A study led by researchers at Oregon Health & Science University, published in JAMA Health Forum in August 2025, found that more than one in ten Medicaid-enrolled children who visited emergency departments for mental health crises were "boarded" — held in the ER for three to seven days — because no psychiatric bed was available. The study analyzed 255,000 hospital emergency department visits for mental health conditions among Medicaid-enrolled youth using 2022 claims data. Lead author John McConnell, Ph.D., director of the OHSU Center for Health Systems Effectiveness, warned: "If you're a parent and your child is having a crisis, you may go to the emergency department and then ideally find a more suitable place to get care after that. Unfortunately, this study reveals that there is often no place to send them."

Oregon's pediatric psychiatric infrastructure has been hollowed out over the past decade. The state has just 38 beds for the highest-acuity pediatric psychiatric cases, plus fewer than 200 residential beds for lower-acuity programs. Since 2014, Oregon has lost more than 40% of its licensed residential behavioral health facilities for children — from 90 facilities down to 53 by 2024. Meanwhile, demand is surging: the number of children requiring a psychiatric consultation at OHSU Doernbecher Children's Hospital has tripled from 150 in 2016 to 453 in the most recent year. Nationally, 2,283 confirmed measles cases were reported in 2025 alone — but in behavioral health, the crisis is quieter and more devastating.

For Oregon's coordinated care organizations and the broader Oregon Health Plan system, the findings spotlight a structural failure. CCOs are paying for emergency department stays that function as de facto psychiatric holds — expensive, clinically inappropriate, and harmful to children whose conditions often worsen during prolonged boarding. Dr. Rebecca Marshall, an OHSU pediatric emergency physician, noted that "when you have a child languishing in the emergency department not able to get the care they need, their condition can get worse." The cost burden falls on Medicaid, which already faces rate adequacy pressures: Oregon's CCOs received a 3.4% per-person rate increase in 2024 while their costs jumped 10%.

Watch for legislative action on pediatric behavioral health bed capacity in the 2027 session. The Oregon Health Authority's Child and Family Behavioral Health division is expected to release updated facility capacity plans. Key questions: whether OHA will invest in community-based crisis alternatives to reduce ER boarding, and whether the upcoming CCO 3.0 contract cycle will include enforceable psychiatric bed access standards. Federal Medicaid funding uncertainty adds another layer of risk — any cuts to EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) benefits would directly threaten the safety net for Oregon's most vulnerable children.