Oregon’s demographics, geography, economy and urbanization

Demographics and urbanization

Oregon’s population of 4 million makes it 27th in population among US states. Oregon has large rural and frontier areas, resulting in an overall population density of 40 people per square mile. Approximately 84 % of Oregonians live in urban areas, while 16 % live in rural and frontier areas. Population density ranges from about 4,228 persons per square mile in Portland to 7 persons per square mile in frontier areas and 23 persons per square mile in areas with 50,000 or less population (US Department of Agriculture). Portland is the largest metropolitan area, with about 2.5 million people. Other urban centers include Salem, the state capital, Eugene, in the mid-Willamette Valley, Bend, in Central Oregon, and Medford, in Southern Oregon. There are 9 Federally recognized Native American tribes in Oregon and Indian people from over 100 tribes make up the approximately 72,000 Native Americans and Alaska Natives living in Oregon. The Portland area has the 9th largest urban Native American population in the US, and 43-member tribes participate in the Northwest Portland Area Indian Health Board.

 

Oregon is becoming increasingly diverse. In the 2010 Census, 83.6% reported as White only, a drop from 90.1% in 2008. Hispanics make up the largest minority population at 11.7%, a 64% increase since the 2000 Census. Other races have remained about the same, with Asians at 3.7%, African Americans at 1.8%, and American Indian/Alaska Natives at 1.4%. Approximately 16% of Oregonians speak a language other than English at home (American Community Survey, 2018).

 

Oregon’s birth rate is declining, with 66 births per 1,000 women ages 15-44 compared to the national average of 69.2 (Oregon Vital Statistics, 2017). In 2018, Oregon had less than 43,000 births, of which 67% were White, followed by 19% Hispanic, 6% Asian, 4% mixed race, 2.3% African American, and less than 2% Native American (OVS, 2018). In 2019, about 6% of the population was under 5 years of age, and 21% was under the age of 18 (USCB, 2019). Overall the median age of Oregonians is 39.6 years, and as of 2017 the median age of mothers for all births is 29 (OVS, 2017).

 

Geography

At 96,981 square miles, Oregon is the ninth largest state in the U.S. Oregon's landscape varies from rainforest in the Coast Range to barren desert in the southeast. Oregon’s large size and geographic diversity create challenges for the Maternal, Child, and Adolescent Health system, including the concentration of services in urban areas, geographic and weather barriers to delivering and accessing health services, and issues related to workforce capacity and training needs varying vastly in different regions of the state. 

 

Geography presents a considerable barrier to accessing care for CYSHCN. Families living in rural and frontier Oregon counties experience challenges getting the services they need, particularly specialty care. Specialty care services for children are concentrated in urban areas along the Interstate 5 corridor, especially in Portland where the only teaching hospital, Oregon Health & Science University (OHSU), is located. Mental and behavioral health services are especially difficult for CYSHCN and their families to access, due to a lack of providers throughout the state.

 

Economy

Oregon’s economy impacts maternal and child health, as well as population growth and state revenues. The top employers are in food services, administrative and support services, trade contractors and construction, health care and hospitals, computer and electronic manufacturing, and retail (Oregon Blue Book). In 2017, Oregon’s population grew by 64,700 people, 56,800 of those due to in-migration.

 

Prior to the COVID-19 outbreak, Oregon’s seasonally adjusted unemployment rate had peaked in May 2009 at 11.6%. Unemployment rates steadily improved over the decade. In February 2020, Oregon’s unemployment rate was 3.3%, placing it 21st among states (Bureau of Labor Statistics, 2020). However, the recovery was unevenly experienced around the state, with county level unemployment rates ranging from 2.8% to 6.3% and southern and central Oregon counties experiencing greater unemployment (Oregon Employment Division, 2020). Oregon, like other states, has experienced unprecedented unemployment during the COVID-19 outbreak, with estimates that unemployment rates could climb past 20%.

 

Oregon’s median household income was $59,393 in 2018, placing it 27th among US states (ACS, 2018). The American Community Survey for 2018 estimated poverty at 14.1%, with 15.4% under age 18 living below poverty. Almost all racial/ethnic minority populations have higher poverty rates than non-Hispanic Whites. In 2018, the unemployment rate for Latino Oregonians was 5.6%, compared to the 4.1% unemployment rate for White Oregonians. In 2014, the last year data was available for Black Oregonians, they faced an unemployment rate twice as high as Whites (Oregon Center for Public Policy, 2019).  Twenty-eight percent of CYSHCN ≤18 years live in households with incomes less than 100% of the Federal poverty level, although this estimate should be interpreted with caution due to small sample size (NSCH, 2016-17).

