SALEM — When Oregon expanded access to Medicaid in 2014, it had no system in place to perform the annual checks on recipient eligibility required by federal law.
That was one of the many flaws of Cover Oregon, a state health care exchange also intended to handle patient registration for Medicaid. Medicaid is the federal government’s health care coverage for the poor and other qualifying groups. In Oregon, about a quarter of the state’s population — approximately 1 million people — receives it.
More than three years after the expansion was launched under the Affordable Care Act, the state is scrambling to finish verifying whether every Oregonian on Medicaid — the Oregon Health Plan — meets the criteria.
Oregon’s new system for managing its Medicaid enrollees, called ONE, has this capability, according to the Oregon Health Authority.
But since ONE was launched in late 2015, patients are still being entered into the system, due in part to disparate datasets and a laborious initial process that requires enrollees to complete a paper application more than 30 pages long.
And the 465 state workers assigned to the task of re-enrollment are not yet finished.
As a result of the problems with Cover Oregon, the state received a series of waivers from the federal government on performing redeterminations until mid-2016. OHA maintains the Centers for Medicare and Medicaid Services are aware of and have approved the agency’s ongoing efforts to resolve the backlog, despite the current lack of a formal waiver.
The governor has given OHA an Aug. 31 deadline to get about 101,000 Oregonians double-checked. Another 14,000 people are in the process of being removed from the Oregon Health Plan because they did not respond to the state’s termination warnings.
Although the OHA emphasizes the process is now about 90 percent complete, the remaining 10 percent has come to the attention of the state’s top auditor, who released a memo arguing that the state could have spent millions of dollars on people who do not qualify for the program.
Secretary of State Dennis Richardson’s memo riled up legislators on both sides of the aisle, who are busy hammering out healthcare budgets and a potential tax on providers to cover some of the costs of expanding Medicaid.
The possibility that the state could have lost money by paying for unqualified recipients — and to clean up the data — in its effort to provide coverage to more people has been highlighted as legislators attempt to close a $1.4 billion budget gap.
Richardson’s office released an audit Wednesday finding the new ONE system functions well when it comes to verifying people for Medicaid. However, auditors also found that manual entry poses a risk to the accuracy of eligibility determinations and payments to healthcare providers.
OHA says the enrollment and redetermination process will be simpler as time goes on because the system can do certain things automatically, such as verifying an applicant’s income by comparing the application to existing datasets.
Asked whether the OHA was equipped to redetermine the eligibility of the approximately 1 million people on the Oregon Health Plan, the agency responded Wednesday that it has “taken aggressive action” to verify recipients’ eligibility since the Cover Oregon failure.
The agency hired 300 temporary employees, according to a spokeswoman. It has brought on multiple private contractors to help with the process, OHA’s Director, Lynne Saxton, told legislators Tuesday.