In a looming crisis for public health, Multnomah County is preparing to implement significant budget cuts that could terminate vital programs and result in mass layoffs for health department employees.
Since 2023, Leigh Richards, a registered nurse with Multnomah County’s Nurse-Family Partnership, has dedicated herself to supporting first-time mothers through one of life’s most challenging transitions.
Richards provides essential medical care and guidance, assisting low-income moms to navigate the complexities of early childhood and the health care system.
But as the fiscal year draws to a close in July, her position is expected to vanish due to drastic budget cuts proposed by county Chair Jessica Vega Pederson.
“What we’ve been told really is that the likelihood of the program being saved is quite slim,” Richards stated, reflecting the uncertainty faced by her and her colleagues.
Richards is among many Health Department employees anxiously awaiting the outcome of a vote by the Board of Commissioners, which could lead to the elimination of up to 81 positions spanning eight divisions, including the removal of the decades-old Nurse-Family Partnership.
Such reductions not only jeopardize the largest public health provider in the Portland area but also threaten to overburden a workforce that is already stretched thin.
Health Director Rachael Banks expressed concern over the impending cuts, voicing the need to minimize impact on the workforce.
Despite these sentiments, she noted, “I think it’s inevitable.”
The county’s financial situation is dire, with a total operating budget decrease of $77.3 million, marking a roughly 3% reduction compared to last year.
This includes a staggering $15.5 million budget gap in its general fund, the biggest pool of discretionary funds available to county officials.
To bridge the budgetary shortfall, Vega Pederson’s recommendations include an 8.6% reduction—or nearly $7 million—from the Health Department budget, which is the largest department in the county.
With these cuts, department leaders are preparing for drastic effects on operations at health clinics, mental health and addiction services, and disease prevention programs.
Banks emphasized the significant role the Health Department plays, saying, “We are the people responsible for the health – physical, behavioral and oral – and wellness of every single person in Multnomah County.”
Over half of Health Department employees have reported feelings of burnout, exacerbating an already precarious staffing situation.
A recent survey indicated that the figures have further deteriorated, with 53% of employees experiencing burnout by March 2023.
Many employees indicated that hiring additional staff could alleviate some of the strain; however, it remains unclear what actions the county has taken in response to these insights.
Vega Pederson acknowledged that the approved budget will “absolutely have impacts on Health Department capacity,” but she aimed to avoid deeper cuts to frontline staff and services.
Currently, the Health Department faces not just financial troubles but an uphill battle against high turnover rates and the prospect of layoffs clouding employee morale.
“Whether it’s the public health workforce or providers, shortages in different variations of primary and behavioral health, those workforces were under strain before these cuts,” Banks noted.
With layoffs looming since February, employees are left in uncertainty about their job status until after the budget is finalized.
County commissioners are weighing numerous amendments to the proposed budget, attempting to prioritize funding for essential health services against other financial obligations.
Despite the proposed reductions, most Health Department programs are expected to remain, except for the Nurse-Family Partnership, which Richards asserts is invaluable for supporting low-income mothers.
The program’s focus is to meet families where they are and to provide comprehensive support to new mothers.
Operating across four states, the initiative currently serves 207 families, with each nurse taking on an average of 25 clients.
County officials suggest reallocating responsibilities to other support programs, but concern grows regarding whether these programs can handle the additional caseload amid their own uncertainties stemming from federal funding cuts.
“We’ll need to do a rebalance based on both what we understand about the state funding landscape as well as the federal funding landscape,” Banks elaborated.
The Nurse-Family Partnership has proven pivotal in supporting families facing numerous challenges, as evident in personal testimonies from those who have benefitted from its services.
Former participant Jenna Brett shared how the program was vital during the birth of her premature son, recounting how her nurse, Thea Nealschneider, provided critical support.
Brett highlighted the importance of having someone there through such a stressful period, emphasizing the need for continued support for new mothers in the community.
As the Board of Commissioners prepares to finalize the budget, the fate of the Nurse-Family Partnership hangs in the balance, amidst discussions focused on prioritizing other programs.
This impending decision signals broader implications for public health services, particularly for low-income families who rely on these resources.
Chair Vega Pederson stated, “We’ve worked very specifically this year to find reductions with the least impact to direct services,” though the actual impacts remain to be seen following budget approval.
Health Department leaders express the urgent need to maintain structural supports for frontline workers in order to ensure effective health service delivery.
“It’s really important to understand, we need those infrastructure supports and those back of house supports,” said Public Health Director Kirsten Aird, stressing the essential nature of these roles in sustaining effective operations.
As clarity on layoffs remains elusive until budget approval, employees are left in a state of anxious anticipation about their futures.
County forecasts suggest that this budget struggle may not be an isolated event, positioning local health authorities for continued challenges in adequately funding essential services moving forward.
To counteract potential instability, Leaders like Banks are looking toward fostering self-sufficiency for programs through insurance billing avenues and implementing workforce retention strategies aimed at reducing turnover.
The situation remains precarious as Multnomah County grapples with decisions that could reshape the future of public health in the area, challenging the capacity to deliver wholesome care and support to its residents.
As the community awaits further developments, the urgency and necessity of these programs become more apparent, underscoring a critical time for Multnomah County’s health authorities.
image source from：https://www.oregonlive.com/politics/2025/06/portlands-largest-public-health-provider-is-bracing-for-large-cuts-it-could-have-lasting-consequences.html
