Auditor: Oregon Spent $29 Million on Health Insurance for People Living in Washington

State auditors says Oregon spent around $445 million on Medicaid benefits for people already receiving benefits in other states.

The analysis, which examines data from 2019 to 2022, highlights flaws in state and federal efforts to crack down on double spending in Medicaid.

Medicaid doesn’t pay for health care services directly. Instead, it makes flat payments to local provider networks, on average around $500 a month, for each person they cover.

In theory, Oregon should stop paying that benefit if someone moves out of state. But that’s easier said than done, especially in the wake of the pandemic in which the federal government relaxed enrollment restrictions. “The federal government does not actively monitor duplicate capitation payments,” auditors found, and the database it provides to states to do it themselves are out of date and unreliable.

The office charged with monitoring it, the Office of Payment Accuracy and Recovery, has the equivalent of only 2.5 full-time employees, who can review only about one-fifth of flagged accounts.

The upshot: “We estimate Oregon potentially spent $29 million on improper Medicaid benefits for recipients residing in Washington from 2019 to 2022,” auditors found. Auditors focused their analysis on Washington, but acknowledge the problem is likely even bigger in California.

The audit recommends the office hire four new employees and create a new process to recoup double payments by 2026.