 

 

Oregon’s strengths and challenges that impact MCH populations

Key state issues impacting Maternal, Child, and Adolescent Health include: health systems transformation, Oregon’s Early Learning System transformation, medical home for CYSHCN including cross-systems care coordination and shared care planning, and the modernization of Oregon’s Public Health system. Upstream factors, including the state of Oregon’s economy, employment, equity, education and the environment are also key drivers of Maternal, Child, and Adolescent Health across the lifespan. The impacts – both direct and indirect – of the COVID-19 pandemic on Oregon’s MCAH population will doubtless be unfolding for many years. This year’s report was written as those impacts are just beginning to be felt and due to limited time and knowledge only briefly touches on issues that will have large long-lasting impacts.  The topics addressed below reflect primarily issues that preceded the COVID-19 pandemic.

 

Oregon health systems transformation

Oregon’s health systems transformation efforts have been ongoing since before the Federal Affordable Care Act (ACA) implementation, and alignment of public health, including Maternal, Child, and Adolescent Health work with health system transformation is a key priority for the state. Oregon’s health system transformation, and the unique role Coordinated Care Organizations (CCOs) in serving the MCAH population is described in detail in section III.E.2.b.iv.

 

CYSHCN needs and health systems transformation 

Children make up 42% of Medicaid and CHIP population as of the last reporting period in January 2020. CCOs are responsible for providing care for people covered by Medicaid. Despite Oregon’s healthcare transformation rollout with its commitment to the Triple Aim, families and partners across the state still report considerable unmet needs for the CYSHCN population. Families experience confusion about who is responsible for coordinating care for CYSHCN across multiple systems. Patient-Centered Primary Care Home standards and CCO incentive metrics do not adequately incentivize primary care providers to prioritize CYSHCN within their practices. Additionally, there are no consistent policies across CCOs regarding the type and amount of services covered, except for the Applied Behavioral Analysis (ABA) mandate for children with Autism Spectrum Disorder.

 

Education

Over their lifespan, children in Oregon have access to private and public preschools, Head Start, public schools, community colleges, universities, and graduate education.

 

Oregon’s Early Learning Division (ELD) supports all of Oregon’s young children and families to learn and thrive. The Division is focused on: child care, early learning programs and Cross Systems Integration, Policy and Research, and Equity. Programs provided through the ELD include Early Head Start, Head Start and Oregon Pre-K, Healthy Families Oregon, Preschool Promise, and Relief Nurseries.

 

Oregon has 197 public school districts, 1,246 public schools, and 582,661 students enrolled from kindergarten through grade 12. Among K-12 public school students in Oregon, 39% are students of color; 47% qualify for free or reduced lunches; 14% are in special education, and 9% are English Language Learners. Oregon’s 4-year high school graduation rate is 83.7%, a significant increase over the past several years (Oregon Department of Education, 2019).

 

Every child in Oregon identified as needing special education has at least one of the disabilities defined in the IDEA. In Oregon, children must have a diagnosed physical or mental condition that is likely to result in a developmental delay to receive Early Intervention/Early Childhood Special Education (EI/ECSE) services. In 2018, 89,125 Oregon children (age 3 – 21 years), were in special education, and 4,388 children age 0 – 3 years, received EI services (Oregon Department of Education).

 

Oregon’s higher education system includes seven public universities and the Oregon Health & Science University, 17 public community colleges, over 50 private colleges and universities, and hundreds of private career and trade schools.

 

Early learning system transformation

Oregon’s early learning system transformation, guided by the Early Learning Council (ELC), is a key partnership for Title V, and another effort that is shaping the changing context for maternal and child health in our state. The vision for early learning system transformation is to: 1) Ensure all Oregonian children arrive at Kindergarten ready to learn and having received the early learning experiences they need to thrive; 2) Children are living in families that are healthy, stable and attached and 3) Oregon’s early learning system is aligned, coordinated and family-centered. The ELC, which includes representation from Oregon’s Title V director, directs the Early Learning Division of the Oregon Department of Education, which is responsible for numerous activities and initiatives including but not limited to:

• 16 regional Early Learning Hubs which coordinate services for children 0 to Kindergarten entry across five sectors: early learning, human services, health, K-12 and business.
• The Office of Child Care, which manages child care licensing and monitoring throughout the state.
• Implementation of a tiered quality rating improvement system for child care known as Spark.
• Coordination with Early Intervention/Early Childhood Special Education services.
• The P-3 Alignment initiative which collaborates with the K-12 system to align curricula and activities across preschool/Pre-K programs and grades K through 3.

 

In 2018, The Early Learning Council (ELC) completed a strategic planning and engagement process, which resulted in the Raise up Oregon plan. Title V was a key partner in its development, and now in its implementation.

 

Transformation of the early learning system continued and included alignment with other child-serving systems.  These efforts have been particularly relevant to CYSHCN.  Early Learning Hubs have led or participated in efforts to systematize screenings and risk assessments in their regions.  Some Hub regions mapped pathways or developed resources to guide high-quality programming for children whose screenings indicated need. The linkages to programs that effectively meet the needs of different families and populations of children with high needs are aimed at ensuring kindergarten readiness.  

Patient-Centered Primary Care Home (PCPCH) Program

The PCPCH Program is Oregon’s realization of the patient-centered medical home concept. The program’s goal is to accomplish the Triple Aim of health care. OHA established a set of recognition criteria, a technical assistance guide, and a self-assessment tool to aid practices in applying for PCPCH recognition. Initially the program consisted of three tiers of recognition, with the 3rd tier being the most advanced level of recognition. In 2017, the program revised the recognition criteria and expanded to five tier levels, with the 5th tier being the highest.

 

Modernization of Public Health

Governmental public health in Oregon is currently undergoing a major restructuring and modernization based on the recommendations of a legislative task force and the core functions of public health. HB 3100, the Modernization of Public Health Bill is based on the Task Force Report and uses a framework of foundational capabilities and programs that are needed throughout the state and local public health system. The changes focus on the need to achieve sustainable and measurable improvements in population health; continue to protect individuals from injury and disease; and be fully prepared to respond to public health threats. A  Public Health Modernization manual has been developed, along with a Modernization Plan based on assessment of the capacity and gaps in the governmental public health structure across Oregon. Phase one funding of $5 million was spent to enhance communicable disease capacity in select communities; phase two funding, approved by the 2019 Legislature provides an additional $10 million to modernize the public health approach to communicable disease, emergency preparedness and impacts of climate change on health. State Title V and local grantees are integrally involved in ensuring that maternal, child, and adolescent health programs are aligned with and central to public health modernization.

 

Housing

The American Community Survey estimates that Oregon has nearly 1.8 million housing units (ACS, 2018). Of households that spend 30% or more of income on housing, 51.6% rent, 31.4% had mortgages, and 14.9% own without mortgages. The median monthly housing cost for each group was $1,050 for renters, $1,647 for mortgaged owners, and $519 for other owners. 2.2% of households did not have a telephone service and 7.5% were without a car or vehicle for transportation. According to the Portland Housing Bureau 2018 report on housing costs and income, the rent growth has slowed in the past two years to just over 2%, and the average rental unit now costs $1,430 per month. Rising rental and home sale prices in recent years have displaced many Portlanders, disproportionately affecting people of color and lower incomes.

 

 

 

Oregon Health Authority’s roles, responsibilities and interests impacting Title V service delivery

 

Oregon’s Title V work is interwoven with the priorities and initiatives of Oregon Health Authority (OHA) and the Public Health Division, the OHSU Institute on Development & Disability (IDD), and those of the local health departments and tribes. At the state level, Title V aligns with the OHA Triple Aim, IDD’s priorities, the Oregon State Public Health Improvement Plan, and the Public Health Division Strategic Plan, as well as with the priorities of the Coordinated Care Organizations (CCOs).

The Oregon Health Authority (OHA) is responsible for most state-level health-related programs in Oregon, including Public Health, Medicaid, Addictions and Mental Health, the Public Employees, and Oregon Education Benefit Boards, and the Oregon State Hospital. The Oregon Health Policy Board oversees the OHA and is a nine-member, citizen-led board appointed by the Governor and confirmed by the Senate.

 

Oregon’s public health statutes and programs are administered by the Public Health Division within OHA, and each of 36 county jurisdictions is the designated local public health authority (LPHA). Currently, there are 33 LPHAs and one health district serving three small rural county populations. LPHAs are legislatively mandated to provide ten core public services. The Conference of Local Health Officials represents and advocates for local health departments in negotiations with the state and works to assure that they have the skills and resources necessary to carry out their work.

 

Oregon Health Authority (OHA) Triple Aim

OHA is the central agency that oversees health transformation in Oregon, guided by the Triple Aim of: improving the lifelong health of Oregonians; increasing the quality, reliability, and availability of care for all Oregonians; and lowering or containing the cost of care so it's affordable to everyone. Title V’s prevention and health promotion work supports the Triple Aim through interventions with vulnerable populations at critical stages of the life course. Section  III.E.2.b.iv describes Title V’s work in support of health system transformation and the partnership with CCOs in more detail.

 

Institute on Development & Disability

The Institute on Development and Disability within the Department of Pediatrics at OHSU works with patients, families, clinicians, researchers and many other professionals to improve the lives of people with disabilities. They perform research, advocacy, and education. They provide health care to people of all ages who face the onset of disabling conditions. They embrace the right of people with disabilities to determine the course of their lives and to live as fully integrated, contributing members of their communities.

State Public Health Improvement Plan

As part of Public Health Accreditation, Oregon created a state health profile and developed a State Health Improvement Plan, which was updated this year with new 2020-24 priorities. The new SHIP priorities include: Institutional bias; Adversity, trauma and toxic stress; Economic drivers of health; Access to equitable preventive health care; and Behavioral health. Title V is a critical partner whose work is threaded across all the new SHIP priorities.

 

CCO Community Health Improvement Plans and Outcome Metrics

Title V work also aligns with and supports the community health improvement plans of the CCO’s, as well as their performance metrics. Each of the 16 CCOs has developed a community health improvement plan (CHIP) which details their commitment to improving population health, and is required to report on those plans annually.  The CCOs are also being measured and receive enhanced payment on their health indicators in key MCAH areas such as pre-K well child visits, child and adolescent immunizations, preventive oral health, depression screening, and postpartum care. OHA chose to drop the longstanding adolescent well care visit metric in the 2020 round of CCO incentive metrics. This change impacted the selection of Oregon’s MCHB priority areas for the new block grant cycle. Newly signed contracts also charged CCOs with addressing social determinants of health. Title V works with the CCOs as a provider of: technical assistance, data, and contracted public health and prevention services.

 

 

Oregon’s system of care for meeting the needs of underserved and vulnerable populations, including CYSHCN

Populations served

About 6% of Oregon’s population is under five years of age, and 21% is under the age of 18 (USCB, 2019). Fifteen percent of Oregonians under age 18 live below the federal poverty level.

 

The 2016-17 National Survey for Children’s Health (NSCH) estimated that 18.7% of Oregon children 0 to 18 years have special health care needs. These CYSHCN were mostly White, non-Hispanic. About 20.5% were of Hispanic ethnicity and 13.5% identified as other, non-Hispanic.

 

Nearly 67.5% of Oregon CYSHCN have a condition that affects their daily activities and over 32.6% experience two or more difficulties related to functionality (NSCH, 2016-17). According to the most recent state-level prevalence rates, 2.7% of Oregon children age 3 – 17 have Autism Spectrum Disorder (ASD), compared to 3.1% nationally (NSCH, 2017). In 2018, about 10,971 Oregon youth age 3 – 21 who received special education had ASD (Oregon Department of Education [ODE], 2018).

 

Significant advances in science and technology have reduced the risk of mortality for CYSHCN, resulting in an increase in morbidity due to chronic illness and disability. Of children under age 18 insured through Oregon Medicaid in 2015-2016, 6.1% of children met criteria for having complex chronic disease. Of those, 6.7% were Black/African American, 5.6% were Native American, and 5.6% were multiracial (OPIP, OHA, DHS, 2018). Eighteen percent were categorized as having non-complex chronic disease. Of those, 19.2% were Black/African American, 17.8% were multiracial, and 17.6% were Native American (OPIP, OHA, DHS, 2018). Youth and young adults with special health care needs (YSHCN) are living longer and assuming productive lives. However, only 51% of Oregon YSHCN graduated from high school in 2014 (NCES, 2013-14). NSCH (2016-17) estimates suggest that less than 19.6% of YSHCN had worked in the previous 12 months, likely due to challenges in managing their own health, difficulty accessing available resources to support their health needs, and other social factors.

