mental Health Agencies, the state expanded employment opportunities and helped alleviate the severe shortage of mental health providers. This policy enabled associates to gain valuable supervised experience while providing much-needed care to OHP members.

The flexibility to work at Outpatient Mental Health Agencies was a win-win: associates had more choices for employment, and clients gained access to a wider network of providers in more localized offices. For nearly a decade, this model has proven effective, with many OHP members building strong therapeutic relationships with their associate-level providers.

The 2025 Proposal: A Restriction on Freedom

The proposed legislation threatens to undo this progress by mandating that associates work only in CMHAs or similar. This change eliminates the freedom of choice for associates, forcing them into employment at county or hospital-run programs, regardless of their career aspirations or preferred work environments. 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. Outpatient Mental Health Agencies often offer a broader range of therapeutic approaches, specialized training, and innovative treatment models. By contrast, CMHAs may not always align with an associate’s career goals or preferred modalities of care. Furthermore, the pay at CMHAs 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 Outpatient Mental Health Agencies effectively denies associates the opportunity to choose the path that best suits their professional development and their ability to survive in today's climate.

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 Outpatient Mental Health Agencies could 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. Outpatient Mental Health Agencies often have distinct policies, specialized programs, and resources that are better suited to certain populations. Clients may find that the care they receive at CMHAs does not meet their specific needs or that they face longer wait times due to staffing shortages or sparse treatment like monthly appointments. This could lead to a decline in overall satisfaction, deterioration of mental health and outcomes for OHP members.

Why This Matters

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, within their schools, of all insurance types. 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.

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 professional development of future licensed therapists. Outpatient Mental Health Agencies 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 that avoids the toxic, work-horse culture, common in other settings. Reversing this decision not only removes vital employment options but also risks exacerbating provider shortages and disrupting care for some of Oregon’s most vulnerable populations.

A Call to Action

People are encouraged to take action by contacting their Oregon legislative representatives in the Senate and the House. You can find your representatives by calling 1-800-242-8478 and asking for your town’s state representative, or by searching online. Ask for their phone number and reach out to share your concerns.

Additionally, it is important to contact the following legislators directly:

Finally, both providers and clients can reach out to the Oregon Health Authority (OHA) for assistance. Providers and clients can call 503-947-2340 to talk to the director of OHA. Feel free to point them to this website for a detailed rebuff to their poorly explored policy recommendation.

Make your voice heard to ensure a fair and effective behavioral health system for all. Legislators must consider the far-reaching implications of this policy change. Restricting associates to CMHAs is a regressive move that undermines progress made in recent years. Instead, Oregon should focus on strengthening its behavioral health workforce by maintaining and expanding opportunities for associates across diverse settings. It should be focusing on the causes of burnout of our workforce, not forcing them into lower paying, higher caseload and geographically constrained jobs.

Clients, providers, and advocates must raise their voices to protect the gains made since 2016. It’s time to remind policymakers that freedom of choice for associates is essential—not just for their professional growth but also for the quality and continuity of care for OHP members. Oregon’s behavioral health system deserves policies that prioritize innovation, flexibility, and the well-being of all stakeholders.

Sign the petition via google forms: https://forms.gle/Ekcj5sXanNq5GHbT7

Join the protest and post this all over social media: