Seven ways to build a workable funding package.

A county uses its own lawfully available public money as the non-federal share of an approved Medicaid payment.

Local governing body and counsel; OHA; CMS for required federal action

The county must have lawful authority, available funds and an authorized appropriation. Review the actual source, enforceable public service or property, consideration, remedies and tax-revenue or credit exposure under Article XI, section 9. OHA separately confirms the eligible source and applicable approved payment method, with any required new federal action.

Potential recurring support, limited by lawful available county funds. No amount is established.

A county may be a local public partner if the member chooses a partnership criterion or option.

Document the actual fund and proposed transaction, including tax/non-tax origin, public services or property secured, appropriation, obligations and recourse. Resolve the local legal basis before modeling the selected Medicaid payment.

Voters form a health district, or an existing district acts. Its revenue then supports health services through a transfer, a service contract or a joint arrangement.

District board; voters where required; OHA/CMS for a Medicaid route

As with county funds, or through a direct service contract outside Medicaid. Lawful district powers and available revenue; formation and voter approval where required; property-tax limits and clear governance. ORS 451 hospital authority is geographically limited, so it is not a general countywide substitute for ORS 440.

Potential recurring revenue. Timing and scale depend on district powers, boundaries, assessed value, compression and any required election.

A district can provide a durable public partnership. The designation alone neither forms a district nor authorizes a levy.

Check existing districts, boundaries, tax capacity, formation requirements, governance and the authority for the intended services.

A hospital owned by a public district can certify its own allowable spending, or transfer its lawfully available funds, as the non-federal share.

Public board and certifier; OHA; CMS as required

OHA claims the federal share on eligible certified public expenditures. Any amount remitted to the certifying provider depends on the applicable approved method; certification itself is not cash, and its federal match is not a pool for other hospitals.

A willing governmental hospital can use an appropriate financing mechanism. Its public status does not transfer to other hospitals or by itself establish an approvable mixed class.

Reconcile a participating public hospital’s allowable expenditures, existing claims and payments, available public funds, payment-limit capacity and required board approvals.

Three separate possibilities: Tribal public transfers, qualifying care-coordination arrangements and direct philanthropy.

Sovereign Tribal decision maker; Indian health care provider; OHA and other parties under their own authority

For eligible American Indian and Alaska Native Medicaid beneficiaries, hospital services furnished through a qualifying IHS/Tribal care-coordination arrangement may receive 100 percent federal match if the conditions in CMS State Health Official Letter 16-002 are met. An agreement alone is insufficient. Oregon already returns a portion of enhanced match to the participating Indian health care provider. The hospital’s ordinary payment does not automatically increase, and this proposal redirects none of those amounts.

Unquantified and dependent on Tribal choice. Public transfers, enhanced federal match and philanthropy must be tracked separately.

A Tribe may choose to participate as a public partner. The designation neither commits Tribal funds nor redirects amounts governed by ORS 413.241.

Identify existing agreements, the actual owner and restrictions of any funds, and the Tribe’s priorities through the appropriate government-to-government process.

A service partnership between a hospital and the community mental health program, aimed at reducing emergency-department boarding and strengthening crisis care.

Contract owners, program board and any grant/settlement administrator

Purchased services, shared staffing, grants, and opioid settlement funds used for approved purposes such as emergency-department navigators, warm handoffs and hospital transition programs. A real service agreement, no double payment for the same cost, and compliance with grant and settlement terms. Under the covered Oregon settlement framework, funds generally must be spent or encumbered within five years of receipt, or seven years for designated capital outlay; the actual agreement controls.

Unquantified. Measure purchased-service revenue and avoided boarding costs after new costs and existing reimbursement; do not count agency goodwill as money.

A real partnership can demonstrate regional essential-service work. It does not itself supply public match or create eligibility for a hospital payment.

Review existing crisis-service agreements, boarding data, funding restrictions and eligible projects; choose one or two measurable service improvements.

Payments for the documented costs of training resident physicians. Oregon already has an approved Medicaid graduate medical education program with specific eligibility rules and payment limits.

Sponsor and hospital record owners; OHA; CMS for a new method

Existing Medicare and Medicaid education payments. A new Medicaid pathway for rural training costs could be added with federal approval. Costs are documented and allocated correctly, the federal government confirms how the payment is treated under the directed-payment limits, and no cost is paid twice.

Unquantified. A new Medicaid payment requires an eligible non-federal share and recognized training costs. An existing sponsorship does not establish a new hospital receipt.

An optional provision could direct OHA to seek an approved rural-training pathway. No exemption from section 71116 or payment above an applicable limit is assumed.

Map approved and filled positions, training-site FTEs, cost-bearing agreements, Medicare and Medicaid claims, payment recipients, grants and existing support before estimating new revenue.

A set of distinct local, restricted and private resources for eligible services, projects or financing.

Source owner, governing body, grantor or lender as the actual terms require

Match eligibility is considered only for a qualifying Medicaid route. Service purchases, philanthropy, grants and credit follow their own terms. Federal money requires an express exception before it can serve as Medicaid match.

No general pool or amount is established. Some routes fund a project, some reimburse an existing cost, and loans remain repayable.

These tools may complement a designation. Each needs its own eligible recipient, lawful purpose, approvals and net-benefit calculation.

Inventory existing awards, local restrictions and commitments, actual eligible services, available balances and decision owners before selecting a project.