Oregon removes nearly 55,000 people from Medicaid after they failed eligibility checks

By Hillary Borrud
The Oregonian, September 1, 2017

Oregon has kicked nearly 55,000 people off its Medicaid program, after the state found they no longer qualified or failed to respond to an eligibility check.

The state made the announcement Thursday, after workers finally cleared a backlog of eligibility checks that built up due to technology troubles and a massive increase in Medicaid enrollment under the Affordable Care Act.

Historically, around 28 percent of Oregonians on Medicaid were found to no longer qualify at annual eligibility reviews. But when the state finished working through its backlog of 115,000 Medicaid enrollees, it took the free insurance away from nearly 48 percent of them.

The Oregonian/OregonLive has reported the state had to process hundreds of thousands of Medicaid applications by hand because an automated eligibility system failed along with the rest of the $300 million Cover Oregon project. More than 500 temporary workers were assigned to the project.

Medicaid is supposed to provide care for people with low incomes. To qualify in Oregon, single people can earn no more than $17,000 a year and a family of four no more than $33,000.

Historically, around 28 percent of Oregonians on Medicaid were found to no longer qualify at annual eligibility reviews. But when the state finished working through its backlog of 115,000 Medicaid enrollees, it took the free insurance away from nearly 48 percent of them.

http://www.oregonlive.com…

The Affordable Care Act supposedly was designed to expand health care coverage, including an expansion of the Medicaid program. Yet in Oregon almost half of Medicaid beneficiaries were kicked off the program. Isn’t that the opposite of one of the major goals of reform?

The reasons were entirely legitimate under our current system (which demonstrates, of course, what’s wrong with the system). Since Medicaid is a program for low-income individuals and families, those with incomes above the qualifying thresholds ($17,000 for individuals and $33,000 for a family of four) were removed. It is ironic that with a program that is designed to expand coverage, Oregon had to hire an additional 500 employees just to kick out those who were no longer qualified.

We have stated repeatedly that it is the highly flawed financing infrastructure that has created extensive administrative inefficiencies while frequently running counter the the stated goals of reform – in this example an increase in administrative activities merely for the purpose of taking coverage away from people.

The pressure is on to move forward in reform by tweaking ACA. Yet no number of tweaks will stabilize the Medicaid population. Not only does eligibility vary based on changing levels of income, other factors such as a change in employment, eligibility for Medicare, eligibility for ACA subsidies, veteran status and the like, perpetuate instability in health care coverage.

A single payer national health program – an improved Medicare for all – eliminates that instability. Coverage is for life. There is no necessity to hire a brigade of employees whose job it is is to see who should be expelled from their programs solely for reasons related to the defective design of the health care financing system rather than for any logical reason.

So the progressive commentators are telling us now that enacting and implementing a single payer system would be too disruptive. Maybe getting rid of those 500 employees who are taking health benefits away from people would be disruptive, but isn’t that precisely the kind of disruption that our highly dysfunctional system cries out for?

Correction of “Oregon expels half of Medicaid patients from their program”

The article used as the source included the following paragraph:

“Historically, around 28 percent of Oregonians on Medicaid were found to no longer qualify at annual eligibility reviews. But when the state finished working through its backlog of 115,000 Medicaid enrollees, it took the free insurance away from nearly 48 percent of them.”

It has been pointed out to me by Beth Capell and by Christopher Lowe that Oregon has over 900,000 enrollees in their Medicaid program (992,000 in May 2017, per KFF). Thus the 55,000 removed from coverage was not half of all enrollees but rather nearly half of the subset of a backlog of 115,000 enrollees.

Although it is a relief to know that only about 6% lost their coverage rather than 48%, unfortunately that does not change the absolute number that did – 55,000 people still lost their coverage.

The conclusion remains the same: “it is the highly flawed financing infrastructure that has created extensive administrative inefficiencies while frequently running counter to the the stated goals of reform – in this example an increase in administrative activities merely for the purpose of taking coverage away from people.”

Though single payer might be disruptive, “isn’t that precisely the kind of disruption that our highly dysfunctional system cries out for?”

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