The Oregon Eligibility System Appropriately Determines Eligibility, But Input Errors Continue to Occur
Learn how the AI-generated research projects were createdOverall Conclusion
The audit found that the ONE system largely determines eligibility accurately for Medical and SNAP programs, and automated eligibility determinations are generally effective. However, input errors, manual data entry, and inconsistent override monitoring create risk for incorrect determinations and benefit calculations, particularly as the system and policies evolved during the COVID-19 Public Health Emergency. While change management is formal and well-documented, testing lacks a formal, unified plan, relying on informal controls. The report recommends automation, stronger override governance, and a formal UAT plan to mitigate these issues and improve input accuracy and overall reliability.
Source Document
Audit Scope
The audit evaluated the Oregon Eligibility System (ONE), a centralized system used by the Oregon Department of Human Services (ODHS) and the Oregon Health Authority (OHA) to determine eligibility and benefits for Medicaid, CHIP, and SNAP. The scope included automated system processes for processing applications and determining eligibility for Medical and SNAP programs. The test period ranged from eligibility determinations authorized on or after July 1, 2021, through May 31, 2023, though some tests evaluated ongoing eligibility beyond that period. The audit also assessed data input accuracy in ONE and the appropriateness of overrides by eligibility workers. It evaluated the sufficiency of ODHS and OHA procedures to analyze and prioritize changes to ONE; it did not assess Deloitte LLC's change management procedures. It also evaluated the sufficiency of user acceptance testing for system changes.
Key Findings Summary
ONE system largely determines eligibility appropriately for Medical and SNAP programs, but some automated functions did not work properly or reliably for a small number of determinations, including interface errors and social security number verification against federal records.
Most errors in eligibility determinations and benefit calculations were the result of manual input errors, not automated processes, with complexity and COVID-19 policy changes increasing manual inputs and input errors.
Manual overrides by eligibility workers, while rare, have reversed appropriate automatic determinations; there are policies but they are not consistently followed and are only recently being reviewed by management; overrides documentation is inconsistent and monitoring is limited (e.g., 0.50% of Medical and 0.08% of SNAP overrides); SNAP overrides review fou…
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AI-Assisted
AI Scope Summary
Assess whether Oregon's ODHS and OHA have designed and implemented sufficient automated controls in the ONE eligibility system to accurately determine and maintain Medicaid and SNAP eligibility, prevent and detect input errors, monitor and document overrides, and control code/configuration changes, during the period July 1, 2021 to May 31, 2023, with emphasis on data quality, override governance, and test planning.
AI-Generated Insight
This audit underscores a critical tension in large, integrated benefits systems: precision in automated logic is high, but human data entry remains a major vulnerability. The COVID-19 emergency amplified this risk by expanding policies and increasing manual inputs. The findings suggest that significant benefits could be gained from targeted automation (e.g., income data entry prompts, mandatory reconciliations on information changes) and strengthened governance over overrides and testing. Implementing formal user acceptance testing and more rigorous change controls would reduce the risk of incorrect eligibility decisions, improve program integrity, and safeguard public funds, while maintaining the ONE system's efficiency gains.