Last Thursday, the Joint Emergency Board of the Oregon Legislature met to discuss the possibility of providing funds to several key industries that are struggling across the state of Oregon. On the docket for the E-Board meeting were discussions about general housing, funding for businesses, emergency housing for domestic violence, establishing an Oregon Worker Relief Fund, creating a critical-access hospital loan program that we discussed last week, among many others.

Below is a breakdown of how Oregon legislators allocated the funding:

Safe Shelter and Rental Assistance – $12 million

This funding will provide rental assistance and safe shelter alternatives for individuals who have lost their income due to COVID-19. It will also provide shelter for people at risk of infection or health problems due to inadequate shelter or housing. $3.5 million will be allocated to purchasing hotel vouches for homeless individuals and farmworkers, and $8.5 million will be allocated for rental assistance for Oregonians who make less than half of the median income and lost wages from the pandemic.

Oregon Worker Relief Fund – $10 million

This funding will provide payments to workers who are ineligible for traditional unemployment, either because they do not have access to traditional unemployment insurance programs or are ineligible due to their immigration status.

Small Business Assistance – $10 million

This funding will establish an assistance program for small businesses with no more than 25 employees impacted by COVID-19 economic restrictions that have not received support from the federal CARES Act. The $10 million small business assistance program will include $5 million from the Emergency Fund matched with $5 million from existing funds in the executive branch’s Business, Innovation and Trade Division.

Domestic Violence Housing Support – $2 million

This funding would provide emergency housing for victims of domestic and sexual violence.

“We have all be hit hard by this pandemic,” said Sen. Peter Courtney, D-Salem. “Today, Legislators from across the state came together to support Oregonians.”

The Coalition for a Healthy Oregon (COHO) has begun meeting on a weekly basis during the pandemic to share ideas, concerns, and solutions that we have found to work in our own communities. From food resources and security solutions to leveraging current resources to meet new needs, we have worked to gather and enact comprehensive ways CCOs can aid their communities during this time.

One health-related concern that is especially hard to tackle is securing housing for OHP members who are currently unhoused our will become houseless throughout the pandemic. We know that many may lose their housing due to interpersonal violence, loss of a job, or other factors.

For these reasons, COHO CCOs put their heads together on policy solutions and ideas, as well as other on-the-ground tips to tackle houselessness, especially during times of crisis.

CCOs across the state are working to leverage their current global budget and put money allocated towards Social Determinant of Health & Equity (SDoH-E) spending toward housing assistance for OHP members. This includes rental support for those have housing but may have lost a job. In some cases, hotel rooms have been utilized for survivors of domestic violence and high-risk individuals experiencing houselessness. This tactic works in well-populated and urban areas, as there are many hotel rooms that can be rented.

Some CCOs that serve areas in more rural areas of Oregon do not always have this luxury. Some areas of Oregon have one or two motels or hotels, but often these do not have the capacity to house the number of OHP members that need to be sheltered. Another catch for utilizing the Medicaid dollars that make up the CCOs’ global budgets is they may not be used for brick and mortar. This means that CCOs must contract with other businesses and organizations if they need to build housing to shelter their members.

Big cities like Portland have begun utilizing spacious entertainment centers, that have a plethora of showers/locker rooms, like the MODA center in order to shelter Oregonians. Because the Metro regional government owns this center, it was fairly easy to use this space as a shelter. Again, not all rural towns and cities across Oregon have access to large stadiums.

However, the cities and towns across Oregon all own something, right? Some plot of land, some tennis courts, a school, even? Big spaces that have lots of bathrooms and showers could serve this purpose while they are closed due to the pandemic. Schools would be especially convenient, as they have dedicated places for consuming meals, recreational activities, and the like. Sports facilities, like indoor tennis courts, or university/community college sport’s facilities would be another place Oregonians could safely be housed through this pandemic. If the land, sports facility, or school is owned by the city or county, realistically, that city or county can grant access to CCOs to utilize during pandemics.

These are complex issues with no easy answers. We welcome the community’s input as we continue to do everything possible to support our members.

