Audit Release – Foster Care in Oregon: Chronic management failures and high caseloads jeopardize the safety of some of the state’s most vulnerable children

Report Highlights


Oregon’s most vulnerable children are being placed into a foster care system that has serious problems. Child welfare workers are burning out and consistently leaving the system in high numbers. The supply of suitable foster homes and residential facilities is dwindling, resulting in some children spending days and weeks in hotels. Foster parents are struggling with limited training, support and resources. Agency management’s response to these problems has been slow, indecisive and inadequate. DHS and child welfare managers have not strategically addressed caseworker understaffing, recruitment and retention of foster homes, and a poorly implemented computer system that leaves caseworkers with inadequate information.

Background

Since 2011, there have been over 11,000 children in the Oregon foster care system each year. These children are vulnerable and are often the victims of child abuse and neglect.

Audit Purpose

The purpose of the audit was to determine what changes and improvements DHS can make to better promote the wellbeing of children in foster care and ensure they are better protected and cared for.

Key Findings

  1. DHS and Child Welfare struggle with chronic and systemic management shortcomings that have a detrimental effect on the agency’s ability to protect child safety. Management has failed to address a work culture of blame and distrust, plan adequately for costly initiatives, address the root causes of systemic issues, use data to inform key decisions, and promote lasting program improvements. As a result, the child welfare system, which includes the foster care program, is disorganized, inconsistent, and high risk for the children it serves.
  2. DHS does not have enough foster placements to meet the needs of at-risk children, due in part to a lack of a robust foster parent recruitment program. The agency struggles to retain and support the foster homes it does have within its network. The agency also lacks crucial data regarding how many foster placements are needed and the capacity of current foster homes, inhibiting the agency’s ability to fully understand the scope of the problem.
  3. A number of staffing challenges compromise the division’s ability to perform essential child welfare functions. These challenges include chronic understaffing, overwhelming workloads, high turnover, and a large proportion of inexperienced staff in need of better training, supervision, and guidance.

Recommendations

We make 24 recommendations that address the agency’s management challenges, foster parent recruitment and retention, and child welfare staffing. Our recommendations also affirm the foundational recommendations Public Knowledge LLC made in September 2016.

The Department generally agrees with our recommendations. The Department’s response can be found at the end of the report.

Read the full report here.

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Audit Release: Oregon Health Authority Should Improve Efforts to Detect and Prevent Improper Medicaid Payments

Report Highlights


Our audit found that Oregon Health Authority (OHA) recovery efforts are appropriate and reasonable, but the agency should strengthen efforts to detect and prevent improper payments in Oregon’s $9.3 billion per year Medicaid program. Prevention of improper payments is more cost-effective than attempting to recover improper payments. We also found that delays in processing eligibility for thousands of Oregon’s Medicaid recipients resulted in millions of dollars of avoidable Medicaid expenditures, a critical issue the agency failed to disclose until raised in a May 2017 Auditor Alert. Furthermore, OHA did not timely disclose relevant information, which impeded our audit work. OHA’s new management has been more proactive and transparent in addressing these issues.

Background

An improper payment is defined by the federal government as “any payment that should not have been made or was made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or other legally applicable requirements or where documentation is missing or not available.”

Purpose of Audit

The primary purpose of the audit was to determine if the Oregon Health Authority could improve processes to prevent, detect, and recover improper Medicaid payments. The secondary purpose was to follow-up on OHA’s progress to resolve issues we raised in our May 2017 Auditor Alert.

Key Findings

Within the context that Medicaid is a very complex and challenging program to administer, we found:

  1. OHA has gaps in procedures for preventing certain improper payments. Insufficient management of the agency’s processes for identifying and resolving payment and eligibility issues, prioritization of staffing resources, and efforts to address technology issues put taxpayer dollars at risk.
  2. OHA lacks well-defined, consistent, and agency-wide processes to detect certain improper payments, especially related to coordinated care. We identified approximately 31,300 questionable payments based on our review of 15 months of data. OHA needs to continue researching these claims to determine how many were improper; OHA reported that only a small percentage were improper based on preliminary research of 2,700 claims.
  3. OHA recovery efforts appear appropriate and reasonable, but may be underutilized due to OHA’s limited procedures for detecting improper payments.
  4. OHA reported completing the action plan to determine eligibility for the remaining backlog of 115,200 Medicaid recipients. Approximately 47,600 (41%) were deemed ineligible as a result, although this figure may decrease slightly through the end of November. Failure to address this issue in a timely fashion resulted in approximately $88 million in avoidable expenditures.

Recommendations

Drawing from national leading practices, our report includes eight recommendations to OHA focused on strengthening efforts to detect and prevent improper payments. Oregon Health Authority agrees with our recommendations. The agency’s response can be found at the end of the report.

Read full report here

 

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