State Quietly Pulls Medicaid Enrollment from OHA and Gives it to DHS

Public pressure from legislators and the media appears to have caused the state to move enrollment for the Oregon Health Plan to the Department of Human Services, where case workers are already assisting low-income and disabled residents with other public benefits.

The Department of Human Services is taking over the responsibility for enrolling people in the Oregon Health Plan from the embattled Oregon Health Authority, a move that comes after outcries from the state legislators that vulnerable people may be losing out on health benefits due to a difficult enrollment process.

The announcement came on Tuesday morning from DHS Director Clyde Saiki, who affirmed the switch in a slideshow presentation on the new computer system for enrolling people in the Oregon Health Plan and other public benefits.

“When the project was originally designed, … Medicaid was to remain with the Oregon Health Authority,” Saiki said. “We decided we needed one agency to handle eligibility for a lot of the programs. I think that’s a very significant change.”

The transfer of Medicaid enrollment out of the Oregon Health Authority comes as the agency continues to reel from the collapse of Cover Oregon in 2014, after which the remaining state-run aspects of the health insurance marketplace were housed not in OHA but in the Department of Consumer & Business Services, which was also given authority over any Affordable Care Act waivers.

Cover Oregon was supposed to take care of Medicaid enrollment as well as individual health insurance enrollment, but when it ended, the Medicaid enrollment portion was shifted back to OHA. Now OHA is losing that responsibility as well.

Saiki’s comments came as an aside in his agency’s larger presentation, but it may have been the first time that state officials acknowledged the shift publicly.

Just last week, Coalition for a Healthy Oregon President Phil Greenhill pleaded with state legislators to shift enrollment to DHS, which has case workers and brick-and-mortar offices where many Medicaid recipients are already receiving other benefits. Greenhill’s organization represents eight of the 16 coordinated care organizations, which manage Medicaid benefits.

In March, the chairman of the House Health Committee, Rep. Mitch Greenlick, D-Portland, lambasted OHA Director Lynne Saxton for her agency’s handling of re-enrollment, telling her it was “a problem of organizational culture.”

With the Cover Oregon system non-functional and its replacement, the ONE eligibility system, not yet online, OHA opted to renew applications through the mail with a 30-page document for members to fill out if they or the children wished to keep benefits. Most lost or lapsed in coverage, with only 15 percent of eligible people on average each month maintaining their medical benefits without interruption.

Once the new ONE eligibility computer system is fully operational, people will be able to apply for all public support programs in one place, rather than be given a litany of forms from multiple agencies, many of which ask for redundant information. “They [currently] have to provide multiple information separate times. These are very old and antiquated systems,” said ONE project manager Nate Singer.

Conspicuously, the update on the ONE system to the Joint Human Services Budget Subcommittee was given by Saiki and two independent project managers -- without testimony from officials attached to the Oregon Health Authority, which had made the decision to borrow the ONE system from Kentucky to clean up the mess in Medicaid enrollment left by the Cover Oregon debacle.

Department of Human Services spokesman Gene Evans provided The Lund Report with internal documentation from February in which Saiki and Saxton proposed to take shared responsibility for the ONE system and streamline enrollment for public assistance.

But Tuesday’s presentation indicated not just cooperation between the two rival agencies but an actual shift in responsibility from OHA to DHS for Medicaid eligibility, which was described in the DHS presentation as a “change of scope” and a move to conform with best practices in other states, which integrate enrollment.

“It’s going to align more with what other states do,” said project manager Eric Smith.

In a follow-up conversation, Evans told The Lund Report: “DHS will handle all Medicaid eligibility and enrollment, and OHA will retain Medicaid policy. It really will be an ongoing shared responsibility for OHP members.”

John Mullin, an advocate for low-income people at the Oregon Law Center, said he had been informed of the switch last month. “We had advocated for enrollment to move to DHS.”

He said he and other advocates of the Human Services Coalition of Oregon were flummoxed when Medicaid enrollment was separated from other social service benefits in 2009 and assigned to the newly created Oregon Health Authority, complicating the process for recipients.

“We had one system,” said Sen. Jackie Winters, R-Salem. “I don’t know how they got separated.”

Regardless of how the state government subdivides its responsibilities on the back end, Mullin advocated that the vulnerable person seeking assistance should have one point of contact to get whatever benefits they are eligible for, not be forced to interact with multiple bureaucracies.

Even with the switch, integration will still be a work in progress. Singer said that case management for Temporary Assistance for Needy Families -- the cash welfare program; long-term care supports; and summer meals for children will be administered outside the ONE system, with Smith promising only that it’s their goal to have all programs in the single ONE system eventually. “There’s a plan to make a plan,” Smith said.

Rep. Cedric Hayden, R-Cottage Grove, said the ONE project managers informed him of the switch just hours after The Lund Report reported that the Oregon Health Authority was keeping thousands of Medicaid members out of the coordinated care organizations and forcing people to return the laborious paper applications.

“It looks like they’re putting eligibility back [at DHS] but they certainly didn’t inform me,” Hayden told The Lund Report on Tuesday.

Reach Chris Gray at chris@thelundreport.org.

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