Flaws emerge in Medicaid renewal process

Several thousand low-income people have been booted off Medicaid in Oregon even though they still qualify for the free health and dental insurance, while thousands of others have been told they will retain coverage even though they don't qualify.

Many of those who've lost benefits are children.

The Oregon Health Authority said in a news release Thursday that medical benefits for 2,268 people had incorrectly ended at the end of September. The health authority added that 1,226 people incorrectly received notices explaining that their benefits would end at the end of October.

It's unclear whether even more people have wrongly lost coverage, whether those two groups are related or how many children have been affected overall.

The Oregon Capital Chronicle asked the agency about this problem more than a month ago, and it has still failed to answer basic questions about the children.

Losing coverage could cause hardships for families inadvertently booted from the program, especially if they need specialized or intensive care. County and federally supported clinics provide care to low-income residents, but they don't usually have dialysis or surgery centers, for example. Hospital emergency rooms will tend to emergencies.

Oregon's Medicaid system is designed to keep people from using emergency rooms as a primary care service. It offers generous benefits, including dental and behavioral health care, with regionally-based insurers managing patients.

During the pandemic, no one lost coverage even if their income grew beyond the limit. But that ended this spring, and since April all states have been reviewing the eligibility of all members. In Oregon, that means auditing the 1.5 million people on the Oregon Health Plan. People first lost coverage in June.

On Aug. 30, the federal Centers for Medicare & Medicaid Services alerted Oregon and other states that a glitch during the automatic renewal process had caused people to be wrongly bumped. It said the glitch appeared to mostly affect children in households with at least one adult enrolled in Medicaid and households required to submit documents to prove eligibility. It ordered the states to pause renewals for families that might be affected and reinstate those who had wrongly lost benefits.

On Sept. 21, the Centers for Medicare & Medicaid Services said 500,000 children had wrongly lost health coverage, which is mostly covered by the federal government, due to the glitch. A total of 23 states reported some of their residents were affected. Oregon was among five that said they were still assessing the situation, along with Delaware, Georgia, Minnesota and Nebraska.

That same day, the Oregon Capital Chronicle asked the health authority how many children in Oregon had lost coverage, their ages, locations and situations. A spokeswoman, Erica Heartquist, said the health authority was checking and planned to meet with the Centers for Medicare & Medicaid Services. On Sept. 25, she said she would know more by the end of the week.

On Thursday, she sent a response that failed to answer several questions about the children, and less than three hours later issued the news release with an update on the Medicaid renewal process. It said 668,000 people in Oregon had retained coverage out of nearly 808,000 reviewed.

"So far, Oregon has the fourth-lowest closure and reduction rates in the nation," the statement said.

The statement later mentioned that 11,700 people who did not respond to renewal requests were informed that they had been renewed - wrongly. Even though they don't qualify, the state has extended their coverage through the end of the year.

And it added that 2,268 people had wrongly lost benefits at the end of September. Heartquist told the Oregon Capital Chronicle they included 619 children. It's unclear how many who were informed they'd be booted at the end of October are minors.

Heartquist said "all potentially affected peoples' benefits will be restored or will be prevented from closing."

Notices will be sent out.

"We will send affected people a new notice in November that their benefits have been restored or are continuing," the news release said.

But members of families whose coverage is being resumed after being terminated could later face losing coverage. Heartquist said that the eligibility of each member of the family will be reviewed.

People on Medicaid will also need to keep their eyes on Medicaid notices next year, when renewals resume again.