Oregon Overpaid $29 Million in Medicaid Benefits to People Living in Washington State
Oregon overpaid $29 million in Medicaid benefits to recipients living in Washington and already receiving benefits from that state between 2019 and 2022.
The State Spent $445 Million on People Registered for Medicaid in Other States
A large portion of the $445 million Oregon spent on Medicaid benefits for people registered in other states elsewhere during the same four years was inappropriate.
To put the overspend into perspective, Oregon paid more for Medicaid in 2023 than for education, public safety, and transportation combined.
This was established by an audit conducted by Oregon, Washington, and the federal government, released on Monday.
Medicaid covers health care for aged residents, low-income earners, and the disabled. The state’s expenditure on Medicaid is drawn from federal and state funds.
Results of the audit established that about 3% of people registered on the state’s Medicaid during the four years from 2019 – 2022 were also receiving benefits elsewhere.
While a portion of those payments may have been legitimate because the recipients live in Oregon, 100 recipients were enrolled in both Oregon and Washington, resulting in a waste of about $29 million.
The audit was undertaken by the Oregon Secretary of State’s Office, the Washington state auditor, and federal inspectors from Human Services and the Department of Health.
Auditors Call for a Program to End Dual Medicaid Enrollment
The auditors have called on the U.S. Treasury to launch a pilot program in partnership with Oregon and Washington to end dual Medicaid enrollment.
They have also called for the appointment of four additional people in a joint Oregon Human Services and Health Authority office to investigate fraud and to find a solution to recoup duplicate payments by 2026.
Agreeing with the audit recommendations, the Oregon Health Authority is planning to recover funds from coordinated care organizations once it has established that a Medicaid recipient lives out of state. Health providers receive monthly payments of $518 for each Medicaid recipient.
Audit is ‘Enormously’ Beneficial, says SoS
Secretary of State, LaVonne Griffin-Valade describes the audit as ‘enormously beneficial’. The SoS assured Medicaid recipients that their benefits would not be affected but that wasteful payments would be eliminated by reducing duplicate enrollments.
Auditors have placed the blame on federal systems that fail to give states up-to-date data needed to prevent duplicate payments to residents who move out of state.
Laura Kerns, Communication Director – Oregon Secretary of State Responds
According to Laura Kerns, the Communications Director for the Oregon Secretary of State (SoS) office, the state “potentially” overpaid $29 million, and that the number was based on testing auditors conducted of a sample of recipients.
Referring to this sentence: “While a portion of those payments may have been legitimate because the recipients live in Oregon, 100 recipients were enrolled in both Oregon and Washington, resulting in a waste of about $29 million.”
She says the $29 million was not a result of the 100 people, but a reflection of what it would have cost if the results were projected to the whole population. Kerns said the 100 people had received about $400,000 in improper payments.