Thousands Could Be Mistakenly Receiving Medicaid in Oregon
By Hillary Borrud
Oregon budget writers plan to meet Tuesday with state health officials to discuss concerns that the state has kept thousands of people on Medicaid while their eligibility is in question.
The state's failure to check that as many as 115,000 Medicaid recipients still have incomes low enough to qualify for the costly benefits they have been receiving was disclosed Wednesday, first by The Oregonian/OregonLive and then by the secretary of state's office.
Lawmakers scheduled the meeting after Secretary of State Dennis Richardson on Wednesday called for Oregon Health Authority leaders to tell lawmakers the potential budget impact of the situation.
Richardson issued his alert after The Oregonian/OregonLive reported that the state dispensed millions of dollars in Medicaid assistance to thousands of Oregonians without conducting routine annual eligibility checks, or "redeterminations." The state did conduct initial qualification checks. The newspaper also reported that auditors at the secretary of state's office recently launched an investigation into the situation, after learning about it while working on a separate audit.
Oregon received several waivers from the U.S. Centers for Medicare and Medicaid to skip the redeterminations starting in 2013, as part of the triage of the failed launch of Cover Oregon and the workload from the Medicaid expansion under the Affordable Care Act.
The state cannot legally kick someone off Medicaid until it determines the person is ineligible. But the last waiver only extended to June 2016. Richardson and Oregon Audits Division director Kip Memmott pointed out that nearly a year later, the Oregon Health Authority still has not determined the eligibility of thousands of Medicaid enrollees. Health authority officials said on Tuesday that they are conducting their own eligibility analysis which they plan to complete by the end of the month.
"As of May 1, 2017 preliminary analysis by the (Oregon Health Authority) has identified approximately 86,000 individuals, representing about 8 percent of the state's entire Medicaid population, who have not undergone the federally required annual benefit eligibility determination process," Richardson and Memmott wrote in a one-page "auditor alert" issued Wednesday morning. "About 14,100 people have been sent renewal notifications but have not returned applications. The preliminary analysis did not clearly identify why the remaining 71,600 have not been redetermined."
On average, an individual on Medicaid costs the state and federal government $430 a month. If 86,000 individuals are ineligible to receive that coverage, the total coverage cost could be approximately $37 million a month, according to Richardson and Memmott.
"(Oregon Health Authority) should work with the federal regulatory authorities to ensure federal Medicaid funding is not jeopardized while (the Health Authority) resolves these eligibility determination issues," Richardson and Memmott wrote.
The Oregonian/OregonLive story and Richardson's auditor alert prompted both Democrats and Republicans to comment on the state's Medicaid program during a floor session on Wednesday.
Rep. Dan Rayfield, D-Corvallis, said he was "frustrated and disappointed" with the news article because it seemed like "a politically motivated attempt to grab headlines and not necessarily an attempt to inform the public about this brand new concern that we've been having in this state."
"This is something that the Oregon Health Authority has been proactively working with in a bipartisan effort to reduce this problem," Rayfield said. Health officials have kept lawmakers updated on the Medicaid eligibility problems, and "it appears the only person who has not been aware of this is our secretary of state."
Rayfield noted that he and three other Democratic lawmakers from the Legislature's budget writing committees met with the secretary of state's office last week to provide information about Medicaid eligibility. Richardson said the lawmakers asked him to delay the release of the auditor alert -- initially planned for last week -- and he agreed.
"It was not an unreasonable request," Richardson said. "But I didn't realize at that point OHA's budget was being considered tomorrow." A public hearing on an Oregon Health Authority spending bill had been scheduled for Thursday, but it was cancelled.
Republicans also chimed in during the House floor session on Wednesday, pointing out that news of the Medicaid eligibility issues came at a politically sensitive time. Rep. Julie Parrish, R-West Linn, said the Legislature should make sure the state has a grasp on the actual number of people eligible for Medicaid, before passing a package of health care taxes to fund a budget shortfall in the program.
"We're having conversations about how much money to raise in hospital provider taxes, in insurance taxes, in (coordinated care organization) taxes and all manner of taxes based on a (Medicaid population) number that may or may not be correct," Parrish said.
(c)2017 The Oregonian (Portland, Ore.)