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OYA asks for two Medicaid billing positions, warns MMIS transition could risk federal funds
Summary
The Oregon Youth Authority asked the subcommittee for two permanent positions to build Medicaid billing capacity for MMIS compliance, saying manual processes and lack of HIPAA infrastructure could expose the state to audits and roughly $30 million in biennial federal funding risk.
During an informational hearing Feb. 10, the Oregon Youth Authority asked for permanent staffing to establish a Medicaid billing function to meet new MMIS requirements directed by the Oregon Health Authority.
Director Mike Tessin told the Joint Ways and Means Public Safety Subcommittee that the Oregon Health Authority expects OYA to transition to the Centers for Medicare and Medicaid Services’ Medicaid Management Information System (MMIS), which requires service‑level documentation, HIPAA infrastructure, reconciliation, and audit‑ready reports. Tessin said that, under current conditions, OYA would need to manually process about 165 youth claims per month without dedicated expertise.
"This will require manual processing of approximately a 165 youth claims per month. Work that demands specialized expertise that we do not have internally," Tessin said. He warned that "non compliance exposes the state to negative audit findings, potential repayment of funds, or loss in federal reimbursements, which equates to roughly $30,000,000 each biennium."
To address the need, OYA requested funding for two permanent positions: an Accountant 1 and an Operations and Policy Analyst 3 to form a small, sustainable Medicaid function that can ensure accurate billing, reconciliation, and audit readiness. Tessin said these roles would reduce the long‑term reliance on state general fund and help stabilize funding for treatment providers that serve youth in OYA care.
The item was presented as an informational request; the subcommittee did not take a formal vote and LFO recommendations were not provided at the subcommittee level, as OYA fiscal requests for the short session are processed through the omnibus appropriations and capital construction committees.
