Rural Health Transformation, Wildfire Season Recap, and Oregon’s Response to Federal Actions on Health and Human Services

Oct 1, 2025 | AOC Advocacy, Health & Human Services

In case you missed it: Sept. 26 Local Government Advisory Committee (LGAC) on Health and Human Services (Meeting recording and chat transcript)

Rural health

Oregon’s Office of Rural Health (ORH) was established by the Legislature in 1979 and moved from the state public health department to OHSU in 1989. It collects data and provides reports, technical assistance and coordination of rural health activities, as well as recruitment support for rural communities’ health care and Emergency Medical Services (EMS). ORH defines ‘rural’ as any geographic area in Oregon ten or more miles from the centroid of a population center of 40,000 people or more, and ‘frontier’ as any county with six or fewer people per square mile. 

Director Robert Duehmig’s slides provide several maps illustrating the locations of these areas, details and links on their available workforce recruitment and retention programs, and examples of the technical assistance and tailored reporting available to rural communities. This technical assistance may be particularly useful to volunteer-staffed EMS to train them on billing practices to maximize service reimbursements.

ORH staff will return to LGAC early next year to provide an update on the implementation of their integrated mobile health program funded by a new Health Resources and Services Administration (HRSA) grant.

Oregon Health Authority (OHA) Policy Director Steph Jarem gave an update on Oregon’s Rural Health Transformation plan development in response to the application released by the Centers for Medicare and Medicaid Services (CMS) on Sept. 15. A public forum will be held the week of Oct. 6 to gather additional input. The application is due Nov. 5 and award decisions are expected by Dec. 31 for a five-year grant. OHA expects to release its RFP in mid-February with local award decisions slated for early May. Director Jarem’s slides provide helpful details on federal eligibility requirements, allowable and not allowable use of funds, and Oregon’s four priority areas. The ‘ruralness’ score estimates for the program are posted on the Sheps Center website.

Wildfire season recap

While there is still some fire activity, the season is quickly winding down. It was a lighter than expected year with only two major events ─ the Rowena Fire in Wasco County and the Flat Fire in Deschutes and Jefferson counties. The state Office of Resilience and Emergency Management (OREM) is providing recovery coordination which includes training and support to local human services partners for safe drinking water and hygiene and providing impact assessment and disaster case management at a per household level. 

The county-based disaster registry is an especially valuable tool, with the help of OREM, to populate ahead of an event to allow for very precise evacuation planning for community members at highest risk and efficient emergency response during a disaster.

Recovery coordination is ongoing for the 2025 spring floods in Harney, Douglas, Coos and Malheur counties and for communities impacted by the 2020 wildfires. Director Ed Flick’s slides include a map of resilience hub resources deployed across the state, details of the Genasys Evac tool OREM is piloting and a look ahead at two likely 2026 legislative session bills.

State response to federal policy and funding actions

Interim Deputy Public Health Director Danna Drum reported that the Women Infants and Children program is the only public health program expected to be impacted by the imminent shutdown of the federal government, with current funding likely to run out Oct. 15. Other programs can be maintained through the end of the calendar year and retroactive payment is anticipated once federal funding resumes.

The Oregon Housing and Community Services department is awaiting direction from federal agencies on the implementation of the presidential executive order on homelessness response. Counties and other federally funded Continuum of Care administrators are concerned about the likely fracturing of local homelessness response programs and coordination when federal policy mandates begin to conflict with state policy mandates for state-funded homelessness prevention and response services. 

Ashley Thirstrup from the OHA director’s office shared this August Oregon Department of Administrative Services analysis which includes the following excerpt:

“H.R. 1 Medicaid program changes have varying implementation dates. Effective fall 2026, OHA anticipates $22 million in reduced funding, impacting services for certain non-citizens, which includes asylees, refugees, and victims of human trafficking. As noncitizens lose access to services under this category, these populations will likely shift to access coverage under the Healthier Oregon Program (HOP) in order to access benefits. It is not yet clear how these changes will impact Tribal populations’ ability to access Medicaid-funded health services.

