A planned shift of Oregon Health Plan patients away from Jackson County Mental Health services is causing angst and confusion, with opponents of the move launching an online petition and about 30 county workers already leaving their jobs.
Jackson County and AllCare Health were not able to reach an agreement in January for the county to continue providing mental health care to AllCare's 23,000 members in the county. Grants Pass-headquartered AllCare is a coordinated care organization managing physical and mental health care for its OHP members in four southwest Oregon counties.
Jackson County had been providing the mental health care for $13 million a year. The county said it couldn't accept an $8 million offer without dipping into its general fund to subsidize the $5 million difference.
A contract between the county and AllCare ends March 31. AllCare asked for a three-month extension in January.
The county and AllCare remain in closed-doors negotiations.
"We're still in negotiations and talking about various options," Jackson County Administrator Danny Jordan said Friday.
Jordan said he does not believe AllCare can transition mental health patients to other providers by the time the current contract expires.
"Right now the contract expires at the end of March. I can't imagine they'll have the capacity to do this on April 1," he said.
The other coordinated care organization serving Jackson County OHP patients, the nonprofit Jackson Care Connect, previously decided to stop using most county mental health services, in part because of cost concerns over the $15 million it paid the county annually.
Jackson Care Connect began an 18-month transition plan to other providers in January. Jackson Care Connect is transferring its OHP members to ColumbiaCare, Kairos and other mental health providers, with the county continuing to provide limited help, such as crisis services.
More than 60,000 Jackson County residents — almost one-third of the population — are now on OHP due to health coverage expansion from the federal Affordable Care Act, also known as Obamacare. The federal and state governments subsidize Affordable Care Act coverage, but Congress and the Trump administration are planning significant changes.
The state is facing a $1 billion budget deficit from the costs of expanding health coverage.
If both AllCare and Jackson Care Connect stop using Jackson County Mental Health for the bulk of services, the county will lay off approximately 200 employees, including about 180 in the mental health division, county officials have estimated.
Jordan said about 30 employees have already left or given notice.
"Thirty employees is a lot of capacity," he said. "It's probably one-quarter of what we recruited in the last year. Our ability to continue is being affected for sure."
The county had been recruiting mental health workers from across the nation to meet the increased service load triggered by the Affordable Care Act and county contracts with AllCare and Jackson Care Connect.
Amid the uncertainty, opponents of the shift away from Jackson County Mental Health services have launched an online petition targeting AllCare. At least 90 people had signed the petition as of Friday.
The petitioners say AllCare should not shift services to Grants Pass-based Options of Southern Oregon because Options lacks enough local providers and services to handle the load.
"There is already a serious lack of services in our area for those with mental health needs," commented petitioner Kristin Bjorklund of Ashland. "Please do not make the situation worse. This could have a very serious negative impact on our community in many ways."
Petitioner Joan Vanderveldt of Medford said the shift in care would put a vulnerable population at risk.
Noel Chatroux, an independent mental health care worker based in Ashland, said, "There is enough uncertainty and perception of danger at the federal level without adding more chaos at the local level. This is very distressing to members and providers."
Jan Yost of Medford, who contacted the Mail Tribune, said she has a loved one who was in a state psychiatric hospital, an Options facility and a ColumbiaCare facility. She said she was grateful to every provider, but it was Jackson County Mental Health that coordinated the care for her loved one, who has Jackson Care Connect OHP coverage.
Yost called the county mental health workers her "angels," and said they care deeply for the people they coach through the system.
"I don't want them to be destroyed. It has taken years to develop their successful programs. These are good people," she said.
In a letter to the editor, Susan Johnson, a nurse at Asante Rogue Regional Medical Center's 18-bed psychiatric unit, said the Medford hospital's emergency room has been inundated with people in mental health crisis in recent years.
She said with contracts in place with AllCare and Jackson Care Connect, Jackson County Mental Health rose to the occasion and provided more services, especially crisis support, to help patients in the overloaded emergency room. Meanwhile, Johnson said, Josephine County-based Options gave minimal help, even during business hours. Jackson County Mental Health workers also provided care for patients coming from Josephine County.
Those who have signed the online petition say AllCare is choosing profits over people, and is shifting away from Jackson County Mental Health in order to spend less on patients. They point to $3 million in 2016 dividends and distributions AllCare — a physician-led, for-profit organization — reported to the state.
Josh Balloch, vice president of government affairs and health policy for AllCare, said that $3 million went from the AllCare coordinated care organization to the AllCare holding company for infrastructure improvements, including a new claims system.
"That money was spent on improving the overall delivery system for members," Balloch said.
He said negotiations are ongoing with Jackson County.
"Right now we are communicating with Jackson County. It's still a work in progress. We remain hopeful for a partnership with Jackson County Mental Health to deliver the best care," Balloch said.
While Jackson County was offered $8 million instead of $13 million for care, Balloch said AllCare remains committed to investing the same amount of money into mental health services in the county. However, those services could be provided in other settings.
Options, which was negotiating on AllCare's behalf with the county in January, made the $8 million offer, according to county officials.
Options Executive Director Karla McCafferty previously said Options made a fair offer to Jackson County for continued services. The difference between the new offer and past payments would have been used to fund expanded mental health care in the community, including psychiatric hospitalizations, residential programs and respite care.
Balloch said AllCare will continue to spend the $13 million in Jackson County, but will use the money to increase the number of providers and diversify the types of providers.
"We wanted to make sure we were using our dollars as efficiently as possible to get the best care," he said. "We are spending the same amount of money. It's about maximizing our ability to get the most services possible for our members. That is our only reason for this move."
Balloch said AllCare patients and concerned community members are welcome to call AllCare at 541-471-4106.
AllCare is also planning a community meeting for people to learn more from 12:30 to 2 p.m. Saturday, Feb. 25, at Pioneer Hall, 73 Winburn Way, across from Lithia Park in Ashland. A second meeting is planned from 5:30 to 7 p.m. that evening at the Medford library, 205 S. Central Ave.
The meetings will include a presentation and question-and-answer period, Balloch said.