Cover Oregon confessions: Are they playing games with your health?

Cover Oregon confessions: Are they playing games with your health? »Play Video

PORTLAND, Ore. – You can decide the worst part for yourself.

Is it the rock-paper-scissors tournament that tore Cover Oregon workers away from the huge stack of applications that needed to be processed?

Or maybe it’s the non-citizens’ applications that were pushed through, even when they were lacking social-security numbers or claiming dependents who live in other countries?

Maybe it’s the private information protected with so little care that KATU’s On Your Side Investigators retrieved an applicant’s name and social-security with little effort?

How about the governor’s office getting first dibs at health care?

Conversations with one current and one former Cover Oregon application processor – they asked to remain anonymous, so we’ll call them Source A and Source B – revealed an unprofessional processing system that encourages workers to push applications through at all costs, while at times doing little to protect taxpayer money or privacy.

“All we were told was you know what, it’s OK - if you mess up, that’s how we learn,” Source A said. “(But) if we mess up, that’s somebody’s application. That’s somebody’s livelihood, you know, their health insurance.”

Rock, paper, scissors

It feels like a scene ripped from “The Office.”

Source A was deep in the middle of processing an application when a manager walked in.

 “He said stop what you’re doing, lock your computers, get up,” Source A said. “I’m going to count you off by threes. Ones over here, twos over here, threes over here.

“We were told to play rock-paper-scissors against everybody in our little group and then the remaining people out of those would play against each other and we would get a certificate.”

Work was piled high. Problems with the system meant hours went by some nights with no work completed, so the staff had a backlog of applications.

Source A didn’t want to play a game of rock-paper-scissors when it felt so much like playing a game with people’s health.

“I told him, I was like, this was not a morale booster,” Source A said. “We were working. And I just went back and sat down and it was really pointless, but it was 15-20 minutes of wasted time.

“I know that it’s a night shift and they need some morale boosters, but they really pushed the limits with some of the stuff that they did.”

‘I feel it’s wrong - I’ve been questioning this since November’

Because the Cover Oregon website still doesn’t work for the public, processors have to do the job.

Here’s how it works.

Paper applications are mailed or faxed in, then scanned into computers.

Processors then enter the information by hand into the Oracle-developed system to record them in digital form.

“It’s tedious work and you get frustrated at some of the things, but typically you just do it,” Source B said.

People being people, those applications often come in with information that’s either incomplete or missing.

There are mountains of applications to process and pressure to show the public that Cover Oregon is working despite the website’s problems.

Shortcuts happen.

Source B said those shortcuts include pushing applications through.

Even if the applicant doesn’t include a social security number.

“I’m not sure when it started but then eventually we were told, if they don’t have a social just go ahead and enter it, just push it on through,” Source B said. “I just couldn’t believe it because it says ‘you must have a SSN to apply for this insurance,’ right on the application.”

Source B claimed to see several applications from non-citizens every day. Some non-citizens – pregnant women, for instance - qualify for coverage.

But Source B said those applications aren’t always properly vetted. If an applicant only partially fills out a space on the form, it’s considered to be missing information and processors try to get in touch to verify it.

But if that same space is left blank?

“We’ve also been told, if they do not even start any information in there, then it’s not considered missing information and just go ahead and process it,” Source B said.

Source B also said there are problems with non-citizens’ applications that do provide social security numbers, claiming that some list dependents still living in other countries in order to manipulate household income and qualify for or improve benefits.

“I feel it’s wrong,” Source B said. “I’ve been questioning this since November when I started working there.”

The stack you want to be in – but almost certainly aren’t

Lots of applications come through the processing offices, but Source A remembers one stack that was high priority.

“Our second week, one of my first times working in the print room, one of the managers came in with a stack and said these get processed first,” Source A said. “It was the governor’s and anybody affiliated with that office. And it was also representatives for the state of Oregon.

Source A said those applications were processed immediately, double-checked by a manager and hand-delivered.

“But (there is no such care taken for) a regular Joe who’s been fighting cancer for three years or somebody’s daughter who has cerebral palsy or who is disabled for the rest of their lives,” Source A said. “There was missing information and we didn’t catch it and it went on to the next step in the process,” And then it got kicked back and (applicants) would miss the deadline.

“Mistakes were getting passed on from shift to shift, they weren’t getting resolved right away. They were just getting passed on to the next person.”

Source A suggested the On Your Side Investigators check out an unsecured dumpster outside the processing center as an example of how sloppily the office is run.

A random handful of papers taken from the dumpster showed a lack of care taken on the part of Cover Oregon staff to protect private information.

One, for instance, had a man’s name, income, social security number and birthdate handwritten on it.

"It's just wrong, it's just totally wrong,” Source B said. “The people need to know what's going on."

Enrolling undocumented immigrants?

Source B also said that managers told processors to "push through" applications listing undocumented dependents living outside the U.S.

The application asks "Who are you claiming?"

"And they'll name those children and ... later on in the application that they're living in Mexico," Source B said.

The On Your Side Investigators have learned there are two groups of illegal immigrants who can legally apply for state medical services: pregnant mothers and those who need emergency services. Under the umbrella of the Oregon Health Plan, Oregon's version of Medicaid, is a program called the Citizen Alien-Waved Emergent Medical (CAWEM).

It is a federally required program for people who have not yet met the requirements of having five years legal residency to qualify for Medicaid. The CAWEM program is limited to pregnant moms and emergency-only services; ongoing medical treatments are not covered according to OHA spokeswoman Rebeka Gipson-King.

In other words, people who are legal residents but have been in Oregon fewer than five years can buy benefits at full price through Cover Oregon, Gipson-King said.

However, rather than enrolling undocumented people in CAWEM, the state wrongly enrolled 2,297 into the Oregon Health Plan.

"For a short time, when Oregon Health Plan enrollments were transferred between Cover Oregon and OHA, there was an error that resulted in some people who qualify for emergency-only services being enrolled in fuller benefits," Gipson-King said in an email.

In another email, Gipson-King added, "The problem was caught quickly, and there have been no further occurrences of this problem since December," she said. "Pending legally required notification, the affected individuals will be transferred to the CAWEM program as of ... March 17."

Gipson-King also said via email "only people residing in Oregon are covered."

KATU dug further for answers about the whistleblowers' accusations of undocumented people receiving insurance but the spokeswoman did not elaborate.

As for the claims of undocumented dependents receiving health insurance through Cover Oregon, Gipson-King told KATU that dependents living outside of Oregon would not be eligible for coverage in Oregon but didn't provide further detail.

Gipson-King did say dependents are listed on the applications "to determine household income (by tax filing group, i.e. Dependents) which is used to determine if the individual (not the whole family) meets the income requirements to qualify for Medicaid."

However, despite many questions about the issue, the OHA spokeswoman did not say if undocumented people's applications - outside of CAWEM - were processed or, if processed, received health insurance.

The Oregon Health Authority originally told KATU the state wrongly enrolled 2,600 undocumented people into OHP (which was broadcast) but updated that number late Thursday, to around 2,300.


Cover Oregon Statement:

For a short time, when Oregon Health Plan enrollments were transferred between Cover Oregon and OHA, there was an error that resulted in some people who qualify for emergency-only services being enrolled in fuller benefits. These emergency-only services are for people who don't meet the federally required five-year residency standard for Medicaid. People who are legal residents but have been in Oregon less than five years can purchase benefits through Cover Oregon at full price. The emergency-only program is federally required to be made available to people residing in Oregon without residency documentation. They are not eligible to purchase a plan through Cover Oregon. 
 
The error was caught quickly. About 2297 people were notified that their OHP benefits are emergency-only.