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Oregon has cleared a Medicaid eligibility backlog

The state had fallen behind on redeterminations of participant eligibility and by late May had a backlog of roughly 115,000 people

By Claire Withycombe

Capital Bureau

Published on August 31, 2017 8:03PM

Last changed on September 1, 2017 8:27AM

SALEM — The Oregon Health Authority said Thursday that it has cleaned up its Medicaid rolls, terminating more than 54,000 people from the program.

In recent months, state auditors raised concerns that the Oregon Health Plan — the Medicaid program that provides health care coverage to the poor and other qualifying groups — was providing benefits to people who no longer qualified.

Oregon Health Plan patients must go through an annual process — called “redetermination” — to have their eligibility confirmed. Oregon had fallen behind on those redeterminations and by late May had a backlog of roughly 115,000 people.

Of that group, the agency announced Thursday that it found that 60,353 people were still eligible for the program.

But 22,937 plan participants were found to no longer qualify, while 31,895 cases were closed due to a lack of response from the recipients.

Altogether, the agency says that the closures due to patients no longer qualifying for the program account for less than 2 percent of the more than 1 million people on the Oregon Health Plan and will not affect the state’s two-year budget.

Auditors said in May that each Medicaid enrollee in Oregon costs, on average, about $430 per month.

Additionally, the agency claims that all current participants are now on a regular review cycle, and a backlog will not continue.

According to the Oregon Health Authority, Oregon Health Plan participants will have their eligibility rechecked automatically by the state’s new system, which is an effort to integrate the eligibility determination process for various safety net programs administered by the health authority and the state Department of Human Services.

It seems that the Oregon Health Authority is eager to put the episode behind it. In the report detailing completion of the project, the agency pinned the backlog issue on the failure of Cover Oregon, which was supposed to be a state-run health insurance marketplace. Cover Oregon, a costly failure under former Gov. John Kitzhaber, was also expected to perform eligibility renewals for Medicaid.

“These nearly 1 million Medicaid renewals conclude and complete the state’s recovery from the failure of Cover Oregon,” the report said, adding that Cover Oregon’s collapse and the dramatic expansion of the state’s Medicaid population under the Affordable Care Act “overwhelmed” the state’s health system.

The report caps off the tenure of Lynne Saxton, who was asked to resign as the health authority’s director by Gov. Kate Brown after revelations of a public relations and media campaign to discredit a Portland-area Medicaid provider surfaced in early August.

Patrick Allen, formerly the head of the Department of Consumer and Business Services, has been named acting director of the health authority.

The news comes as a group of state House Republicans continues to collect signatures to refer the state’s plan for funding Medicaid to the ballot.

The legislation in question, House Bill 2391, outlines assorted revenues to pay for the state’s program; the petitioners want to refer parts of the legislation, such as a 1.5 percent tax on health insurance premiums, to voters.

Their deadline to gather nearly 59,000 signatures is Oct. 5. If the petitioners are successful, the issue will go to the ballot in a special election Jan. 23. A committee was appointed by the state Senate president and House speaker this week to write the ballot title.

The Capital Bureau is a collaboration between EO Media Group and Pamplin Media Group.


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