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Oregon Health Authority Lies About Breaking Federal Rules

It took a whistleblower at the Oregon Health Authority to alert the Secretary of State that OHA was breaking Medicaid eligibility rules, giving thousands of Oregonians who didn’t deserve it free health insurance.

Secretary of state questions Oregon’s spending on Medicaid


Sherri Buri McDonald

The Register-Guard

May 18, 2017

As Oregon government grapples with a $1.6 billion budget hole, Secretary of State Dennis Richardson said Wednesday that the state may be spending hundreds of millions of Medicaid dollars on Oregonians who might not qualify for the public health care program for low-income and disabled people.

Richardson said auditors from his office recently discovered that for three years the Oregon Health Authority has spent what may total hundreds of millions of dollars providing health services to tens of thousands of Oregonians whom the state hasn’t evaluated to know whether they meet federal eligibility guidelines for Medicaid.

In Oregon, Medicaid is called the Oregon Health Plan.

The health authority is spending as much as $37 million a month on Medicaid services for recipients who might not be eligible, Richardson said in an “audit alert” issued Wednesday to all 90 Oregon legislators and the media.

The federal government, which pays the great majority of Oregon’s Medicaid costs, sets strict limits on how much income Oregon Health Plan recipients can have.

The health agency responded that it was concerned about Richardson’s assertions. Richardson’s statement contained preliminary information and didn’t explain how eligibility is determined and renewed for the OHP, the state health authority said in a statement.

All 1,028,509 Oregonians now enrolled in OHP were deemed eligible “at some point in time,” health authority spokeswoman Courtney Warner Crowell said.

Oregon received permission from federal regulators to temporarily stop re-determining each OHP patient’s eligibility for about three years while the state moved from the failed Cover Oregon online health care enrollment program to a new enrollment system, state officials said Wednesday.

Since the health authority resumed renewing OHP patients’ eligibility, about 14,000 are being dropped because they didn’t respond to the health authority’s attempts to contact them, the agency said. About 17,000 patients responded to a renewal notice and will be evaluated by Friday, the agency said. And 84,000 patients are being evaluated to determine what action is required, Warner Crowell said.

“Just because redetermination is not complete does not indicate that they are ineligible for Medicaid,” she said.

Richardson, a Republican from Central Point, campaigned on the pledge that he would restore accountability and transparency to government.

He told The Register-Guard on Wednesday that he released Medicaid information before the audit is to be completed in November because he felt legislators should have the information as they decide on the state health authority’s budget. Lawmakers are working to craft by June 30 a budget for the fiscal biennium starting July 1.

Richardson said he hoped “the subcommittee over the health authority’s budget gets answers to the questions that we were not able to get answers to, and they’re able to use that to determine the appropriate budget for OHA.”

Richardson’s warning drew deeply divided responses from the Legislature, with some Democrats calling it a headline-grabbing political ploy and some Republicans expressing outrage at government incompetence and calling for an inquiry into the state’s Medicaid spending.

“We absolutely need to clean up our enrollment data, fix the problems in our process to determine Medicaid eligibility, and hold the right people accountable for any waste, fraud, or abuse in this system,” Rep. Dan Rayfield, a Corvallis Democrat, said in a statement. “That’s exactly what legislators have been working on for months in several public hearings. Unfortunately, political ploys aimed at grabbing headlines before the full information is available will only serve the politicians who are pointing fingers — not the Oregonians who need access to affordable health care or the genuine efforts to solve the complex problems facing our state.”

Rayfield is co-chairman of the Joint Ways and Means Subcommittee on Human Services.

Senate Republican Leader Ted Ferrioli of John Day said in a statement that Oregon needs answers on the “Medicaid fiasco.”

“It’s the Legislature’s responsibility to dive deeper, to look deeper, and to exercise diligence in determining the facts,” he said. “We would welcome a bicameral, bipartisan inquiry, and if Democrats are unwilling to participate, Senate and House Republicans should proceed.”

While the health authority says all 1.03 million Oregonians enrolled in OHP had been deemed eligible at some point, the question is whether they’re all still eligible. The health authority said it doesn’t have that answer because it has been moving from the Cover Oregon enrollment system to a new system. During that transition, which has taken more than three years, the state health authority asked its federal regulator, the Center for Medicare and Medicaid Services, to waive eligibility renewals so no OHP patients would lose health insurance while the state was setting up its new enrollment system.

The regulator approved a series of waivers until June 2016, the state said.

In March 2016, the state health authority resumed its OHP eligibility renewal process using the new enrollment system. As of earlier this month, 733,695 enrollees had been entered into the new system, the health authority said.

The health authority said it should determine by May 31 what needs to be done with the remaining clients.

Richardson’s statement said the eligibility of more than 71,000 OHP enrollees still has not been determined.

“Of those 71,000 recipients, nearly 36,000 have been carried on the books since the months following the Cover Oregon fiasco in 2013,” he said. “At $430 per month, per recipient, we’re talking about a great deal of money.”

“OHA failed to disclose its ongoing violation of federal eligibility rules until after our audits team was recently tipped off to the situation by an OHA whistleblower,” Richardson said in a statement. “Even after we learned of the problem and requested detailed information, OHA has delayed providing full disclosure.”

The health authority responded that it has reported about its progress with Medicaid eligibility renewal to the governor, the Legislature and the federal regulator repeatedly in the past three years.

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