Oregon Spending Millions On Ineligible Medicaid Recipients, Secretary Of State Warns

By Kristian Foden-Vencil (OPB)
Portland, Oregon May 17, 2017 5:12 p.m.

The Oregon secretary of state sent an audit alert to all 90 lawmakers Wednesday warning that Oregon Health Authority may be sending as much as $37 million a month to ineligible Medicaid recipients.

When the Affordable Care Act dramatically expanded the state’s Medicaid population, the Oregon Health Authority was overwhelmed by the workload. So it got permission from the federal government to skip the yearly reviews that made sure recipients were still eligible.


An investigation by The Oregonian has found that as many as 115,000 recipients may have incomes too high to qualify. That's like sending the entire population of Gresham $430 per month.


Secretary of State Dennis Richardson issued the audit alert, saying a hard look at the Health Authority’s budget could yield savings for the general fund. It’s facing a $1.4 billion shortfall.

"We don't know how severe the problem is because we didn't get accurate and complete disclosure from the Oregon Health Authority," he said. "But we got enough information to know that it’s a problem a that it may have an impact on Oregon’s budget.”

The Oregon Health Authority says it is working hard to clarify which Medicaid recipients have incomes low enough to qualify.

OHA spokesman, Rob Cowie, issued a statement saying: "...all recipients on the Oregon Health Plan today have been deemed eligible at some point in time. It is also important to understand that if an OHP member has been deemed ineligible for benefits, they must be informed of the decision and given opportunity to respond, prior to termination of benefits."

The statement added that: "The process to transition from the Cover Oregon failure to the new ONE eligibility system has taken over three years and is still underway, however, we are in the final stages of that transition and the subsequent clean-up of cases. As part of this final clean-up of cases, there are a number of individuals who OHA has identified as needing further analysis to determine what action, if any, is necessary."

The statement says the analysis will be finished by the end of May.