Good intentions run amok in OR Medicaid expansion

There is a disheartening similarity to the revelations of government fraud and waste arising periodically in Oregon. Typical elements include the sudden creation or massive expansion of a well-intended program; reliance on computer software either dating to the digital dark ages or still just a gleam in an eager vendor’s eye; and lax oversight by an agency that insists its hundreds, if not thousands, of employees are stretched way too thin.

Most recently, we learned the Oregon Health Authority — which is seeking an infusion of new money, and had been finding favor with that request heretofore — has been dispensing average payments of $430 a month to 115,000 Medicaid clients who may no longer be eligibile.

More than 30,000 of those clients failed to respond to a query designed to ascertain their current status, and that comes against the backdrop of an economy pushing unemployment rates to record lows. So it’s a safe bet lax agency oversight is costing us millions, and we’re told there’s no hope of stanching the bleeding before Aug. 31, at the earliest.

Unfortunately, the response from Gov. Kate Brown rings the same.

She’s currently promoting a budget that would hike taxes to stave off a projected Medicaid shortfall, so the waste allegation catches her at an awkward moment. In response, a spokeswoman tells us Brown is committed to “strengthening the program’s integrity capabilities,” hoping to thereby ensure “all Oregonians who are eligible get the care and benefits they need.”

Not, mind you, to ensure that all Oregonians who face annual income tax obligations get the benefits they are paying for. No, to ensure Medicaid clients actually meeting state income standards continue to request their stipends without interruption.

We’re all for infusing the agency with some additional “integrity capabilities,” if that’s what it takes to right the ship. But it seems to us that taxpayers are the ones wronged here, not clients. So they are the ones to whom earnest assurances might most appropriately be directed.

This debacle began the way so many state disasters start in Oregon — with a burst of good intentions bolstered by a massive underestimate of usage and cost.
Officials projected 222,700 signups the first year of state participation, but actually had 386,000. They projected costs of $217 million the first full budget cycle of state underwriting, but actually incurred $369 million. As a result, Medicaid obligations are expected to account for 10 percent of the state budget, up from 6.2 percent at present, by 2020.

The Energy Department’s protracted Business Energy Tax Credit boondoggle got its start in exactly the same fashion, under Gov. Ted Kulongoski. So did the infamous Cover Oregon calamity, under Gov. John Kitzhaber. Only the names of the governors seem to change.

Rolling out a new or expanded government endeavor demands careful assessment of the costs and benefits. It also requires rigorous oversight every step of the way. That’s the only realistic recipe for avoiding calamitous headlines on down the road.