Oregon needs more youth ‘respite’ homes, but funding problems stand in
the way
[October 29, 2026]
By DANIELLE DAWSON/InvestigateWest
Megan Miller knew she and her son needed breaks, but for a long time,
she didn’t know how to get one.
As a single mom in Eugene, Oregon, caring for her neurodivergent — or “neurospicy,”
as she calls it — 8-year-old left her feeling overwhelmed and isolated.
A standard childcare or after-school program wouldn’t accept him given
his special needs, and Miller doesn’t have family nearby. Her son’s
Medicaid plan for people with an intellectual and developmental
disability covers two weeks of “relief” overnights per year, but she
said she has never been able to use it because the benefit only covers
limited situations and there are few providers.
This struggle worsened when they moved homes and schools. Miller said
her imaginative, Spider-Man obsessed boy became so depressed amid the
changes he was expressing thoughts of suicide. She became desperate for
a solution.
For decades, experts have recommended a service for kids with complex
behavioral health needs called respite, which provides short-term
supervision from trained providers and gives families like Miller’s a
break from the kind of stress that can lead to emergency room visits,
caregiver burnout, and in some cases, abuse or neglect. But the service
isn’t easily accessible in most of Oregon.
There is no statewide funding available for youth behavioral health
respite, and Oregon is one of only two U.S. states that does not mandate
Medicaid coverage. As a result, it is largely up to Oregon’s regional
Medicaid networks to decide whether or not to pay providers for this
care.
While some do cover it, providers still find it hard to cover the cost
of offering a service that must be able to accommodate a child with
complex needs at any time. That’s led to program closures, including the
shuttering of one youth respite home in Southern Oregon, Interval House,
just last year after a decade in operation.
Kairos NW, the nonprofit youth mental health and foster care services
provider that ran Interval, decided to close the home after the regional
Medicaid administrator, Jackson Care Connect, significantly scaled back
its funding for the program, citing low utilization and a need to direct
their limited dollars elsewhere.
Oregon’s health and child welfare agencies have invested in recent years
in other youth outpatient behavioral health services designed to
stabilize a child after a crisis. For years, the state has ranked among
the worst in the nation for access to youth mental health care. But
providers, state commissions and local mental health authorities have
repeatedly said there are still serious gaps in pediatric services — and
flagged respite as one of the biggest needs remaining to build a
functional support system for kids and their families.
“(Respite) gets taken for granted,” said Sarah Hollingworth, outpatient
services director at Kairos NW. People assume families can just “deal
with it” without these types of services, when finding appropriate care
for a kid with complex behavioral health needs is not simple, she added.
State officials are now exploring how they can require Medicaid coverage
to help make respite more available to families across Oregon, but that
wouldn’t solve the funding problems. Regional Medicaid networks say
costs have risen and they are already overstretched by the existing
behavioral health services they’re required to provide. Federal cuts to
Medicaid funding are expected to add to these pressures.
After months of trying, Miller found a daytime respite program in Lane
County that had space for her son. It’s only a few hours of care on a
Saturday, once a month, but she said it was a game changer. It gave her
son the space to simply be a kid, with others like him — and her a
much-needed break.
“There were so many times that I felt like I was failing as a parent
because it was so hard to find services for my child,” Miller said. “We
have set up this system where we are not helping families to flourish.
We are setting them up to fail.”
A break for kids and their caregivers
Before it closed, Kairos NW’s Interval House was one of only a few youth
behavioral health respite providers offering overnight services in the
state. With its closure, there’s now only one respite provider available
within the three-hour drive between the California border and the city
of Eugene in southwestern Oregon. It’s in Grants Pass, 140 miles south
of Eugene.
As a licensed behavioral rehabilitation services center, Interval was
staffed with trained providers 24/7 and could accommodate up to three
kids at a time, each for a few days.
The experience was designed to feel like a trip to “grandma’s house”
instead of a day in a full-time residential treatment facility, said
Susan Tremper, who worked as a live-in provider at the Medford facility.
The staff structured a child’s day to be as close to their usual routine
as possible, while incorporating opportunities to address specific
behaviors, like anger or shyness. Kids did arts and crafts, went to the
movies or local science center, and got time to do homework. They were
allowed to choose what they wanted to do, whether they wanted time to
themselves and what they wanted to eat. Instead of adding another
therapy appointment or requirement in their day, Interval gave them
structured choices, Hollingworth said. That real world practice with new
skills, including building trust with adults, helps kids translate what
they’re learning from other programs into instinct.
“We found that our respite providers were able to see more success in a
shorter period of time that builds on a lot of those other skills,” she
said. Especially for foster kids, respite care can help create routine
and normalcy in a destabilizing experience, and increase the success of
a foster placement, she added.
Respite care dates back to the 1980s, when states shifted away from
institutionalizing kids in favor of keeping them with their families.
For nearly a decade, Oregon did fund local respite care networks, but it
was cut from the state budget in 2010. Now, youth respite is largely
provided by a handful of nonprofits across the state like Kairos.
Anna Williams, director of Oregon’s System of Care Advisory Council that
is tasked with improving local youth services, said respite is a “proven
approach” that saves the state money in the long run. It relieves the
stress of dealing with trauma or complex disabilities, which can
fracture family relationships. And it can prevent kids from experiencing
deeper — and more expensive — crises that send them to emergency rooms
or child welfare.
“If we can get people into respite care, we may not need an emergency
room or an inpatient setting,” Williams said. “It can be massively
preventative if people can just take a break.”