All our member CCOs are doing a stellar job meeting OHP members’ needs and keeping folks out of the hospitals! This week, we are highlighting Umpqua Health Alliance for their incredible work and investment in a local domestic violence advocacy center, Peace at Home.

The rate of domestic violence is already quite high in the United States, with someone experiencing violence at the hands of their partner every 20 minutes. Across the nation, we have seen spikes in domestic violence since social distancing measures began, giving us a clue at what it must be like to be quarantined in a violent situation with no reprieve, for a period of time that is completely undetermined. In fact, one of Peace at Home’s 22 community-integrated advocates shared that every day last week, they interviewed someone who had been strangled by an intimate partner.

Umpqua Health Alliance (UHA) knows and believes that safety during this pandemic also means safety from violence in the home, and relief is about more than just economic relief. So, UHA reached out to a local domestic violence advocacy center in Roseburg to see how they could help.

Peace at Home currently offers incredible emergency services to its community like a 24-hour crisis line, peer counseling, safety planning, assistance with securing food, door lock changes, and most importantly of all, emergency shelter.

Before this collaboration, Peace at Home was already running two shelters for those experiencing family violence, sexual assault, and human trafficking. These shelters were communal living, meaning that people in the shelters often shared quarters and had less independence.

Working together, Peace at Home and UHA concluded that the community most needed more shelter room or capacity to meet the increased demand for safe space during COVID-19. By using dollars from UHA’s COVID-19 Relief Fund, Peace at Home now had the ability to move currently sheltered Oregonians from the communal shelters into rooms of their own where they can self-isolate and be more independent.

This incredible investment by Umpqua Health Alliance has also freed up all the space in the communal shelter, which can now go to other Oregonians living in unsafe situations during this pandemic. UHA did not just make an investment and leave it there—instead, leadership at UHA has continued to reach out to Peace at Home to learn how they can better serve their members who are survivors of violence at home, as well as better understanding the help those Oregonians need.

Thank you, Umpqua Health Alliance, for your dedication to safety and relief during the COVID-19 pandemic, and your desire to help those experiencing violence at home. We look forward to sharing more about what UHA is doing with the remainder of their COVID-19 Relief Fund.

The Oregon Health Authority (OHA) shared late last week that they submitted a Section 1115 Waiver to the Centers for Medicare and Medicaid Services (CMS) to request a COVID-19 Disaster Relief Fund. This waiver, like the one that OHA previously submitted (detailed here), are generally used during emergencies like the current COVID-19 pandemic.

In OHA’s waiver request, they reference that while Oregon is lucky to have a lower COVID-19 caseload then other states, our adherence to aggressive social distancing and the cancellation of elective procedures is creating a huge financial strain on our health systems. This move would increase flexibility for how federally matched payments can be used with Medicaid being the payer of last resort. While this could bring in federal resources for some COVID-19 spending, the Oregon Health Plan faces a budget shortfall that General Fund dollars may not be able to fill.

This waiver, submitted by the state’s Medicaid Director, Lori Coyner, is dated April 17, but as far as we know, the state has not yet received approval from the Federal Government.

Without federal dollars to help our health systems, we will lose our ability to preserve access to care. CCOs have done a great job keeping people out of the hospitals, but the cancelation of nonemergency procedures has led to decreased revenues for hospitals and other providers.

At the same time, hospitals are incurring new costs related to COVID-19, including telehealth platforms, bed reconfiguration, off-site screening venues, and quarantine/post-acute care sites. The result is a need to cut costs, including staff reductions, which poses a threat to Oregon’s health care delivery system.

It is common knowledge that other medical technology like ventilators, respirators, and personal protective equipment (PPE) is in high demand and very short supply. OHA expressed doubts as to whether CARES Act funding would meet specific needs of Medicaid providers, so the Disaster Relief Fund is needed to help cover critical expenses.

Under the proposal, health systems would likely need to first seek support through other public and private means, so that Medicaid is the payer of last resort, and any dollars paid out would be subject to audit.

We will keep you updated on the status of this request.

All our member CCOs are doing a wonderful job filling gaps and providing services to their members, and this week we are focusing on Cascade Health Alliance of Klamath Falls, Oregon.

