It was during the administration of former Gov. John Kitzhaber that Oregon became something of a health care darling in Washington, D.C. The state’s effort to transform the delivery of medical services through cost-conscious Coordinated Care Organizations to an expanded Medicaid population held the promise of reduced medical spending in Oregon and, potentially, the nation. The drive to “bend the cost curve down,” as Kitzhaber had repeatedly put it, conflated well with some of the purposes of Obamacare.
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That was then. In Oregon, 16 CCOs successfully took root, but the attempt to enroll people for insurance through the tech debacle known as Cover Oregon derailed momentum and drew the state into acrimony with vendors and within its political leadership. The feds understood Oregon’s predicament, meanwhile, and multiple times extended waivers to regulators for re-certifying the eligibility of Medicaid recipients – at one point topping 1 million Oregonians.
But the last waiver for accountability extended only through June of last year. And things have fallen seriously behind. It is not known whether thousands of Medicaid enrollees in Oregon should be receiving benefits at all – and whether millions of federal and state tax dollars have been misspent in supporting them.
Reporters Jeff Manning and Hillary Borrud of The Oregonian/OregonLive reported last week that the Oregon Health Authority was working to clarify whether as many as 115,000 Medicaid recipients had incomes low enough to qualify for the benefits they have been receiving. While a completed accounting could show deep financial losses, the state’s information gap has immediate consequence: The Oregon Legislature, struggling to close holes in the state’s budget, is unable to accurately calculate the state’s finances.
Secretary of State Dennis Richardson’s auditors had discovered the problem while performing a separate audit. Yet he found the potential for lost money sufficiently alarming as to issue an “audit alert,” signaling a full audit on Medicaid enrollment was yet to come. An exasperated House Republican Leader Mike McLane, meanwhile, last week issued a terse statement: “Our state government’s incompetence with taxpayer money never ceases to amaze me. Lawmakers and the public deserve a full accounting for what led to such a significant failure of management and oversight.”
Yes. This is a serious situation with unknown potential impact on the state’s finances, and, perhaps, those of Oregon’s innovative CCOs.
The federal government pays by far the larger share of Medicaid costs, but Oregon still shoulders millions in reimbursements. Will money need to be paid back? To whom and by whom? As those questions are parsed, the Oregon Health Authority must accurately portray its financial commitments to the Legislature, awash in spreadsheets that detail money in, money out. Let this be the last headache in the state’s Cover Oregon hangover, a record-keeping mess deepened by the explosion in the number of Medicaid enrollees under Obamacare.
In an interview last week with The Oregonian/OregonLive Editorial Board, Oregon Health Authority spokesman Robb Cowie argued the remedy is near: A full accounting of the eligibility of Oregon’s Medicaid enrollees is scheduled for completion and release on May 31. Good. A real number by then will allow not only the OHA to balance its books but the Legislature to choose wisely as it configures a budget serving Oregonians fairly and frugally.
Up-to-date accounting is essential in a lawmaking environment of so many moving pieces. Manning and Borrud reported that lawmakers and Gov. Kate Brown are weighing a budget deal that could raise taxes on health care to prevent cuts to Oregon’s Medicaid program. Separately, the U.S. Senate considers a repeal or overhaul of Obamacare, which fostered the rise in Oregon’s Medicaid population in the first place.
The drive to contain medical costs didn’t begin or end with Kitzhaber. But it does face new political headwinds. Inexplicably incomplete Medicaid enrollment information should not get in the way.
-The Oregonian/OregonLive Editorial Board