Oregon doesn’t require Medicaid coverage, creating funding problems
Since Oregon does not require respite care be covered by Medicaid, local
Medicaid administrators, known as coordinated care organizations, have
discretion over whether or not to cover it — and many do not. Only half
of these networks currently list providers offering overnight respite
care in their member benefits documents.
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 Yet the need is more widespread.
Multiple local systems of care, including those in Lane,Linn, Benton
and Lincoln counties, have told state officials that regularly
accessible respite is one of their community’s biggest unmet needs.
A special report in a lawsuit against Oregon for its practice of
placing foster kids in hotels called for the state to provide more
respite options. And a state commission that reviews what services
should be covered by Medicaid has continually recommended respite as
a treatment for nearly three dozen behavioral health conditions.
Some families may be able to get respite care if their child is in
foster care or another state-run youth system, but there aren’t
enough providers to meet demand.
To run Interval House, Kairos relied on funding from Jackson Care
Connect, a coordinated care organization in Jackson County. The
Medicaid network covered the lion’s share of the home’s
approximately $58,000 in annual operational costs and separately
reimbursed for any clinical services provided to kids.
Last year, however, Jackson Care Connect cut the operational funding
it provided, leaving only a reimbursement for each bed occupied.
Jeremiah Rigsby, chief legal and public affairs officer for
CareOregon, which operates Jackson Care Connect, said they decided
to rightsize the funding, since it was considered underutilized
compared to other services.
“Our specific contract with Kairos evolved as initial projections
for care utilization substantially differed from the level of
services that our members actually used,” Rigsby said, noting
Jackson Care Connect members still have one other respite provider
available.
Interval House served, on average, about 30 children a year, whereas
some of Kairos’ other programs see upwards of 700 kids, according to
Hollingworth. She said Interval had limited capacity in part because
of the individualized care it provided. For instance, when Interval
accepted a child with a history of aggressive behavior, Hollingworth
said they wouldn’t place other kids in the home at the same time for
safety. There was also often a waitlist for weekend appointments
while weekday slots were vacant.
In 2024, Hollingworth said, Kairos was in talks with Jackson Care
Connect, the Department of Human Services and another coordinated
care organization to open a second home so they could serve more
kids.
“That’s a hard loss to have had (respite) for so long and then for
it to go away without much notice or a plan,” Hollingworth said.
Health officials have already observed a troubling rise in children
boarding in emergency departments for behavioral health concerns
over the past few years — which a report released earlier this year
by the Oregon Health Authority’s Ombuds Office says is linked with
inadequate outpatient services for youths before they reach a
crisis.
Children of all ages saw a 15% increase in emergency room visits for
mental health crises or substance use between 2020 and 2024,
according to the report. The increase was especially pronounced for
those under age 6, jumping 74%.
“Almost without exception, they’ve all attempted to access treatment
and care for their young children,” said Cate Drinan, a pediatric
patient advocate with the Ombuds team. “Either the services that
they have in place in the community aren’t sufficient to hold them,
or the services that they need don’t exist or aren’t available in
their region.”
After repeated emergency room visits and no help to manage their
child’s needs, Drinan says, she has seen some families hit a
breaking point where they choose to relinquish their child into the
custody of child welfare, having come to the conclusion there’s
nothing else they can do to help. If they were already in the care
of foster parents, it could mean another disorienting move.
“The children are sent back home, and the cycle starts all over
again because they haven’t found any meaningful intervention,”
Drinan said.
Playing ‘catch-up’
Oregon health and child welfare officials have been trying for years
to reintroduce respite services statewide, although it remains a
tall order.
Right now, they say the best option to improve statewide access of
youth respite care would be to add it as a standard service under
Oregon’s Medicaid program, as 48 other states have done. Providers
currently negotiate privately with coordinated care organizations
over how to provide and fund respite care, making it hard for them
to compare notes.
To do that, the state would need to get a waiver from the Centers
for Medicare and Medicaid Services allowing it to deviate from
federal standards. Oregon’s current Medicaid waiver that could
include respite care expires in 2027, creating an opening for the
request.
“Until we get it turned on at the Medicaid level, which is how you
actually ensure statewide access,” said Williams, the System of Care
Advisory Council director, “it’s going to continue to be a kind of
catch-up.”
It’s unclear whether CMS would approve it. Under President Donald
Trump, the federal Medicaid agency has made a number of changes to
make it harder for states to obtain a waiver. Even if respite care
was approved, Oregon would likely need to pitch in state dollars to
fund the service, Williams said — something lawmakers have declined
to do at least three times since 2023.
Mandating statewide Medicaid coverage also wouldn’t solve the
operational, licensure and administrative costs that can make it
hard to finance programs that must be ready to care for children at
any time.
Rigsby, the CareOregon representative, said coordinated care
organizations are already stretched thin, between rising costs and
state Medicaid expansions that have grown the list of services they
must provide.
“We have a healthcare benefit that honestly we can’t afford,” Rigsby
said, adding that their priority has to be on services with the most
demand.
Williams said it will likely require teamwork from multiple corners
of state government, including action by lawmakers, to expand access
to this care.
“It’s going to take a significant amount of time and a decent amount
of state-level investment in order to get something up and off the
ground like this,” Williams said.
Kairos is still trying to find a way to reopen Interval House.
Families who once used the program are constantly asking when it
will reopen, Hollingworth said. After seeing improvement with
respite care, some caregivers told her they’ve seen old concerning
behaviors return, putting strain on the whole family.
“It cannot be overstated the impact that the break has on
everybody,” Hollingworth said. “The benefits ripple out to every
single system a child touches.”
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