A recent audit of the Oregon Health Plan Bridge has highlighted concerns regarding the program’s eligibility determination processes, leading to significant financial implications. Released by the Oregon Secretary of State’s Office on March 31, 2026, the audit revealed flaws in the ONE Eligibility system, which is responsible for processing applications for the program. These flaws resulted in improper payments to residents who did not meet the program’s income qualifications.
Launched in July 2024, the Oregon Health Plan Bridge aimed to assist residents who earn too much to qualify for Medicaid but still struggle to afford private insurance. However, the audit found that the system did not fully enforce the federal income eligibility requirement of 133% of the federal poverty level (FPL), allowing ineligible individuals to be mistakenly enrolled in the program.
Eligibility System Flaws Identified in Audit Report
The audit determined that the ONE Eligibility system, which was supposed to assess eligibility based on federal income guidelines, failed to enforce the income threshold correctly. Specifically, the system did not properly apply the 133% of FPL rule, resulting in individuals being enrolled despite exceeding the program’s eligibility limits.
This oversight persisted until June 2025, when the error was corrected by the system’s vendor. While the issue was eventually addressed, the failure to enforce eligibility requirements for nearly a year resulted in a large number of improper enrollments, which placed unnecessary financial strain on the state’s budget and raised concerns about the program’s overall effectiveness.
Audit Estimates $15 Million in Improper Payments
According to the audit, the eligibility system errors likely led to $15 million in improper payments to ineligible individuals. These payments were made to those who did not meet the program’s income requirements, further exacerbating the financial challenges facing the state’s health programs. The audit notes that the improper payments represent “questioned costs” due to the eligibility discrepancies.
The Oregon Health Plan Bridge relies on federal funding, and the errors identified in the audit could complicate efforts to secure future funding. If the program does not address these eligibility issues in a timely and comprehensive manner, it could face serious challenges in maintaining its financial support and continuing to serve those who truly need assistance.
Financial and Compliance Risks for Oregon Health Plan
The audit’s findings highlight several critical risks for the Oregon Health Plan Bridge, particularly in terms of financial sustainability and compliance with federal health regulations. Auditors issued a rare adverse opinion regarding the state’s adherence to federal income eligibility requirements, pointing to weaknesses in how the program was managed.
Federal law mandates strict compliance with income eligibility criteria for programs like the Oregon Health Plan. The failure to enforce these guidelines consistently puts the program at risk of financial penalties and could lead to a reduction in federal funding. The adverse opinion issued by the auditors reflects the seriousness of these compliance gaps and the need for immediate action to ensure future adherence to federal standards.
State’s Response and Planned Improvements
In response to the audit’s findings, the Oregon Health Authority (OHA) has committed to addressing the eligibility system’s shortcomings. OHA officials have outlined a series of corrective measures, including updating the system’s coding and introducing more stringent oversight procedures to ensure the accuracy of eligibility determinations moving forward.
Additionally, the OHA has pledged to improve accountability for the contractors responsible for maintaining the eligibility system. By implementing enhanced monitoring and regular audits, the state aims to prevent similar errors from occurring in the future. Lawmakers are also expected to review the audit’s findings and recommendations to determine whether additional legislation or oversight measures are needed.
Efforts to Address Eligibility and Compliance Challenges
While the Oregon Health Plan Bridge program has faced challenges in ensuring eligibility compliance, the state is taking proactive steps to resolve the issues. The Oregon Health Authority’s prompt response to the audit findings is crucial to restoring the integrity of the program and protecting its future viability.
As part of its efforts, the state will focus on ensuring that the Oregon Health Plan Bridge only serves those who meet the established eligibility criteria, preventing further improper payments. By making necessary system upgrades and improving oversight, the state aims to ensure the program can continue providing essential coverage to those in need while maintaining full compliance with federal regulations.