Late last week, Cascade Health Alliance (CHA) got an email from Basin Transit, alerting them to the fact that starting now, no one will be allowed on public transit in Klamath Falls without a face mask. This could be detrimental to some OHP members if they do not have the ability to buy or make their own face masks, as many OHP members travel using public transit.

This concern over their member’s safety while using public transit was a catalyst for CHA. They sprang to action to ensure that their OHP members, employees, and their employees’ families have access to face masks—especially those being made and sold locally.

Because so many Oregonians are currently out of work, CHA’s team started looking for a local supplier so the money they spend on face masks could go directly back into the community and help other Oregonians pay their bills.

With some luck, a lot of hard work, and a couple community asks, CHA was able to find a local supplier of face masks who used to run a different small business. This community member re-tooled her shop to make and sell reusable, COVID-19 safe facemasks to those who need them. With the income earned from selling masks, the local supplier was able to hire three more neighbors who had also been laid off due to COVID-19.

To be sure the masks were COVID-19 safe for their members, Cascade Health Alliance had a trusted provider of 25 years, Dr. Raul Mirande, a general surgeon, check that the masks were up to snuff.

Once they got approval from Dr. Mirande, CHA was thrilled to collaborate with these amazing Oregonians who were already making masks for their neighbors and friends! Cascade Health Alliance commissioned 2,500 masks from their community partner, which is the largest order the small business in Klamath Falls had ever received!

These face masks will be delivered weekly to OHP members and CHA employees through no-contact delivery, or during a non-emergent medical transport.

Now, while running errands, riding the bus, or going to work, OHP members served by the Cascade Health Alliance, and CHA employees will be able to keep themselves safe.

People of Klamath Falls, we have good news! Cascade Health Alliance literally has you covered!

Thank you CHA for your hard work and commitment caring for people in the Basin and for quickly and thoughtfully addressing this problem.

In Portland every night at 7:00 p.m., Oregonians gather on their porches and front lawns to bang together pots and pans, play their drums or other instruments, and cheer for health care providers working to keep our communities safe during this pandemic.

Do health care workers and providers hear our cheers and thanks? What do they think about the state’s response to COVID? Do they need more Personal Protective Equipment (PPE)? Do they have any advice or thoughts about what regular people like you and I should be doing?

Most importantly: if we could speak with a health care provider about what it’s like to be working during COVID-19, what would they say?

We had the opportunity to sit down with a Certified Nurse Assistant (CNA) named Emily who works for an Oregon-based company that provides daily medical assistance and other necessary health services to folks on Medicaid and Medicare.

In a normal shift, Emily cares for Oregonians in hospice care, may be paraplegic, have at least one underlying health issue, if not several, and need help with daily tasks. She is responsible for helping her patients with wound care, personal hygiene, and grocery shopping.

When asked about what PPE she has access to daily, Emily shared that she has a single surgical mask that does not have the ability to stop the novel coronavirus the way an N95 mask would— and she reuses it every shift. Gloves provided by her company are either not available or they rip. She tries to keep a personal stash of gloves but says they are nearly impossible to find.

We talked about how it feels as a frontline health care worker to help her clients with wound care when her medical education tells her that the efficacy of her mask decreases by the hour.

Not only is Emily serving her community as a CNA, she is only weeks away from graduating nursing school, and taking the NCLEX. Unfortunately, the novel coronavirus has also thrown a wrench into completing the NCLEX for her license, because completing it is impossible while social distancing.

Despite all the challenges and lack of PPE, Emily shared with me that she is happy to be helping in the face of a pandemic. She knows that the State of Oregon is working hard to ensure that frontline workers have access to PPE and expanded testing to keep her and her patients safe.

When asked how she felt the state was responding to this crisis, she shared that the expansion of unemployment benefits, Oregon Health Plan (OHP) benefits, the Governor’s decision to send ventilators to another state in need, and many other actions feel very citizen-oriented, and she feels as though we are headed in the right direction. Emily also mentioned that despite her current cheer to serve those in need, she may be feeling the emotional effects of working through this pandemic for quite some time.

