PERSPECTIVE FROM THE 19^TH HOLE: This is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus use an image from my favorite sport, golf. Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all of my professional positions, including as a Congressional press secretary in Washington, D.C., an Oregon state government manager in Salem and Portland, press secretary for Oregon’s last Republican governor (Vic Atiyeh), and a private sector lobbyist. This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write.

The Secretary of State’s Office issued a breathless “audit alert” a few days ago suggesting Oregon was facing a huge financial deficit by granting Medicaid payments to ineligible citizens.

It was almost as if the contention was that questionable payments had been made intentionally.

Not true.

There is an issue here, to be sure, but my view from cheap seats – in other words, from my position as a retired state lobbyist – suggests that the Secretary of State’s alert was way overstated. Frankly, that has been the case for years as secretaries of state have capitalized on their audit function to come across in the media as guardians of state taxpayer dollars.

In this blog, I try to be careful about what I write on issues where I served as a lobbyist for many years. In this case, I handled major health care issues, including Medicaid, for more than 20 years as a representative of Providence Health System, a major health care provider in this state which operates eight hospitals, a number of special programs and a health insurance carrier.

However, I set aside my caution this week, given the huge discrepancy that exists between what the Secretary of State announced and the true context.

That context emerged this week as Oregon Health Authority (OHA) officials appeared before a Joint Ways and Means Subcommittee to provide a report on the Medicaid eligibility issue.

The history is this. When the Cover Oregon health insurance exchange collapsed, Health Authority officials were left with a huge task – to determine how many individuals supposedly covered by Cover Oregon were eligible for Medicaid, the cooperative health care entitlement system for low income individuals financed jointly by the federal and state governments.

They also faced a legal requirement to review eligibility at least once a year because, unlike Medicare and Social Security, Medicaid is a “dynamic” program, meaning recipients cycle on and off based on their income, as well as family status.

The rigorous eligibility determination process – sometimes called re-determination — is still under way and will be completed by August 31, according to what Oregon Health Authority officials told the Joint Ways and Means Subcommittee.

It is possible that a total of 32,000 Oregonians might have received payments in error. That won’t be known until the end of the determination (re-determination) process in late summer. That total is part of a 115,000 person backlog of re-determination issues that is proceeding apace, with an estimated an estimated 6,200 cases resolved each day.

The size of federal Medicaid matching funds is an interesting sub-issue here. For those citizens who are in the so-called “expanded Medicaid population” (newly and potentially eligible for Medicaid under the more liberal standards of the federal Affordable Health Care Act), then the federal government bears 94 per cent of the cost of their care. That is way above the normal federal Medicaid matching rate for Oregon – 64 per cent.

Another issue that arose in the Secretary of State audit alert dealt with whether there had been coordination between the federal agency responsible for Medicaid, the Center for Medicare and Medicaid Services (CMS) and OHA. The Secretary of State contended that such coordination did not occur.

The fact is that it did. State and federal officials have been meeting at least weekly – by phone conference, of course — to share updates on the Medicaid eligibility determination process. Further, the federal government has approved Oregon’s process by granting additional waivers.

In its report on the Joint Ways and Means Subcommittee hearing, Salem Statesman-Journal newspaper quoted subcommittee member Senator Sara Gelser, a Democrat from Corvallis, as saying this:

“I think that we can and should expect of our Secretary of State to send out information that is accurate, that is honest. I expect more. I can’t begin to imagine the amount of work this has caused by sending out an alert that clearly has some faulty and inaccurate information.”

The Secretary of State has a role to play in all of this – to audit state agency programs – and it is a worthwhile endeavor. But the clarity gets very clouded when the office overstates the reality of a problem.

As the legislature drives toward the finish line a month or so from now, one of the issues at stake here is an important one. It is whether to approve taxes on hospitals and health insurances to help finance Medicaid.

Principals from hospitals and insurers are negotiating the tax issues, which are likely to occur if only because the health of so many low income Oregonians is at stake.

But the Secretary of State’s audit alert made the tax agreement much more difficult. The Oregon Health Authority appearance before the Joint Ways and Means Subcommittee did a lot to set the record straight.

Footnote: It should be noted that Lynne Saxton, director of the Health Authority, is a good friend. We have known each other for years and have worked together on a number of important public policy issues. My friendship did not influence this blog: I was interested in dealing with competing views of a major public policy issue for Oregon.