People with severe mental illness in Multnomah County will qualify for Medicaid long-term care benefits when they leave hospitals, jails and treatment centers.

The change comes under a new agreement between the county and the state of Oregon aimed at stopping the cycle of institutional discharge to unsheltered homelessness.

Under the program, outreach workers will connect with people preparing to leave institutions and enroll them in services funded through Medicaid Section 1915, a federal program that pays for caregiving and supports for people with disabilities. Those services include help with basic living tasks, health care, financial management and household chores, as The Lund Report reported.

Commissioner Meghan Moyer and representatives from the Oregon Department of Human Services (DHS) and the Oregon Health Authority briefed county commissioners on the plan Oct. 13.

"What we are doing is dismantling obstacles to a benefit that has existed but not been able to be utilized by this population," Moyer told KGW.

The problem is well-documented. Nearly 50% of people accessing shelters in Portland have a severe mental illness diagnosis, according to Moyer.

A point-in-time survey conducted earlier in 2026 found that about three out of every four incarcerated adults in the county's two jail facilities have a mental health diagnosis or substance use disorder.

In the Multnomah County Detention Center alone, more than 92% of prisoners have a mental health diagnosis or addiction issue, according to county figures reported by The Lund Report.

Moyer said no pathway existed to qualify for Medicaid long-term care based solely on severe mental illness. Existing channels measured eligibility based on age or physical disability, but not mental illness alone.

Dana Hittle, deputy director of the state DHS, acknowledged the gap at the Oct. 13 briefing.

The state's siloed structure, with separate behavioral health, homelessness and Medicaid programs, made it difficult to connect people with mental illness to support services, Hittle said, according to The Lund Report.

The county's Supportive Housing Services (SHS) tax will cover the housing side.

The SHS fund, approved by voters in Multnomah, Clackamas and Washington counties in 2020, raises about $250 million annually across the region.

Multnomah County spends about $52 million a year from the fund on services, according to Moyer. The state's agreement to provide Medicaid dollars is expected to relieve pressure on the SHS fund.

The program grew out of a pilot Moyer spearheaded more than a year ago. That effort deployed a small group of eligibility workers to enroll people in Section 1915 services, but the state was not honoring the applications. The Multnomah County Board of Commissioners then sent letters to the state raising concerns, which led to the current agreement.

Moyer said the state should have been providing these funds for more than a decade, since Oregon approved its Section 1915 program. No state response to that claim appears in public reporting.

Oregon will allow Multnomah County to begin enrolling eligible individuals in June, at the end of the state fiscal year. Moyer said the county aims to be the first in Oregon to implement the program, but that meaningful results could take about two years. The number of people enrolled will depend on available providers. Moyer said she believes a few hundred could be served in the first year.

Residents can track the program's progress through the Multnomah County Board of Commissioners' public meetings.