Emily’s point makes us stop and consider: what mental health supports are we providing our health care workers? How can we better support them in this area?

Emily, thank you for your hard work and dedication to Oregonians in need during this critical time. You are genuinely appreciated.

Last week, we reported on the early release of 2019 incentive dollars to Coordinated Care Organizations (CCOs). Following this early release, COHO CCOs have been working hard to allocate these funds quickly and responsibly while keeping their members at the center of all decisions.

First, we should talk about what incentive funds are. Each year, the Oregon Health Authority (OHA) withholds a portion of CCOs’ global budget, which can be earned back based on achieving positive health metrics for members they serve. Incentive dollars are allocated by CCOs’ boards through a rigorous process and primarily go to hospitals, clinics, and other providers as part of value-based contracts (think of it like a bonus for helping meet aggressive preventive care goals determined by the state).

The incentive dollars that were released at the end of March were earned in 2019 by the hardworking providers contracted with CCOs to serve Oregon Health Plan members. In fact, many providers that work with CCOs have this incentive pool “bonus” built into their contracts—meaning that many of the dollars that are being released early will go to providers and health systems that are badly in need of financial support.

In normal times, a portion of these funds would also go toward community-driven programs and health innovation. CCOs are quickly pivoting to ensure funds are dedicated to supporting community needs related to COVID-19. This may include rental assistance for members, delivering groceries and supplies, and securing Personal Protective Equipment (PPE), among other things.

With all the needs related to COVID-19, what will our CCOs invest in, and how will they make every dollar count? We look forward to sharing more success stories in the weeks ahead. We are also partnering with OHA on policy adjustments to protect providers and ensure community investments can continue. Stay tuned.

You may think that hospitals and health care providers are incredibly busy caring for those that have contracted the novel coronavirus, but in our state where only 303 patients are currently hospitalized for COVID-19, this pandemic has actually increased costs and decreased revenue, causing a major cash crunch across our health care system.

The cash flow issue stems from added costs of increasing emergency department capacity and ensuring extra staff are available if a hospital surge occurs. Meanwhile, the cancellation of all elective and non-emergency surgeries has decreased revenue, pushing some hospitals and health care providers into dangerous financial territory.

We know that hospitals’ and providers’ ability to keep their doors open and serve Oregonians is critical not only during this pandemic, but also to preserve our health care delivery system. In southern and rural Oregon where there is less access to providers, clinics, and hospitals, existing hospital and health systems remaining open is paramount.

For these reasons, Governor Brown and her policy experts are crafting a bridge loan program for 24 critical access hospitals across the state. This loan program is still in the beginning stages of drafting, but it’s clear the Governor has heard the concern from hospital and provider systems about cashflow and intends to do something about it.

The legislation proposed to deliver aid to these critical access hospitals appropriates $50 million dollars to this program and indicates that the source of the capital would be the dollars given to Oregon through the federal CARES Act relief package. And while this program is dedicated to bailing out hospitals that are currently in financial dire straits, it does require those health systems to pay back the state at a low interest rate of zero to one percent. There are also requirements in the legislation around hospital staffing and labor.

Currently, the Governor’s office and other stakeholders are working diligently to ensure that critical access hospitals and other providers have the financial resources they need to continue the battle against COVID-19 while still ensuring that the state maintains a balanced budget.

Are you worried that you might have the novel coronavirus, but think you might not meet the criteria to be officially tested? Last week, the State of Oregon launched a “Coronavirus Checker” online program that checks your symptoms and gives you advice based on clinical best practices, current CDC guidelines, illness severity, and risk factors like age and underlying medical conditions.

The website,, will direct you to a hospital with enough capacity to treat you, if it determines you need emergency care. If you don’t have severe symptoms, it will direct you to continue to maintain your social distance but recommend that you call a health care provider. During the season change that causes symptoms fairly like those of COVID-19, this tool will be a very helpful device in calming concern that you may have caught the virus.

Once you’ve clicked the link above, it will take you to the home page, which has a “Get Started” bar.

