School Mental Health Update
Oregon School Leaders,
I hope all of you had a restful and restorative holiday season. I know we’ve been back to school for a couple of weeks, and I imagine you are all really quite busy. Since 2020, I have provided an annual update to educational leaders on mental health service systems. The goal is to equip educational leaders with the current status of youth mental health in Oregon. Working across the academic and behavioral health sectors, I know the power of education to make an impact in the lives of young people struggling with mental health concerns. As you read, you will find several articles and resources. This summary will provide context for the material as you read.
Mental Health America (MHA) State of Mental Health Report 2025 - This report continues to serve as a national benchmark for evaluating the strength and performance of state mental health systems. Policymakers and system leaders widely use the report to understand trends in access, prevalence, and outcomes across states. Each year, it provides a comparative snapshot of how well states are meeting the mental health needs of children, youth, and adults.
Persistent low performance despite access gains: Oregon continues to rank near the bottom nationally for youth mental health outcomes and has remained in the lowest tier for nearly a decade. While access to services has improved, youth outcomes have not followed. High prevalence of depression, substance use, and suicide risk continues to drive Oregon’s poor standing.
Access improvements without outcome improvements: The state has invested significantly in clinical infrastructure, reimbursement systems, and service-delivery capacity, reducing barriers for providers and expanding treatment availability. At the same time, MHA tracked indicators of youth wellbeing, including thriving, engagement, and overall functioning, which continue to decline. This gap highlights that access alone is not producing meaningful population-level change.
Implications for schools and community systems: Youth mental health cannot be addressed solely through downstream clinical care. Schools and community environments play a central role in daily regulation, skill development, and healthy functioning. The disconnect between treatment availability and youth outcomes points to the need for a more comprehensive approach that integrates prevention, practical skill-building, and everyday supports alongside clinical services.
School Medicaid Expansion Update - OHA and ODE, in consultation with the School Medicaid Advisory Committee (SMAC), continue to make substantive improvements in the overall structure of Medicaid billing across the state. Medicaid, through the Oregon Health Plan, covers approximately 50% of all youth in the state.
Recent rule changes in the School Medicaid Program explicitly broaden Personal Care Services to approved services on an Individual Plan of Care (the official documentation required for billing services to youth covered by OHP). This change creates a sustainable reimbursement pathway for school-based support services that have historically been funded entirely through education dollars, with meaningful implications for staffing stability and long-term service capacity. This means that the support and personal care services offered by many educational assistants in Special Education Settings can generate billable income. This change, along with improved guidance and technical support from OHA, offers more pathways for school districts to expand reimbursement for services they have long provided their students.
Legislative session and state policy recommendations - All of us are moving towards the upcoming legislative session with a mix of anticipation and anxiety. The changes from Federal House Bill 1 have a resounding impact across our state. Even with these risks, there are policy implications from nationwide leaders that show potential opportunities for our work moving forward. In Oregon, we continue to move forward slowly towards implementation. In terms of building sustainable school-based mental health systems, I am encouraging school leaders to consider two key issues:
The primary barrier to effective school Medicaid utilization in Oregon is not statutory authority, but limited district-level capacity to implement existing rules. Inadequate staffing, uneven training, and weak billing and documentation infrastructure, particularly in rural and frontier districts, continue to suppress participation. As a result, additional rule changes that do not invest directly in local implementation capacity are unlikely to increase service delivery or federal Medicaid drawdown.
Districts that employ a dedicated Medicaid Coordinator consistently demonstrate stronger enrollment practices, more accurate documentation, and higher claim submission and approval rates, while districts without this role struggle regardless of how simplified the rules become. Targeted investment in district-level Medicaid coordination is a high-impact, low-visibility policy solution that strengthens billing infrastructure, supports workforce stability, and allows school-based mental health systems to become more financially sustainable over time. This policy solution could be implemented both at the legislative and local levels, as has happened in the Wallowa Educational Services District Region. When these local resources are in place, districts have more financial resources to spend on student services.
School leaders speak with unique voices on behalf of Oregon’s young people. Nationwide opinion research has shown that there is deep bipartisan support for Medicaid resources to support mental health, especially in battleground states. Where possible, add your voices to advocate for your students’ behavioral health. Thank you for your ongoing advocacy for young people in our state and your support of youth and their families who are struggling with mental health challenges.
Best,
Joseph Leykam, LCSW, MSW, AH
