Governor Calls for Medicaid Accountability, But Brown’s Proposal Would Actually Stay the Course

Oregon Health Authority Director Lynne Saxton said the state does have approval of the federal government for its haphazard re-enrollment process, which should be finished by the end of summer. But new deadlines from the governor merely affirm the schedule Saxton has outlined.

Democratic Gov. Kate Brown issued a press release Tuesday calling for new accountability measures into the Medicaid renewal process, but everything she suggested are things that the Oregon Health Authority is already doing.

Citing numbers from the Oregon Health Authority, Brown claimed that the 115,000 left for redetermination were “some of the most important” and “facing significant health challenges.”

But in fact, the Oregon Health Authority processes about 80,000 applications every month of all types, and they are merely nearing the end of the cycle. The other 35,000 are applications from a hodgepodge of sources, including some from April that are still waiting to be processed, as Medicaid recipients have 30 to 95 days to respond.

“I’ve directed the Oregon Health Authority to process these final renewals as quickly as possible and to ensure that the Oregon Health Plan is protected from fraud and abuse,” Brown wrote in a statement. “I have set a deadline to determine the eligibility of these final cases by August 31, 2017, and have directed OHA to provide weekly updates to me on their progress.”

Again, August was already the deadline that the Oregon Health Authority itself had promised to finish the cycle of re-applications.

In a thinly veiled attack on Oregon’s only statewide Republican officeholder, Secretary of State Dennis Richardson, Brown declared, “Elected officials should be focused on protecting the health care of Oregonians, not playing politics with it.”

Last week, Richardson reported an audit of the sloppy Medicaid renewal process, showing that the state had 71,000 people it had not proved were eligible for the program and 14,000 being terminated for ineligibility.

Richardson shed light on a deeply flawed enrollment process that Democrats have been familiar with for months, but the majority party has done little to challenge Saxton or her agency’s poor handling of the re-determination process.

On Monday, Richardson told The Lund Report that since the release he has had six new whistleblowers come forward to tip him off to additional problems with the Medicaid re-enrollment process.

Until Medicaid members can be moved over to a new electronic system, Saxton has directed her staff to mail a challenging 30-page booklet to be filled out by Medicaid recipients, many of whom are functionally illiterate or don’t have stable housing.

Sixty percent of those people each month don’t renew, either because they are no longer eligible or they simply do not or cannot respond. Of those that do renew, the state initially silos them in a substandard open-card system instead of putting them immediately back in the local coordinated care organizations that had been delivering their care. About 147,000 people were marooned unnecessarily in this alternative system as of March, resulting in a loss of millions of dollars each week to the CCOs.

At a budget hearing on Tuesday morning, legislators asked probing questions, but answers from the state often seemed incomplete.

“I was hypercritical of the OHA leadership and the lack of information given to the Republican caucus,” said Rep. Greg Smith of Heppner, the ranking Republican on the Committee on Ways & Means, and one of the most moderate and widely respected members of his caucus. “I’m trying to reconcile what’s going on.”

Smith said the first time he learned about the turmoil that the Oregon Health Authority has faced renewing people was after reading about Richardson’s audit in the newspaper, and he complained that the agency appeared to be stonewalling his caucus members, including Rep. Cedric Hayden, R-Cottage Grove, when they asked for information.

“We want to provide all the information that anyone needs,” Saxton said, disputing this.

As for the 115,000 Oregon Health Plan members still waiting to have their applications renewed, policy analyst Jon Collins said that any CCO members would simply be cut off and disenrolled if they were found ineligible, and the Oregon Health Authority would not try to recoup premiums it has already paid to the CCOs -- a move it has done previously when it changed rates mid-year.

Saxton said that the problem highlighted in Richardson’s audit was an issue that the federal government was aware of, telling a group of lawmakers that her agency was in regular contact with the feds. “We have approval from CMS,” she said, referring to the Centers for Medicare and Medicaid Services.

Hayden asked Saxton and OHA director of health policy, Leslie Clement, why the health authority couldn’t just line up its application process with the Department of Human Services, which has had trouble controlling costs but has not reported tremendous difficulty linking patrons with services.

Clement said the agencies ask for different information and often serve different populations, but she admitted the Department of Human Services application is actually more complicated than the Oregon Health Authority application needs to be, since OHA primarily must just verify citizenship and income, suggesting there is little need for a 30-page booklet to remain on Medicaid.

“We are in information overload,” said Sen. Jackie Winters, R-Salem. “How much information are we asking that we don’t really need?”

Reach Chris Gray at [email protected].

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