Oregon wasted millions to pay for health insurance for people living in other states, audit finds

Oregon spent $445 million on Medicaid benefits for recipients enrolled in the program in other states from 2019 to 2022, improperly making those payments in a large portion of those cases, a state and federal audit released Monday found.

The audit determined that Oregon likely overpaid $29 million during the four-year period for Medicaid benefits for recipients who lived in Washington and were already drawing benefits from that state, according to auditors in Oregon, Washington and the federal government. Overspending may have been even worse in California, the audit found.

Oregon spent more on Medicaid in 2023 than it did on education, transportation and public safety combined, the audit said. Medicaid provides health care for the elderly, low income people and people with disabilities – but only Oregon residents are supposed to receive that help.

The money Oregon spends on Medicaid comes from a mix of federal and state funds.

The Oregon Secretary of State’s Office worked with the Washington state auditor and federal inspectors at the Department of Health and Human Services to gauge how frequently Oregon was paying for people enrolled in other states. The audit found that about 3% of people on Oregon’s Medicaid rolls from 2019 to 2022 were also enrolled elsewhere.

A portion of the payments the state made for people enrolled elsewhere were probably legitimate because the recipients reside in Oregon, auditors wrote. But when auditors dug into 100 recipients enrolled in both Oregon and Washington, they discovered that about half of Oregon’s payments for those people were inappropriate. Auditors estimated the state wasted about $29 million for duplicate payments in Washington alone.

Auditors put the bulk of the blame on federal systems. The federal Centers for Medicare and Medicaid Services doesn’t give states the up-to-date data they need to quickly figure out whether they are duplicating payments for a resident that moved to another state, the audit said. The federal agency argues that giving states access to current enrollment data in other states would be “redundant, inefficient, and potentially confusing,” according to the audit.

The audit also recommends that the U.S. Treasury start a pilot program with Oregon and Washington to help prevent dual-enrollment in Medicaid. It also recommends that a joint Oregon Department of Human Services and Oregon Health Authority office that verifies payment accuracy and investigates fraud hire four more full-time employees and find a way to recoup duplicate enrollment payments by 2026.

The Oregon Health Authority agreed with those recommendations. It plans to try and recover money from coordinated care organizations – networks of health providers which receive monthly payments averaging $518 for each Medicaid recipient – when it can prove that the patient was living out of state.

“The results of this audit analysis are enormously beneficial,” Oregon Secretary of State LaVonne Griffin-Valade said in a news release. “Reducing concurrent enrollment does not eliminate anyone’s Medicaid benefits, it simply eliminates a wasteful duplicate payment.”

Sami Edge covers higher education and politics for The Oregonian. You can reach her at [email protected] or (503) 260-3430.