Cover Oregon health insurance exchange fiasco spawns problems for low-income Oregonians' health plan
Nearly 4,000 applicants for a
state program
that provides undocumented immigrants with pregnancy services were
instead enrolled in full Oregon Health Plan coverage, contrary to
federal law, thanks to problems with the Cover Oregon health insurance exchange.
State officials say they discovered the problem several weeks ago and are correcting it.
The
pregnancy program goof, however, is just one of many little-known
problems that Oregon Health Plan members, providers, care groups and
state officials have wrestled with as Oregon’s system for enrolling
people undergoes chaotic change.
It’s the flip side of the Cover
Oregon debacle, where much of the attention has focused on the travails
of people applying for private or commercial insurance.
Two
thirds of Cover Oregon’s enrollments -- more than 70,000 -- have gone
into the low-income Oregon Health Plan, the state’s version of Medicaid.
Combined with other enrollments since Oct. 1, OHP membership has
swelled by more than 200,000, or about a third -- a favorite talking
point of state officials.
Many of those enrollments, however, have not gone smoothly:
- Thousands
of OHP enrollees were labeled as individuals rather than family
members, meaning some families were split between care organizations –
creating needless hassles for parents seeking care.
- For months, the state grappled with inaccurate Medicaid coding, crucial to securing accurate federal matching funds.
- Department
of Human Services workers who used to help clients afflicted by
erroneous information now face difficulties doing so because their
responsibilities have been transferred to Cover Oregon.
Some
of the problems with OHP enrollments are due to limitations with the
Cover Oregon exchange information technology. Others stem from flaws in
the many “workaround” band-aid systems set up to patch for problems with
the exchange. Officials say they are working through these issues
slowly and attribute them to standard growing pains.
“It never
works perfectly the first time out,” said Kathleen Paul, an Oregon
Health Authority manager who has worked on the Cover Oregon
information-technology project.
The Cover Oregon health
insurance exchange was designed to communicate electronically with the
Oregon Health Authority, which has a system for tracking Oregon Health
Plan members.
That interface failed to work, however, and in
late November Cover Oregon set up a backup system by which new OHP
enrollee information is sent to the Oregon Health Authority, where state
workers upload the data manually.
The information was sent over
incorrectly and in an incomplete fashion until a few weeks ago, Paul
said Friday. That resulted in 3,800 applicants for the
Citizen/Alien-Waived Emergent Medical
program receiving full OHP benefits instead. The program is set up for
immigrants who are either undocumented or haven’t met the residency
requirement for Medicaid.
“We were just getting people into the
services,” Paul said, adding that the state will finish fixing the
problem in the coming week.
Not only that, but Cover Oregon sent
over names of thousands of Oregon Health Plan enrollees as individuals,
rather than labeling them properly as families. In some cases this has
caused some family members to be assigned to one care organization and
provider group while others are assigned to a completely different one.
Paul says that problem is being fixed manually on a case-by-case basis.
“It’s
been a mess for us,” said Jeff Heatherington, CEO of Family Care, Inc.,
one of the organizations that cares for Oregon Health Plan members in
the Portland area. “It makes it very difficult for us to tie families
together in our database. We can’t identify them, so we have to go
through and set up a new data structure internally and then match
addresses -- all of which have been hand-entered so they don’t
necessarily match.”
Jan Buffa, CEO of the Willamette Valley
Providers Health Authority, an OHP provider organization based in Salem,
says her group has seen fewer problems, but has been perturbed by
mysterious fluctuations in its member rolls maintained by the Oregon
Health Authority.
“We had a few hundred people disappear off of
our enrollment, and (OHA) couldn’t explain it,” she said. “We’ve been
waiting patiently for their explanation.”
Another problem:
Oregon Health Authority workers have had to send out federally required
notices to OHP members by hand, rather than in the automated way
originally intended.
Many of the problems faced by OHP clients
filter down to the caseworkers and eligibility specialists who staff the
offices of the Department of Human Services, which used to handle
enrollment before the exchange came along.
There, workers used
to be able to fix problems such as address changes or incorrect
information. But now, under the new system, they are largely denied the
ability to change files to correct the many problems clients are
reporting.
“It’s a very confusing and trying time right now,”
said Jan Mautz, an eligibility analyst for the Oregon Health Authority,
who says the situation was “horrendous” but is improving. She spoke
through the Service Employees International Union, which represents
Mautz and other caseworkers. “We're trying our best to get people
through the broken system. The systems don’t talk to each other.”
Lawmakers
recently received an anonymous letter from state employees detailing a
dozen such problems affecting tens of thousands of enrollees, including
that the new IT system used by the Oregon Health Authority for OHP
doesn’t properly calculate the code used to determine federal matching
funds. “Medicaid has suffered an assault (and) is bleeding profusely,”
the letter said.
Paul says there have been problems with the Medicaid code cited, but
they’ve been recently fixed and stemmed not from the technology, but how
the system was programmed. She said the letter reflects a
misunderstanding of many of the issues, and many of the problems have
been resolved.
“Things are different than they used to be, and that is presenting challenges for staff,” she said.
The
agency is slowly making progress, officials stressed. For instance, a
backlog of 30,000 applications and change orders that existed in late
January has been whittled down to about half that figure.
Donald
White, a spokesman for the Office of the Inspector General for the U.S.
Department of Health and Human Services, said he couldn’t comment on
the allegations made by the anonymous state employees.
“Until
we have the results of an investigation, or at least a request for an
investigation, there’s not much that I could actually say,” White said.
“To the degree that there is HHS grant money involved, of course the
Office of the Inspector General is very interested in pursuing the facts
of this matter.”
--Nick Budnick
[
sidebar: The State of Oregon has about only the OREGONIAN to feed the poor individuals in the State nothing but, the JEWS' FORKED WAGGING TONGUES' KILLING TIME! So while the IMMIGRANT POPULATION was brought to America, AGAIN, nothing new here, NEW AMSTERDAM that would be NEW YORK NEW YORK, built a WALL on a STREET and did to the INDIANS the exact same Apartheid - Genocide and Hitler used the model and here we go again with the JEWS' FORKED TONGUE OREGONIAN KILLING ALL THAT MOVES, except what OBEYS the NEW WORLD ORDER. And we can now assess what this looks like. PILGRIMS are migrated to destroy the societies of PILGRIMS over and over and over. When do we choose to be a higher intelligent form here? Not with the KITZHABER "Nazi Cult" allowed to be in charge, PORTLAND CITY had Chief of Police Kruger in the power position and the NAZI ROCKY BUTTE CULTISTS' are very clever in how they fraudulent induce and then transfer all wealth -- MEDICARE-OBAMACARE does not matter the name of the FRAUD is FRAUD, just as the DIGITAL so called 'money'. Virtual fraud is the 21 Century demon to avoid.
JUST SAY NO to Orygone's FRAUD from early-mid-late ? 1950s!!]
Tyler Durden on 03/05/2014 
l
Posted on March 4, 2014 by Liberty Staff 
Astonishingly, US Secretary of State John Kerry
said today: “You just don’t invade another country on phony pretext in
order to assert your interests,” John Kerry said during an interview
with NBC’s Meet the Press. “This is an act of aggression that is
completely trumped-up in terms of its pretext. It’s really 19th century
behaviour in the 21st century.”