 

Oregon’s Birth Anomalies (birth defects) Surveillance System (BASS) tracks prevalence of select birth anomalies using birth certificate, hospital discharge, and Medicaid data. Children who get home-visiting public health nursing care coordination services through OCCYSHN’s CaCoon program are tracked through a statewide database. The most frequent risk factors and conditions cited for CaCoon recipients during FY2019 were developmental delay, other chronic conditions, Autism Spectrum Disorder, and behavioral or mental health disorder. Children can have more than one risk factor recorded. In FY2019, 66% of children in the CaCoon program had multiple risk factors.

 

Health services infrastructure

Primary care and safety net health services are available through private medical providers and through the following facilities.

• Hospitals:  62 Hospitals
• Federally Qualified Health Centers: 32 FQHCs operating 232 sites
• Rural Health Clinics:  102 clinics in 30 counties
• Tribal and Indian Health Service:  18 clinics among 9 tribes and 10 counties
• School-Based Health Centers:  79 clinics in 26 counties

 

Oregon’s Primary Care Office (PCO) works closely with the non-profit Oregon Primary Care Association (OPCA) and the Office of Rural Health to support Oregon’s safety net services. Oregon has 148 designations for primary care Health Professional Shortage Areas (HPSA), 124 mental health HPSAs and 134 dental HPSAs. More than 300 sites have been approved as part of the National Health Service Corps (NHSC) to provide health care to all, regardless of ability to pay. In 2018, Oregon’s Community Health Centers provided 1,780,420 visits for 393,324 clients, including 121,163 children. Of these patients, 19% were uninsured and 57% were covered by Medicaid (NACHC, 2018).

 

Oregon’s safety net includes a robust network of school-based health centers (SBHCs) which are statutorily defined, certified and funded. During the 2018-19 school year, there were 79 SBHCs in 47 high schools, 6 middle schools, 11 elementary schools and 15 combined-grade campuses. During the 2018-19 service year, SBHCs provided 130,586 visits for 38,057 clients.

 

Oregon Health Plan (OHP), Oregon’s Medicaid program (medical, dental, and mental health care services), is provided primarily through Coordinated Care Organizations (CCOs) - Oregon’s version of Accountable Care Organizations. There are currently 16 CCOs serving Oregon’s 36 counties. CCOs currently serve nearly 90% of OHP clients. The innovative structure and function of CCOs is a central component of health reform in Oregon, as described in previous reports.

 

Integration of services

Integration of primary care, behavioral health and social services continues to be an area of opportunity in Oregon. Several cross-agency workgroups have been formed in the past several years to identify solutions to these issues. Most recently, in 2019 a Governor’s Behavioral Health Advisory Council was created with the task of developing recommendations aimed at improving access to effective behavioral health services and supports for all Oregon adults and transitional-aged youth with serious mental illness or co-occurring mental illness and substance use disorders. This work will be closely aligned with similar state level efforts, including the State Health Improvement Plan, the Oregon Alcohol and Drug Policy Commission Strategic Plan, and the Oregon Tribal Behavioral Health Strategic Plan. Membership in these groups reflects the diversity of sectors that support Oregon’s children and families in various settings, including schools, early learning, transportation, housing, criminal justice, and health.

 

Financing of services

Insurance coverage

According to the most recent Oregon Health Insurance Survey, more than 3.9 million Oregonians - 94% - are covered by health insurance. However, 11% were uninsured at some point in time in the past year.   While insurance coverage is high in Oregon, low income people are less likely to be covered. Young adults, between ages 19 – 34 were less likely to be covered than any other population. Among children 18 and under, 97% were covered for insurance.  Disparities in un-insurance by race and ethnicity are evident, with Asian Oregonians having the lowest un-insurance rates, and Hispanic Oregonians having the highest. About 21% of Hispanics were uninsured at some time in the past year.

 

Despite Oregon’s high rate of health coverage, more people could be covered. Most people who were uninsured when the study was conducted were eligible for the Oregon Health Plan or a subsidy to reduce the cost of commercial health coverage.

• Children: 9 out of 10 children who lack health coverage are eligible under OHP or a premium-reduction subsidy through the health insurance marketplace.
• Adults: Similarly, nearly 9 in 10 young adults and 8 in 10 older adults (ages 35-64) qualify for OHP or a subsidy for commercial health coverage.
• Reasons for lack of OHP coverage: A large portion of the uninsured were eligible for OHP. The top three reasons Oregonians cited for not being covered by OHP were: concerned about high costs of coverage (44 percent); not eligible, make too much money (36 percent); and concerned about quality of care (21 percent).

