Oregon Health Plan Bridge, the state’s basic health program, did not comply with income requirements, according to a March 31 audit from the Oregon Secretary of State.
Auditors issued an adverse opinion of the program, which was implemented in July 2024, over failure to follow federal requirements. Oregon’s ONE Eligibility system was missing the program’s lower income threshold — 133% of the federal poverty level — allowing people below that bar to also enroll and access benefits. The program should have been limited to those between 133% and 200% of the federal poverty level.
The eligibility system’s vendor received a ticket in December 2024 asking to fix the problem, and the issue was resolved in June 2025. As of this March, the department is working to pay back improper payments.
The auditors determined $8 million in questioned costs and 3,586 ineligible individuals who were involved. Oregon has until Feb. 28, 2027, to execute financial restitution.
A random selection of 60 basic health program individuals highlighted other cases of enrollees who were improperly included. The department determined a system error in May, and, as of August 2025, workers have been using an interim process to manually close these cases. Some cases resulted from human error.
Based on the sample, known program benefits amounted to $17,733 paid on behalf of the ineligible individuals. The system error, with a rate of 3.8%, permitted some individuals making over 200% of the federal poverty level to get benefits. The auditors projected likely questioned costs to be $7 million, but the state did not agree with that estimate. The state recommended a refund to the trust fund and further education for eligibility workers, continuing to update training materials until Dec. 31, 2026.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
