State mismanagement hurts patients

More than a year after Gov. Kate Brown fired its director, the Oregon Health Authority still can’t seem to avoid controversy and questions about its ability to manage the state’s massive Medicaid program. The OHA’s most recent scandal involves severely mentally ill patients kicked out of locked facilities at the recommendation of an outside contractor hired to determine the patients’ eligibility for Medicaid benefits.

In a lengthy investigative report, The Oregonian found that in at least three cases, vulnerable patients were injured after they were discharged from locked facilities over the objections of care providers that they were not capable of managing their own affairs. In many cases, patients were told they no longer qualified for care, but the state had no place else to send them, resulting in extra charges to leave them in place.

The contractor, Kepro, was instructed to review patients’ eligibility for care with the goal of reducing the average length of stay in locked residential facilities. The federal Justice Department also was pressing the state to make sure more mentally ill people were living in community settings.

Kepro’s contract says the more people the company disqualifies from Medicaid eligibility, the more money it can make — $1,000 extra per person disqualified, up to $10,000 a month. But OHA director Patrick Allen insists the incentive language isn’t resulting in bad decisions denying care.

Still, The Oregonian’s reporting found Kepro was moving faster to deny coverage than OHA’s ability to keep up, prompting Allen to tell his staff to instruct Kepro to slow down its work. That instruction apparently never got to Kepro; the agency can’t say why.

Other things the agency can’t say: It doesn’t know why the contract with Kepro calls for cutting the average length of stay in locked facilities by 64 percent rather than the 20 percent figure the state and the Justice Department had agreed on. And it doesn’t know how many of the hundreds of people Kepro recommended for removal from locked facilities ended up hospitalized, homeless or dead.

The specific cases in the newspaper’s report are chilling. They include a 54-year-old woman with severe schizophrenia who was moved out of a locked facility over the objections of her care providers. She walked away from the unsecured facility she moved to, went missing for a week and was found catatonic and suffering from exposure. Another schizophrenic patient went off his medication and drank bleach within weeks of being moved from a locked facility into an apartment. A professional guardian told the newspaper that six of her clients wound up in a higher level of care after Kepro disqualified them; one is in jail on assault charges.

Allen maintains the overall data show a drop in hospitalizations after discharge from a locked facility, from 9 percent before Kepro’s contract started to 6 percent the next year.

But overall performance data aren’t much comfort to the families of patients who suffered because they were discharged when they should not have been. Human beings don’t fit neatly into statistical pigeonholes. It’s the Oregon Health Authority’s responsibility to manage the state’s Medicaid program as efficiently as possible, but also to protect the vulnerable people who receive care.

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