Crisis Resolution Center plans changed

It secured most of the needed $50 million in grant funding, as Wasco County Commissioner Brady said during the June 26 Community Affairs meeting, and has been in the works for five years.

Earlier this month, Oregon Health Authority (OHA) deemed that, based on its interpretation of the federal Medicaid Institutions for Mental Diseases (IMD) rule, the project could not continue as planned. Ebony Clarke, a behavioral health director with OHA, announced the decision at the Behavioral Health Crisis System Advisory Committee Meeting on June 24.

Instead, Mid-Columbia Center for Living (MCCFL) will lead the construction of a smaller, OHA-compliant facility that includes residential substance use treatment and the small 23-hour crisis resolution facility.

Meanwhile, project leaders are calling OHA’s interpretation “arbitrary” and “legally questionable.”

“The Oregon Health Authority (OHA) is the primary obstacle to developing crucial mental health infrastructure,” said Magill in a press release.

He went on to say that OHA’s refusal to compromise on its “1,500-foot rule” deepens the mental health and substance use crisis in Oregon, stopping a project that could have addressed the Gorge’s lack of local services for its most vulnerable people.

“The bureaucratic roadblocks and failed leadership from the Oregon Health Authority are not abstract policy debates; they have real, tragic consequences,” said Magill in his press release. “As the sheriff of Wasco County, I have seen firsthand the devastating damage OHA’s inaction perpetuates. Every day, my deputies and I encounter the human cost of a broken system. We see the residents of the Columbia Gorge who are suffering, and we see the families torn apart by addiction and untreated mental illness.

“People are dying on our streets. They are dying in our communities. This is not hyperbole; it is the grim reality of OHA’s continued failure to support common-sense, community-driven solutions like the Columbia Gorge Crisis Resolution Center. While we work to build solutions from the ground up, OHA’s rigid and legally questionable policies actively stand in our way. The citizens of our counties, and all Oregonians, deserve better. They deserve an agency that works to save lives, not one that creates barriers that lead to more suffering and death,” he wrote.

OHA responded, "Oregon Health Authority is committed to partnering with communities across the state to support solutions that improve the lives of the people we serve. We share the strong commitment of Wasco, Sherman, and Hood River Counties to expanding access to behavioral health services and recognize the unique challenges rural counties face in meeting these needs.

"We carefully reviewed plans for three proposed residential treatment facilities, one substance use disorder facility and two mental health facilities, to determine whether they would comply with federal rules. We determined that the proposed substance use treatment facility would likely be eligible for Medicaid funding under the state’s current federal Medicaid waiver for Institutions for Medical Disease (IMD). We determined that treatment services at the two proposed mental health residential treatment facilities would not likely be eligible for Medicaid funding under federal requirements.

"OHA encouraged Wasco County to consult the State Medicaid Manual or Centers for Medicare and Medicaid Services to assure that services at the planned facilities would be eligible for Medicaid funding."

The project

More than 75 people and organizations from Wasco, Sherman, and Hood River counties began collaborating in 2019 after a Sequential Intercept Mapping study that “highlighted the urgent need for a local facility to serve individuals experiencing acute mental health crises, substance use disorders, and dementia-related conditions,” reads the press release. The Columbia Gorge Resolution Center (CGRC) Advisory Council, a multidisciplinary group tasked with developing a comprehensive solution, formed one year later.

They planned a 16-bed, secure residential treatment facility for those posing a danger to themselves and others; a 16-bed mental health residential treatment facility; a 16-bed substance use disorder residential treatment facility; a 6-8 chair crisis stabilization center; a consumer drop-in center; and a psychosocial rehab office.

“This campus model was designed to provide a continuum of care, addressing the complex needs of the community, particularly the high prevalence of individuals with a dual diagnosis of mental illness and substance use disorder,” said the press release.

In August 2023, the project’s first operating partner withdrew and an existing residential treatment facility in The Dalles closed. In response, Mid-Columbia Center for Living (MCCFL) and Wasco County administrators stepped in as leaders.

They proposed to reduce the secure residential treatment facility to eight beds max and use the remaining funds for a 20-bed residential treatment facility for substance use and dual diagnoses, and asked OHA for their original funding.

But the IMD rule forbids the use of federal Medicaid funds by facilities with more than 16 beds.

To comply, the Gorge Crisis Resolution Center planned multiple 16-bed facilities on one campus, each with a different purpose.

