HB 4004 Workforce Stability Grant Application


  • Mental health or substance use disorder crisis line providers; or
  • Urban Indian Health Programs in Oregon; or
  • Tribal Behavioral Health Program grant recipients in Oregon; or
  • Behavioral health care providers (services and supports for individuals with mental health or substance use disorders) that meet the following criteria:
  • Serve adults or youth, at least 50% of whom are uninsured, enrolled in state medical assistance programs (Medicaid), or enrolled in Medicare
  • Are not hospitals; and
  • Qualify as one or more of the following:
  • Certified by Oregon Health Authority to provide behavioral health care
  • Provides behavioral health care through program contracting with or administered by the Oregon Youth Authority.
  • Provides behavioral health rehabilitation services through a program contracting with or administered by the Department of Human Services
  • Licensed opioid treatment program
  • Provides withdrawal management services; or
  • Is a sobering center


Attestation: by an authorized representative that: (1) the applicant is an eligible applicant and the basis for such eligibility; (2) the applicant has reviewed, understands, and acknowledges the terms and conditions of receiving grant funds under HB 4004 as described in this application and the applicant agrees to comply with all terms and conditions; and (3) all information provided to OHA in connection with this application is true and correct, and the applicant agrees to notify OHA immediately in writing if the applicant becomes aware that any such information is inaccurate or incomplete.


Yes-I affirm our agency meets the above criteria

Total staffing costs (gross pay) for Oregon operations, including benefits, for one month. (Please do not include independent contractors who are not employees, such as consultants or contract nurse/providers).

Our organization is committed to pursuing these innovative strategies and will submit a one-page summary of our recruitment strategy as part of the Incentive Distribution Report due on August 1, 2022


Yes - I affirm the above statement is true

Please upload the following:

1. A description of other employee retention strategies that are unrelated to financial incentives

2. A one page summary of the innovative recruitment strategies you are committed to set in motion with intent to increase staff diversity and expedite and filling open positions (if recruitment strategy is under development, please submit by August 1, 2022.

Please upload document below.

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