An audit by the Oregon Secretary of State’s Office released Wednesday found the state accurately determines Medicaid eligibility, enrolls people into the program and makes payments on their behalf.
At the same time, the audit came across information that hadn’t been entered into the Oregon Health Authority’s enrollment system correctly and determined that the eligibility changes, or overrides, caseworkers make aren’t sufficiently monitored. That could result in ineligible people joining the program or eligible people being denied access, the report said.
“Although the IT system examined in this audit appears to be performing well, an IT system is only as good as the data fed into it,” Oregon Secretary of State Dennis Richardson said in a statement. “OHA’s negligence regarding inaccurate inputs and eligibility overrides is putting tens of millions of dollars at risk. Inappropriate payments and improper overrides need to end so that we can redirect savings to help the most vulnerable Oregonians.”
Expenditures on Oregon’s Medicaid program, known as the Oregon Health Plan, totaled $9.3 billion in 2016, $1.2 billion of which came from state general funds. The low-income health care program grew from being a $5.5 billion program with about 650,000 people in 2013 to more than 1 million following its 2014 expansion under federal health care reform.
OHA uses an automated computer program called the Oregon Eligibility system, or ONE, to determine whether people are eligible for Medicaid. It also uses a system called the Medicaid Management Information System to enroll Medicaid clients into so-called coordinated care organizations, regional groups that oversee their care, and pay those groups.
The audit turned up errors in seven out of 30 randomly selected Medicaid client case files, one of which resulted in an ineligible individual being enrolled in the program. The errors involved incorrect household sizes, application dates and income levels.
Mark Fairbanks, OHA’s chief financial officer, said in a statement that his agency appreciates the confirmation that its eligibility system is working as it should and the help identifying areas where the process can be improved.
“We look forward to implementing a number of the recommendations included in the audit and working to ensure that all Oregon Health Plan members get the quality health care they need,” he said.
The audit comes on the heels of a highly critical “Auditor Alert” Richardson’s office issued last week that said OHA could be spending millions of dollars per month on Medicaid for people who aren’t eligible because it is not performing annual eligibility determinations required under federal law.
OHA officials disputed that characterization, explaining that it takes time to shift members to the new ONE system, and they have kept the Centers for Medicare and Medicaid Services apprised of the agency’s status.
Contrary to Richardson’s assertion that the OHA was not cooperating with his ongoing audit, which began in 2015, OHA Director Lynne Saxton told lawmakers in a hearing Tuesday her agency had provided written responses May 11 to a set of questions from his office.
Richardson issued the alert May 17, and Saxton said OHA officials received no warning ahead of time.
“We read it in the paper when you read it in the paper,” she told lawmakers.