 

Oregon has expanded Medicaid coverage (Oregon Health Plan – or OHP), to cover adults whose income is 133% of the Federal Poverty Level (FPL). Pregnant women are covered to 185% FPL, and children to 300%. OHP pays for medical, dental and mental health services for low-income Oregonians. Since ACA implementation, OHP enrollment has grown by 557,000 people, and OHP now covers nearly 1 million Oregonians. OHP pays for 53% of Oregon births, including prenatal and delivery coverage for approximately 3100 undocumented women covered through the state-funded prenatal expansion program and Citizen Alien Waived Emergent Medical (CAWEM) program. About 20% of all Medicaid enrollees are Hispanic, 3% African American, 1.5% American Indian/Alaskan Native, 3% Asian or Pacific Islander, 58.5% Caucasian, and 14% “Other” or “Unknown”. More than one-third (36%) of Oregon CYSHCN < 18 years were insured through Medicaid (NSCH 2016-2017).

 

In July 2017, the Oregon Legislature passed Senate Bill 558, which expanded the Oregon Health Plan to include all children and teens under 19, regardless of immigration status, up to a household income of 305 percent of poverty. The estimated impact is that 17,000 undocumented children and teens are eligible for healthcare as of January 1, 2018.

 

Also passed into law in July, 2017, was House Bill 3391, known as the Reproductive Health Equity Act (RHEA). This bill provides for expanded coverage for Oregonians to access reproductive health services, especially those who, in the past, may have not been eligible for coverage of these services. It also provides protections for the continuation of reproductive health services with no cost sharing, and prohibits discrimination in the provision of reproductive health services. The Reproductive Health Equity Act ensures that people with Oregon private health insurance plans, including employee-sponsored coverage, have access to reproductive health and related preventive services with no cost sharing regardless of what happens with the Affordable Care Act. Medical care for undocumented women up to 60-day postpartum will also be covered.

 

State revenues and budgets

Over 90% of the state’s general fund support core functions in three areas: education, health and human services, and public safety. Oregon does not have a sales tax, and recent attempts to increase corporate taxes through ballot measures have failed to pass. Furthermore, state law mandates a “kicker” refund to taxpayers in any year in which state revenues exceed projected by more than 2%. Consequently, even with robust employment and income tax, the state continues to face budget shortfalls.

 

Oregon statutes and regulations with relevance for Title V Block Grant authority and state programs

 

State statutes with relevance to Title V

The following are key state statutes for Oregon’s Title V program:

• ORS 413 defines to the Oregon Health Authority (OHA) and the Oregon Health Policy Board, which were created by the Oregon Legislature in 2009. Most health-related programs in the state are under the OHA including Public Health, Medicaid, Addictions and Mental Health, the Public Employees and Oregon Education Benefit Boards. OHA is overseen by the Oregon Health Policy Board.
• ORS 431.375 governs the policy on local public health services; local public health authority, and the provision of maternal and child public health services by tribal governing council.
• HB 3650, passed in 2011, sets the framework for health system transformation and the CCOs which are a cornerstone of Oregon health system transformation and provide care to Oregon’s Medicaid (OHP).
• HB 3100, passed In July 2015, implements the recommendations made by the Task Force on the Future of Public Health Services and sets forth a path to modernize Oregon’s public health system so that it can more proactively meet the needs of Oregonians. Legislation to expand support for Public Health modernization is being considered in the current session.
• ORS 326.425 establishes the Early Learning Council, which oversees the Oregon Early Learning System.
• ORS 444.010, 444.020 and 444.030, the Oregon Health and Science University (OHSU) is designated to administer a program to extend and improve services for CYSHCN, including the administration of federal funds made available to Oregon for services for children with disabilities and CYSHCN.
• Oregon is one of 39 states that passed ASD mandates that require health insurers to provide the behavioral therapy Applied Behavior Analysis (ABA) to children with ASD and other developmental disorders under 18 years old who have health insurance.
• HB 4133, passed in 2018, created Oregon’s Maternal Mortality and Morbidity Review Committee (MMRC).
• SB 526 (2019), passed universally offered home visiting for Oregon newborns.