Mental Illness Diagnosis Shouldn’t be Necessary to Address Social Determinants of Health

Written by Tim Buckley, March 2023

A single mom with three children, also experiencing a high-risk pregnancy, was facing eviction due to her inability to pay rent.  She was unable to work and hesitated to leave the apartment for doctors’ visits or even household essentials because her car has been unreliable. With no family support, she was having a difficult time caring for her children. She feared losing them to foster care. 

Fortunately, she called a Community Health Worker (CHW) who had given her a business card some months before, when making rounds in the neighborhood. Because of that sole connection, she received quick access to health care, food boxes, rent assistance, clothing and diapers.

CHWs are crucial as a central point of contact for a variety of services increasingly important in society, especially in communities where poverty rates are high and health disparities evident. However, families in need often don’t have access to a CHW because the services CHWs provide, which are based on the social determinants of health, are not currently reimbursed through the state’s billing codes.   For CHW services to be covered, you must first be seen at a medical or mental health clinic and receive a specific clinical diagnosis. This creates barriers to care and increases costs to the state.

One of CBEL’s collaborative partners (Fostering Hope Initiative) proposed that the billing system, and the requirement for diagnosis, be changed. After first exploring an administrative workaround, it became evident that changing Oregon law is necessary.

Working with Senator Deb Patterson’s office, Fostering Hope helped to get Senate Bill 1074 written. If passed, it will begin in Marion and Polk counties next year as a demonstration project.

Senate Bill 1074, will make it easier…and way less expensive…for families to receive quality professional care through a Community Health Worker (CHW) in their neighborhood without first having to get a diagnostic code for insurance purposes. It will also allow organizations employing CHW professionals who work out in the community versus in clinical settings to receive payment through insurance billing.

According to the legislative bill: “The demonstration project will give community health workers flexibility in working with families with children who are receiving or eligible to receive social services, or who are at risk of entering the foster care system, by enabling the community health workers to be compensated for providing services to the families that are based on and focused on addressing an assessment of a family’s social determinants of health and that are otherwise not reimbursed by the state.”

The new law will reduce costs while improving outcomes for low-income families. In place of endless medical referrals between specialists, the CHWs will use their social service networks to streamline the process of getting families the help they need to overcome adversity.

“An hour of mental health therapy is about $200 for an individual session.  In contrast, a CHW can build what we call ‘protective factors’ around entire families at a cost of about $40 an hour” said Mona Roberto Hayes, Chief Communications Officer for Catholic Community Services.   “Sometimes a diagnosis and therapy are necessary, but sometimes what is needed is concrete support like temporary rental assistance and food, or help building a supportive network of parents who are facing the same challenges. CHWs can provide this support and so much more at a significant return on investment.”

The new law will require data keeping about the extent of services for each case. Thus, if the project is successful, the family protective factor services formerly not compensated can be integrated into the state billing system to be reimbursed in the future.

Please consider calling or emailing Sen. Patterson’s office to voice your support. In the Oregon House of Representatives, please contact Representatives Ed Diehl, Kevin Mannix, and Paul Evans, who are adding bipartisan support for the legislation.