The Oregon Eligibility System Appropriately Determines Eligibility, But Input Errors Continue to Occur

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 found 40% lacked case notes and 90% were not approved by policy.

Change management for ONE is formal and well documented, but state tests of changes rely on informal controls and user acceptance testing lacks a formal, comprehensive plan.

Input controls exist to ensure required fields are completed, but accuracy of input data not controlled by automated checks is challenging, relying on staff; training materials exist but are primarily instructional; multiple internal units perform data accuracy reviews, yet prevent/detect errors remains insufficient, especially under the PHE.

During testing, residency and income data errors were found; 156 residency-related instances where residency status should have ended eligibility after change; 29 cases where workers did not rerun eligibility after residency change; various income data issues, and instances where high reported income was entered manually; test results showed inaccuracies in SNAP benefit calculations and Medicaid eligibility due to manual input errors (e.g., misstatement of household size, incorrect income entries, misrecorded expenses); 156 residency errors could lead to continued eligibility when not appropriate once PHE ended.

Evaluate opportunities to improve input accuracy through automation and propose changes to the ONE system to enforce them, including requiring entry into income fields necessary for eligibility and requiring rerun/authorization when information changes.

Refine override processes to ensure overrides are restricted to authorized personnel, consistently documented, and monitored: limit override rights to leads/managers or require approval, implement automated note requirement, formal override review schedule, and procedures to correct detected override errors.

Develop a formal user acceptance testing plan for changes, consolidating existing practices into an overarching plan that defines test types, priorities, risk assessment, coverage, resources, documentation of decisions, and a target of implementing a comprehensive UAT plan by 9/30/2025.