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FILE – Clinic details at Dr. Lisa Reynolds\u2019 pediatrics clinic in Portland on Friday, Dec. 13, 2024. (Rian Dundon\/Oregon Capital Chronicle)<\/p>\n
Rian Dundon \/ Rian Dundon<\/p>\n
A free Oregon health care program for adults who make too much money to qualify for Medicaid could have improperly given out $15 million in payments related to benefits for recipients, according to a recent audit of state-managed federal programs.<\/p>\n
The \u201cquestioned\u201d funds surfaced in a 124-page report<\/a> this week by the Secretary of State\u2019s Audits Division, which found that the state spent $21.1 billion in federal funds from July 2024 to June 2025 across 433 programs. <\/p>\n The agency zeroed in on 16 programs that accounted for nearly 70% of total spending over that period.<\/p>\n While most of the funding Oregon spent complied with federal law, the state\u2019s Basic Health Program, also known as the Oregon Health Plan Bridge, received an adverse opinion from the Secretary of State. <\/p>\n That is the harshest response the agency can offer during an audit. <\/p>\n \u201cThe State of Oregon takes our responsibility to be good stewards of tax dollars seriously,\u201d Secretary of State Tobias Read said in a statement. \u201cThis audit will help agencies improve their administration of federal programs to ensure the state is efficiently spending public money to the best benefit of the public.\u201d<\/p>\n The findings come as Oregon is under pressure from the GOP\u2019s 2025 federal tax and spending law to reduce its error rate for determining eligibility for benefits, and as Oregon health officials seek to expand the health program. <\/p>\n Democrats and benefit-eligibility workers say the law\u2019s increased<\/a> administrative burden and new work requirements will make it harder to accurately determine benefits for Oregonians. <\/p>\n The Basic Health Program, run by the Oregon Health Authority, kicked off in 2024 and allows for Oregonians who have a household income over 133% and under 200% of the federal poverty level to access health coverage. That would be anywhere<\/a> from $20,820 to $31,300 per year for a single individual, or from $42,768 to $64,300 for a family of four.<\/p>\n People who have access to affordable employer-backed insurance plans are not eligible for the service, which does not require co-pays, premiums or deductibles. <\/p>\n Around 41,100 people have signed up and use the program\u2019s services, according<\/a> to a state dashboard, though the state is aiming<\/a> to onboard a total of 100,000 people onto the program.<\/p>\n State auditors found that the state\u2019s ONE eligibility system made coding errors when it came to determining the 133% income threshold, and that the system failed to cut off benefits for people when a \u201cresponse to a request for information\u201d suggested an individual was over the maximum 200% income threshold. <\/p>\n Auditors recommended that the agency ensure the health program is refunded for the payments made for ineligible Oregonians and to ensure benefits are ended for them. The audit also suggested the agency continue to monitor the ONE eligibility system.<\/p>\n An Oregon Health Authority report after implementing the program in July 2024 found that Oregonians were receiving basic health program benefits despite having an annual income below that base threshold. The agency also noted that the threshold was \u201cinadvertently removed\u201d from system testing controls.<\/p>\n Oregon Health Authority responds, disputes some calculations<\/p>\n In response to the findings, the Oregon Health Authority issued a statement noting that it identified the errors raised before the audit, notified \u201cour federal partners,\u201d and has since taken steps to resolve the issue. <\/p>\n Franny White, a spokesperson for the agency, said the coding errors that caused the inaccurate determinations were fixed in June and that the agency has been working to ensure financial restitution will be made to the health plan\u2019s trust fund.<\/p>\n \u201cOHA and (Oregon Department of Human Services) determined that an error involving the\u202fONE Eligibility\u202fSystem \u2013 a single, streamlined application through which the state determines if people are eligible for various\u202fbenefits \u2013 resulted in inaccurate enrollment when some individuals earned too little to qualify for OHP Bridge,\u201d White wrote in an email.<\/p>\n White said that both the Oregon Health Authority and the Oregon Department of Human Services have implemented manual changes to reduce instances of \u201cincorrect enrollment\u201d until a broader systemic fix can be implemented.<\/p>\n But tucked inside the agency\u2019s response was some disagreement with the way auditors reached their final calculation of up to $15 million in \u201cknown and likely questioned costs.\u201d <\/p>\n The figure was split between two errors amounting to an estimated $8 and $7 million, and the health authority disputed that latter figure in its response. <\/p>\n \u201cAs was communicated to the Secretary of State in the agency\u2019s management response, OHA\u2019s own analysis does not align with the Secretary of State\u2019s questioned costs for this issue because those costs do not line up with the estimated number of members impacted or the length of time they were enrolled,\u201d White said.<\/p>\n Individuals who have been impacted by the revealed errors are being transitioned to the Oregon Health Plan or the state\u2019s health insurance marketplace, White said. <\/p>\n She added that people can remain on the basic health plan if any changes are allowing them to now meet the program\u2019s eligibility requirements.<\/p>\n \u201cThe process for\u202fdetermining\u202fcoverage\u202feligibility is complex and\u202foccasionally\u202fresults\u202fin some people being enrolled in\u202fthe wrong program,\u201d the agency said in a statement. \u201cWhen this happens, OHA works diligently to\u202fidentify\u202fthe issue, determine\u202fwhich people\u202fare\u202faffected, and\u202fdetermine how to best\u202fcorrect\u202fthe\u202ferror.\u201d<\/p>\n Two outlined plans for corrective action that state health officials are set to take in response to the audit are expected to conclude in February 2027 and December 2028.<\/p>\n Oregon Capital Chronicle is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501(c)(3) public charity. <\/p>\n Oregon Capital Chronicle maintains editorial independence. Contact Editor Julia Shumway for questions: info@oregoncapitalchronicle.com. Follow Oregon Capital Chronicle on Facebook<\/a> and Bluesky<\/a>.\u201d<\/p>\n This republished story is part of OPB\u2019s broader effort to ensure that everyone in our region has access to quality journalism that informs, entertains and enriches their lives. To learn more, visit opb.org\/partnerships<\/a>. <\/p>\n","protected":false},"excerpt":{"rendered":"FILE – Clinic details at Dr. Lisa Reynolds\u2019 pediatrics clinic in Portland on Friday, Dec. 13, 2024. 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