Well over a year and a half into an effort to revamp the state’s “backbone” system for funding and delivering behavioral health care, counties are still balking at the Oregon Health Authority’s pitch.

Under Oregon’s fragmented mental health care system, the disputed arrangements, known as County Financial Assistance Agreements, have for decades been the primary way the OHA partners with counties to fund and organize services like case management, substance use disorder treatment, and problem-gambling programs—particularly when those services are not eligible for Medicaid dollars.

The state, which is seeking to finalize revamped agreements in a matter of weeks, describes its plan this way: It would make it easier for counties to shape their plans around regional needs. It would provide th

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