“Beginning January 1, 2027, OHA will have to implement changes to meet updated requirements to access Medicaid-funded services. To comply with these changes, OHA will need to make upgrades to existing IT systems to ensure that benefits are being offered in alignment with H.R. 1 provisions. OHA noted a potential need for additional staff to manage call centers to help benefit enrollees navigate pending program and benefit application changes, and staff will be needed to begin verifying eligibility of plan holders beginning in 2027. OHA projects that upon implementing processes to verify benefit eligibility every six months, Oregon will see a reduction in Medicaid funding of $127 million in the 2025-27 biennium, $534 million in the 2027-29 biennium, and $571 million in the 2029-31 biennium. When OHA implements processes to ensure that enrollees comply with work requirements, the projected revenue lost is $344 million in the 2025-27 biennium, $2.2 billion in the 2027-29 biennium, and $2.3 billion in the 2029-31 biennium.

“While OHA manages upgrading existing IT systems to enact this work, the agency will also be working to complete work to stand up a new State Based Marketplace for individuals to secure health insurance coverage. It will be important to ensure that OHA has the capacity and clarity needed to deliver on the work required in H.R. 1, as well as projects included in the agency’s 2025-27 budget. OHA anticipates receiving approximately $175 million to support rural hospitals and health systems during the 2025-27 biennium. 

“H.R. 1 will also reduce the resources OHA can draw down from Medicaid based on the Hospital Provider Tax assessed on providers and insurers. The projected reductions to revenue will be $603 million in the 2027-29 biennium, and $1.7 billion in the 2029-31 biennium. Additionally, adults that have Medicaid-funded plans through the Affordable Care Act will have to share a portion of the costs for accessing benefits and services.”

Oregon Department of Human Services Deputy Director of Self Sufficiency Programs Jessica Amaya Hoffman shared the agency’s analysis of the impacts of H.R. 1 on the USDA’s Supplemental Nutrition Assistance Program (SNAP) in Oregon. Immediate impacts include:

“The current levels of support to community providers serving existing SNAP clients will be insufficient to meet needs once SNAP benefits are reduced or eliminated for a portion of the current caseload. The exemption of certain individuals from SNAP benefits will likely place additional pressure on the food bank system as well as other systems of social support throughout Oregon. About 310,000 adults will need to be reviewed for work requirements or exceptions for SNAP eligibility; about 3,000 individuals will lose benefits, including refugees, asylees and other conditionally allowed individuals. SNAP benefits won’t rise with food prices, making it harder for people to afford groceries. About 29,000 households will see an average monthly benefit decrease of $58.

“It should be noted that ODHS expects significant staffing cost increases to comply with the changes in H.R. 1, particularly in the Oregon Eligibility Partnership (OEP) to administer the new Medicaid-eligibility and redetermination requirements. The effective date for many of those changes is December 31, 2026. The changes will require extensive administrative infrastructure, including monthly verification systems, rulemaking, notices, and coordination across ODHS, the Oregon Health Authority (OHA), and the Employment Department. Implementation of the changes will also require significant IT system changes that will carry additional costs. For example, ODHS has estimated a need for approximately 600 positions solely for the more frequent Medicaid eligibility redeterminations.

“Aside from immediate impacts to ODHS customers, the Department is in the process of forming a team to bring down the SNAP error rate. Under H.R. 1, if the SNAP error rate is below 5.99 percent, a state’s share of the cost of benefits remains at zero percent. Only eight states are below 5.99 percent, according to the most recent data reported by Federal Funds Information for States. OEP has indicated that the SNAP error rate will still be above the national average for federal fiscal year 2024, the error rate is expected to be closer to 13 percent, compared to 16 percent in 2023 and 22 percent in 2022. If Oregon can bring down the SNAP error rate, potential savings are significant. If the current error rate continues, the state will be responsible for 15 percent of SNAP benefit costs or approximately $0.5 billion per biennium.”

Contributed by: Jessica Pratt | Legislative Affairs Manager