Ohio Medicaid needs to pay back $29.5M

State department says enrollment counted correctly.

The Ohio Department of Medicaid owes back $29.5 million in bonuses that the federal government said wouldn’t have been paid out if Ohio had counted its enrollment numbers properly.

Ohio Department of Medicaid disputes the federal report, saying in a letter to the U.S. Department of Health and Human Services that state counted its enrollment numbers the way Congress intended when it set up the bonus system in question.

The dispute centers around whether Ohio should have counted children who are blind or have disabilities in its Children’s Health Insurance Program enrollment numbers when it comes to certain federal bonuses.

When Congress reauthorized CHIP in 2009, it appropriated $3.2 billion for performance bonuses for 2009 through 2013 to offset the costs of increased enrollment.

However, the U.S. Department of Health and Human Services Office of Inspector General maintains in its report that the bonuses are not for children who are blind or have disabilities.

The inspector general’s office reported nearly half of the $64 million in bonus payments Ohio received between 2010 and 2013 were improperly received.

The inspector general has done similar audits in recent years that claimed similar unpermited bonuses in Colorado, New Mexico, North Carolina and Wisconsin.

Michelle Horn, chief financial officer for Ohio Medicaid, stated the state maintains its numbers were submitted in accordance with the law’s intent. She noted states have been instructed to include children that meeting blindness or disability criteria for other calculations, so not counting these children for the bonus payments “doesn’t seem correct for both the word and spirit of the statute.”

Horn wrote that Centers for Medicaid and Medicare’s approach for calculating bonuses “is in opposition to Congressional intent meant to reward states for increased enrollment of all eligible children, not just non-disabled eligible children.”

The federal report says that Ohio overstated its eligible enrollees each year between 2010 and 2013, with the number of improper enrollees ranging from between 40,925 and 33,851.

That translates to disputed annual bonuses between $4.7 million and $10.8 million during those years.

Ohio Department of Medicaid’s budget is about $25 billion for fiscal year 2017.