The Oregon Health Authority is working to determine how much it owes the federal government after determining it improperly enrolled more than 41,000 people in expanded Medicaid under the Affordable Care Act.
The errors, which occurred between 2014 and 2016, happened due to a flaw in the Cover Oregon electronic enrollment platform, which never officially launched for public use. During that time, the federal government paid 100 percent of the health care costs of people who qualified for Medicaid under the ACA’s expanded eligibility guidelines. The health authority spent $74 million in federal dollars on those who were mistakenly placed into that category.
Robb Cowie, a spokesman for the health authority, could not say how many of the 41,400 incorrectly categorized people — 11,300 in 2014, 16,400 in 2015 and 13,700 in 2016 — reside in Central Oregon. It’s also unclear whether some people were counted in more than one of those years if they were improperly enrolled for more than one year.
The agency was able to repay the federal government $10 million of the payments in 2016, bringing the total dollar amount in question to $64 million, Cowie said.
The people erroneously categorized as Medicaid expansion enrollees were actually dually eligible for both Medicaid and Medicare, in which case the federal government pays a smaller share of their Medicaid costs, about 64 percent.
Health authority officials are trying to determine whether the Medicare program can cover a portion of the overpayments, Cowie said.
“Once we have more information on that front, then we will have a better sense of how we move forward and what the state is liable for and then what the time frames will be for repayment,” he said.
In a statement, Gov. Kate Brown praised newly appointed health authority director Patrick Allen for acting quickly to bring transparency to the agency.
“I thank Director Allen and his team for responding quickly,” Brown said in the statement. “It’s vital that we have a transparent, efficient and accountable healthcare system because the lives of so many Oregonians depend on it.”
Brown’s political rivals were quick to criticize her for allowing such oversights to occur under her watch.
“Gov. Brown’s incompetence is jeopardizing the health and security of Oregon’s Medicaid program,” Rep. Knute Buehler, a surgeon from Bend who is running to replace her, said in a statement. “Every dollar wasted is a dollar that can’t be spent helping Oregonians who need it. As a physician, I find this appalling.”
It’s one in a string of negative disclosures about the Oregon Health Authority in recent months. The authority’s former director, Lynne Saxton, resigned in August at Brown’s request after it surfaced that she and others within the agency discussed using the media to discredit a Portland health agency.
Secretary of State Dennis Richardson issued a scathing report in May that warned the agency could be spending millions of dollars per month providing Medicaid to people who aren’t eligible. That’s because the agency was not performing annual eligibility determinations on members required under federal law. Health authority officials said that’s because they were transitioning members from the failed Cover Oregon portal to a new one, a time-consuming process that requires contacting members individually.
On Wednesday, Richardson wrote in a statement that the news about the erroneous enrollments endangered Oregon’s already precarious budget situation.
“I appreciate the new OHA director’s public disclosure of longstanding mismanagement of taxpayer funds,” he wrote. “It’s the first of many necessary steps current leadership should take to improve transparency, efficiency, and accountability to Oregon taxpayers.”
Richardson also wrote that he plans to release an audit on improper Medicaid payments in the coming weeks.
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