  1. Click the “Get Started” Bar

Once clicked, the site guides you to a second page, which explains that this does not replace or constitute the practice of medicine—as always, if you believe that someone in your care is incredibly sick, call a health care professional. If you scroll to the bottom of the page, it requests that you accept terms and conditions.

  1. Accept the Terms & Conditions

Next, in order to gather accurate data about you, the website requests your age.

  1. Enter your age into the empty field provided, then click “Next”

Then, it asks your location.

  1. Enter your zip code in the empty field, and click “Next”

Next, it requests information on your symptoms. The options are fever, cough, shortness of breath, fatigue, body aches, headache, diarrhea, sore throat, loss of sense of smell or taste, or none of the above.

  1. Choose all the symptoms you currently have, then click “Next”

Next, it asks if you have had any life-threatening signs since you became sick. Some options include a very hard time breathing, unable to keep down food or drink for 12 hours, feeling lightheaded, or having altered or slurred speech.

  1. If you have experienced any of those symptoms, choose them, then click “Next”

Do you have any underlying medical conditions? This website wants to know. The website gives a list of common pre-existing conditions, and requests that you choose all the conditions you have been diagnosed with.

  1. Choose your underlying conditions and click “Next”

Once you have completed these steps, you should find yourself at the final page, which gives you a summary of what you reported, as well as recommendations for reaching out to a health care provider, or for immediately seeking emergency help. The website also offers information on how to protect yourself, as well as up-to-date information from the CDC about how the virus spreads.

For more resources and information, you can also visit the Coalition for a Healthy Oregon’s resource page, which is updated weekly.

Health care providers know that when facing a pandemic like the novel coronavirus, the more we test Oregonians for it, the clearer the picture is for what our state needs to prepare for. However, creating the type of accurate modeling needed to give public health officials a clear answer is made more difficult by the fact that there is not widespread availability of the rapid in-clinic testing, and the PCR testing that has been used by health care providers up until now is only accurate 85 percent of the time.

If Oregon lawmakers push for making the rapid in-clinic test widely available, we might be able to create a much more accurate model of this pandemic. In the next few weeks, there will also be widespread deployment of antibody tests that can determine whether a person had the virus, recovered, and built up an immune response, making them less likely to contract the disease again.

Will Oregon lawmakers push for making the rapid in-clinic testing widely available? The House Republican page on COVID-19 updates mentions the rapid testing but says that supplies to run the test are short at this time. Widely testing residents has been a clear desire of the legislators on the Joint Coronavirus Response Committee, as they made clear to the Oregon Health Authority during their sessions last month. Could a more accurate model allow our state to get back to work sooner?

From a scientific standpoint: yes. Scientists believe that we need at least six more weeks of social distancing. If our state is able to procure wide enough testing that almost every single person currently in Oregon can get tested, while continuing these aggressive social distancing measures for the next six weeks, we might be able to create quarantine-like policies that provide specific guidance for populations based on the result of their test. This would allow folks who test negative, or those who are immune but not a contagious carrier, to return to work.

If we can achieve this level of stability, our state could work full force on manufacturing PPE, getting aid to other states, and helping to end this more quickly for our entire country. We wouldn’t need to worry about overly extensive economic fallout from the shuttering of our businesses.

However, from a political standpoint: unless California and Washington join us, and the science agrees, we will not be able to reopen as quickly. With President Trump announcing his “Council to Reopen the U.S. Economy,” several states, including New York, which carries more than 32 percent of the country’s COVID-19 cases, have banded together to coordinate their re-openings together. This move by Democratic governors across the nation is a signal to the Trump Administration that they will only be open for business when it is safe.

Indeed, on Tuesday morning, Governor Brown hosted a press conference in which she addressed the future systematic re-opening of Oregon’s many restaurants, bars, clothing stores, etc. In her comments about the framework of this reopening, she said “The best path forward is a cautious one. A path that proceeds gradually, incrementally, and carefully. A path that relies on science and facts to determine each step forward.”

Governor Brown is incredibly committed to not moving forward unless the science is strong enough to signal that it is safe to begin incrementally opening our state back up. Until then, we will be FaceTiming our family and friends, sitting outside but only in our backyards, and typing up articles like this on my kitchen table.