Report 2024-27
Why this audit is important
As of April 2024, over 1.4 million people were receiving Medical benefits under the Medicaid and Children’s Health Insurance Program (CHIP) and over 700,000 received Supplemental Nutrition Assistance Program (SNAP) benefits.
The Oregon Eligibility System (ONE) is a complex system used by the Oregon Department of Human Services and the Oregon Health Authority to determine eligibility and benefits across a wide range of aid programs such as Medicaid and SNAP.
Some Medicaid programs and SNAP were implemented into the ONE System starting in 2020, with other Medical programs implemented in 2015.
In fiscal year 2023, Oregon spent approximately $18.7 billion on Medicaid, CHIP, and SNAP. The ONE system has cost a total of $416 million to implement.
What we found
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Most automated functions used by ONE to determine eligibility function appropriately, including those handling income calculations, preventing overlapping benefits, and calculating benefit amounts correctly.
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Some errors or inconsistencies still occur in ONE, such as interface errors and social security number verification against federal records. We found they did not directly affect eligibility determination or affected small populations.
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While some controls and strategies are in place to prevent or detect input errors, most errors in eligibility determination and benefit calculations we detected were the result of input errors, not automated processes. The complexity of the system and frequent policy and process changes throughout the COVID-19 Public Health Emergency all led to increased manual inputs, along with input errors.
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Manual overrides by eligibility workers, while rare, have reversed appropriate automatic determinations. There are policies to guide and reports to monitor overrides, but we found these were not consistently followed by workers and are only recently being reviewed by management.
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Changes made to the system are consistently planned, reviewed, and tested prior to release. However, there are opportunities to improve user acceptance testing through more formal plans to ensure sufficient coverage.
What we recommend
We made three recommendations to the Oregon Department of Human Services. The agency agreed with two of our recommendations and partially agreed with one. The response can be found at the end of the report.
