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By Shaanth Nanguneri, Oregon Capital Chronicle<\/strong><\/p>\n SALEM, Ore. — Oregon’s free health care program for adults who earn too much to qualify for Medicaid may have improperly awarded $15 million in benefits-related payments to recipients, according to a recent audit of the state-administered federal program.<\/p>\n The “questionable” funding was revealed this week in a 124-page report by the Secretary of State’s Office of the Auditor, which found the state spent $21.1 billion in federal funds across 433 programs from July 2024 to June 2025. The agency focused on 16 programs that accounted for nearly 70% of total spending during the period.<\/p>\n Although most of the funds spent by Oregon complied with federal law, the state’s essential health program, also known as the Oregon Health Plan Bridge, received negative feedback from the Secretary of State. This is the harshest response authorities can provide during an audit. <\/p>\n “Oregon takes seriously its responsibility to be good stewards of its tax dollars,” Secretary of State Tobias Reed said in a statement. \u201cThis audit will help agencies improve the management of federal programs and ensure that states are spending public dollars efficiently in the best interest of the public.\u201d<\/p>\n The findings come as Oregon faces pressure from the Republican 2025 federal tax and spending law to reduce the rate of error in determining benefit eligibility, and as Oregon health officials seek to expand health programs. Democrats and benefit eligibility officials argue that the legislation’s increased administrative burden and its new operational requirements will make it difficult to accurately determine benefits for Oregonians. <\/p>\n The Basic Health Program, run by the Oregon Health Authority, began in 2024 and provides access to health insurance for Oregonians with household incomes of at least 133% but less than 200% of the federal poverty level. This ranges from $20,820 to $31,300 per year for an individual and $42,768 to $64,300 for a family of four.<\/p>\n People with access to affordable employer-sponsored insurance plans are not eligible for this service, which requires no copays, premiums, or deductibles. Approximately 41,100 people have enrolled and used the program’s services, according to the state’s dashboard, but the state is aiming for a total of 100,000 people to participate in the program.<\/p>\n State auditors found that the state’s ONE eligibility system made a coding error in determining the 133% income threshold, and the system failed to cut off benefits to people when a “response to a request for information” suggested an individual was making more than 200% of the maximum income threshold. The auditors recommended that the agency ensure that health care programs paid to ineligible Oregonians are reimbursed and benefits discontinued for them. The audit also indicated that authorities will continue to monitor the ONE qualification system.<\/p>\n An Oregon Health Authority report after the program was implemented in July 2024 found that Oregonians were receiving basic health program benefits even though their annual incomes were below the threshold. The agency also noted that thresholds had been “erroneously removed” from administering system tests.<\/p>\n In response to the findings, the Oregon Health Authority issued a statement saying it identified the errors flagged prior to the audit, notified “federal partners,” and subsequently took steps to resolve the issues. <\/p>\n Agency spokeswoman Frannie White said the coding error that caused the inaccurate determination was corrected in June, and the agency is working to ensure financial compensation is provided to the health insurance trust fund.<\/p>\n \u201cOHA and the (Oregon Department of Human Services) have determined that an error involving the ONE eligibility system, the single streamlined application by which the state determines whether people are eligible for various benefits, resulted in inaccurate enrollment of individuals with incomes too low to qualify for OHP Bridge,\u201d White wrote in an email.<\/p>\n White said both the Oregon Health Authority and the Oregon Department of Human Services have implemented manual changes to reduce instances of “misregistration” until broader systemic fixes are implemented.<\/p>\n But the agency’s response included some disagreement over how auditors arrived at the final calculation of up to $15 million in “known and possibly questionable costs.” The figure was split into two errors estimated at $8 million and $7 million, and health officials disputed the latter figure in their response. <\/p>\n “As communicated to the Secretary of State in the agency’s management response, OHA’s own analysis is not consistent with the costs questioned by the Secretary of State on this issue because these costs are not consistent with the estimated number of members affected or the length of the enrollment period,” White said.<\/p>\n White said individuals affected by the disclosed errors are transitioning to the Oregon Health Insurance Marketplace or the Oregon Health Insurance Marketplace. He added that people could continue to have basic health insurance if the changes allow them to meet the program’s eligibility requirements.<\/p>\n “The process for determining coverage eligibility is complex, and in some cases, people are enrolled in the wrong program,” the agency said in a statement. \u201cWhen an event like this occurs, OHA works diligently to identify the problem, determine who is affected, and determine the best way to correct the error.\u201d<\/p>\n The two corrective action plans state health officials plan to take in response to the audit are expected to be completed in February 2027 and December 2028.<\/p>\n<\/p><\/div>\n #Oregon #gave #millions #dollars #incorrect #benefits #state #health #plan #audit<\/p>\n","protected":false},"excerpt":{"rendered":" By Shaanth Nanguneri, Oregon Capital Chronicle SALEM, Ore. — Oregon’s free health care program for adults who earn too much to qualify for Medicaid may have improperly awarded $15 million in benefits-related payments to recipients, according to a recent audit of the state-administered federal program. The “questionable” funding was revealed this week in a 124-page … Read more<\/a><\/p>\n","protected":false},"author":1,"featured_media":525,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,2],"tags":[2075,2074,1736,2072,36,2073,978,398,37,404],"class_list":["post-524","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general","category-health-care","tag-audit","tag-benefits","tag-dollars","tag-gave","tag-health","tag-incorrect","tag-millions","tag-oregon","tag-plan","tag-state"],"_links":{"self":[{"href":"https:\/\/golliza.com\/index.php?rest_route=\/wp\/v2\/posts\/524","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/golliza.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/golliza.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/golliza.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/golliza.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=524"}],"version-history":[{"count":0,"href":"https:\/\/golliza.com\/index.php?rest_route=\/wp\/v2\/posts\/524\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/golliza.com\/index.php?rest_route=\/wp\/v2\/media\/525"}],"wp:attachment":[{"href":"https:\/\/golliza.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=524"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/golliza.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=524"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/golliza.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=524"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}Oregon Health Authority responds, disputes some calculations<\/h4>\n