Al Barton, executive director of Mid-Columbia Center for Living (MCCFL), the tri-county mental health authority serving Wasco, Hood River, and Sherman counties, is sounding the alarm on a convergence of federal funding threats that could gut behavioral health services in eastern Oregon. Barton warns that looming Medicaid changes — including new work requirements and income verification rules — could reduce enrollment by up to 15% starting in 2026. In eastern Oregon, where up to 40% of residents rely on Medicaid, that translates to thousands of people losing access to crisis services, outpatient counseling, addiction recovery programs, and intensive youth and family services.

The federal threat is not hypothetical. In January 2026, SAMHSA abruptly terminated over 2,000 grants totaling nearly $2 billion in behavioral health and substance use disorder funding — reinstating them only after massive backlash. Programs for pregnant and postpartum women, youth overdose prevention, medication-assisted treatment, drug courts, and recovery services were all momentarily cut. Oregon ranks 47th nationally for access to behavioral health care despite some of the nation's highest rates of mental illness and substance use disorders. The state has invested $60 million in behavioral health workforce incentives — scholarships, loan repayment, and clinical supervision grants — but rural areas continue to struggle with recruitment.

For MCCFL's 160 employees serving three counties across The Dalles, Hood River, and Wasco, the math is stark. Federal funding instability already forced the organization to abandon plans for a full-scale behavioral health crisis campus in partnership with Wasco County. Instead, they pivoted to a scaled-down crisis receiving center and local residential addiction recovery facility. If Medicaid enrollment drops as projected, the organization faces the paradox of more demand and fewer resources — uninsured residents pushed out of Medicaid will still need crisis services, but the funding to provide them will shrink.

Watch for MCCFL's next moves on the crisis receiving center, and whether Oregon's Behavioral Health Talent Council's final report, released in February 2026, leads to concrete legislative proposals. The bigger question: whether the federal government follows through on Medicaid work requirements during the 2026-2027 budget cycle, and how Oregon's waiver requests to OHA and CMS will address rural coverage gaps. Eastern Oregon communities like Wasco and Sherman counties — already designated as Health Professional Shortage Areas — have no margin for further erosion.