But OHA said these beds, located within 1,500 feet of each other and under the same ownership, broke the rule. That meant the project couldn’t get Medicaid funding for patients and was thus not financially stable.

Legal challenges

In response, the Oregon Association of Community Mental Health Providers commissioned a legal analysis from an independent contractor. That found the OHA’s decision is “inconsistent with the plain language of the federal Medicaid Act and guidance from the Centers for Medicare and Medicaid Services (CMS),” Magill wrote. The key points:

• The federal IMD law uses the term “institution” to mean a single facility or establishment, not a governing organization; therefore, analysts found, the 16-bed limit should only apply individually.

• The CMS State Medical Manual says that facilities should be considered separate if they are separately licensed. The Crisis Resolution Center’s proposed facilities would be separately licensed.

• OHA made its own IMD interpretation that said facilities must be 1,500 apart. The legal analysis found “no basis in federal law or CMS guidance” for this “arbitrary” and “overly restrictive” choice.

Still, OHA continues to enforce the “1,500-foot rule.” On June 24, it announced it won’t support any campus facilities that break the rule. It also enforces ORS 443.422, which requires agencies, before licensing a new facility, count any similar facilities within a 1,200-foot radius.

The IMD rule was created to address a rash of large, inhumane facilities in the 1900s. That’s not a problem in the Gorge now; a 2024 OHA study found the Columbia Gorge has zero residential beds for mental health, substance use, adult foster homes, or clinically managed withdrawal facilities (which help people stop their substance use).

“I want to personally thank those individuals who have supported this project from the very beginning. I want to especially thank the current members of the CGRC Advisory Council as well as those members who have gone before us. Your sacrifice for this project does not go unnoticed and for that I am so grateful,” Magill wrote.

“... May we never forget the lives of those our community has lost to addiction and suicide.”

The problem for law enforcement

In Wasco County, deputies and officers often handle mental health calls, people suffering from overdosing, and/or for substance use. Those issues cause other crimes like trespassing and disorderly conduct, The Dalles Police Chief Tom Worthy told Columbia Gorge News earlier this year.

It can even cause animal neglect problems, Magill said in a 2024 Columbia Gorge News interview. “Somebody has a drug addiction problem and has a dog. Guess what? They’re going to feed their addiction problem before they feed their dog.”

Substance use and mental illness are related. Between 2021 and 2022, Magill’s office did a study at NORCOR, examining the number of people incarcerated for behavioral health and drug and alcohol addiction.

They found that 54.1% of people repeatedly arrested had a mental health condition, Magill said in 2024. “Of the 54% that have a mental health condition, 47% of those actually have a drug and alcohol disorder,” he added.

If a person’s having mental health issues and their crime does not require “mandatory arrest,” officers are required to take them to MCCFL for evaluation before jailing them. To avoid taking a person with mental health issues to jail, officers will often substitute a cite and release for an arrest, Magill said. The person still gets charged and gets a court date. If they don’t pass that evaluation by MCCFL’s mobile crisis team, the person goes to a Portland facility for treatment on a police officer’s hold.

However, OHA’s Portland facility is currently facing fines and a federal ruling that says they’ve violated the U.S. Constitution by failing to “aid and assist” members of the public in need of urgent help: Because the need is so great, they can’t get certain mental health patients, those determined “unfit to stand trial,” into the state facility within seven days, as reported by KOIN. At least two individuals have died while waiting for transport there.

Another issue is that OHA cannot release patients in a timely manner due to lack of residential treatment facilities elsewhere.

For crimes that are “mandatory arrests,” such as a domestic altercation, Oregon law says the suspect must be arrested. Then, MCCFL dispatches to NORCOR, or NORCOR’s on-staff mental health clinician helps with the evaluation.

Some medical needs can be taken care of at NORCOR. If it’s a serious crime and someone in mental crisis cannot be released, NORCOR has a mental health wing — a separate block for people with such diagnoses.

“We have found that when you take certain individuals to jail that are having a mental health crisis, or they have mental health symptoms or things like that ... it can make it tenfold worse,” Magill told Columbia Gorge News in 2024.

“We can’t arrest our way out of that problem. Mental health, mental health crisis ... behavioral health issues are a medical issue. I understand that certain people commit crimes, they have to go to jail that have those issues. The reality of it is still a medical issue,” he said.