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The Oregon Health Authority will
continue health coverage for children and pregnant women who rely on the
Children’s Health Insurance Program (CHIP), despite Congress’ failure to
reauthorize the program. CHIP provides coverage for vital health services such
as prescriptions, doctor’s visits, preventive care and emergency care.
OHA took action in response to a letter from Governor
Kate Brown directing the agency to keep children’s health
coverage in place through April 2018.
Congress failed to renew funding for the program in September, but
Oregon secured $51 million in one-time left over CHIP funds to last through
December. After that the state runs out of money to cover children on CHIP.
CHIP covers children from low- and middle-income families whose parents make
too much to qualify for Medicaid but who may struggle to afford to buy coverage
in the marketplace. Currently
120,000 Oregon children and 1,700 pregnant women rely on the federally funded
program.
Watch this video featuring a family that was helped
by the CHIP program.
Yesterday
the Secretary of State released an audit of payments in Oregon’s Medicaid
program. The audit recognized several existing, effective processes within OHA
and made several recommendations to improve how OHA processes Medicaid
payments.
OHA Director
Patrick Allen said, “We will implement each of the audit team’s recommendations
and report our progress to the Governor and the public.”
OHA leaders did not agree with all the audit’s estimates or assumptions. For example, the audit identified $88 million in “avoidable” payments for about 115,000 children and adults on the Oregon Health Plan. Federal officials approved suspending eligibility renewals for these cases after Cover Oregon failed. Federal law obligates Oregon to pay for health coverage for vulnerable children and adults until each person completes the renewal process.
In addition,
the audit identified 31,000 “questionable” Medicaid payments. However, a sample
check of 2,700 of these transactions found that more than 98 percent were
appropriately made.
Director
Allen said, “I do appreciate the SOS audit team’s recognition that Medicaid is
a massive and complex program to operate.” To put the findings in context:
- The fee-for-service
payment error rate in OHA’s Medicaid program is below the national average.
- The $88
million in audit-identified “avoidable” state and federal expenses accounts for
less than 1 percent of Oregon’s annual $9.3 billion Medicaid budget.
- The 31,000
“questionable” payments account for only 0.06% of the more than 52 million
payments OHA processed during that period.
Director Allen also said, "While OHA has successfully expanded
health coverage to more than 400,000 Oregonians and saved taxpayers $1.3
billion in health care costs, the effort to meet these challenges (as well as
respond to the Cover Oregon failure) has not allowed us to build a foundation
of consistent operational rigor and accountability in our Medicaid operations.
"We can do better. We are making changes to improve the accuracy
and transparency of our programs.”
OHA is extending its current five-year contract with the
coordinated care organizations (CCOs) for another year. The contract was set to
expire December 31, 2018. It will now be extended to December 31, 2019.
This decision was reached in collaboration with OHA's health
care transformation partners including the Legislature, Governor Brown’s office
and the Oregon Health Policy Board.
This extra year will give OHA time to develop a new
five-year contract that will further advance Oregon’s health transformation
goals.
The agency is drafting a governance structure and forming
teams to accomplish this work, and hopes to have them in place by the end of
December.
OHA is proud of the work CCOs have done to transform the
health care delivery system to bring better health, better care and lower costs
to Oregonians and hopes to continue
this work with the next contract. .
You can learn more about the history of CCOs and how
coordinated care organizations work on the OHA website.
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