Medicaid eligibility system is under fire
Second study finds faults in $1.2B service
For the second time this week, a review has revealed widespread problems with Ohio's $1.2 billion online system for determining eligibility for Medicaid.
The faulty and complex system, state Auditor Keith Faber said, is costing taxpayers hundreds of millions in erroneous payments.
“As one of Ohio's largest budget items, with annual spending in excess of $27 billion, any inefficiencies in the Medicaid system can quickly run up a large tab,” Faber said.
“We must reduce the chance for error by streamlining and simplifying processes and ensuring accuracy in enrollment and reporting. The systemic problems we identified arose over several administrations and must be fixed now.”
The tax-funded Medicaid program provides health coverage to more than 3 million poor and disabled Ohioans, a number expected to continue to rise as the coronavirus pandemic has pushed the state into an economic recession.
Faber's 91-page audit focused on the Ohio Benefits system, an online database created in 2013 to determine whether an applicant is eligible for Medicaid benefits. In 2018, it began processing requests for the Supplemental Nutrition Assistance Program and Temporary Assistance to Needy Families as well.
In a review of 324 Medicaid beneficiaries from 27 counties, including Franklin, where 1 in 4 are enrolled, audi
tors found that 5% of those receiving coverage were ineligible for the program. Assuming a similar error rate statewide, potential losses add up to more than $455 million a year.
County caseworkers who rely on the system to process Medicaid applications and annual renewals say it is “inefficient” and “frustrating,” and they can't keep up with the continuous flood of computer alerts and updates.
For example, the audit found nearly 17 million system-generated alerts in a single year notifying caseworkers of a change in a beneficiary's income or other circumstances that could affect eligibility. One county reported 5,000 in a single day.
“It's dumping so many alerts that there is no way anybody can go through and manage that,” Faber said in an interview. “If you have an alert that somebody is getting benefits in multiple counties, you aren't even looking at it because there are too many alerts.”
Large numbers of system updates to improve functionality are equally disruptive. In a single year there were 654 changes made, 533 directly affecting how caseworkers perform their work.
“After years of development and inclusion of other benefit programs, the system does not work properly – with inaccurate or missing data sometimes leading to incorrect determinations, overpayments and payments out of the wrong aid category,” the audit found. Ohio's problems are not new. Faber noted that past state audits have made similar findings, and federal regulators have also questioned the accuracy of eligibility systems in Ohio and elsewhere.
In 2019, Seema Verma, administrator of the Centers for Medicare and Medicaid Services, told state Medicaid directors that recent state audits and federal reviews identified deficiencies and lax eligibility practices that jeopardize the sustainability of the Medicaid program.
In response to federal concerns about Ohio's backlog of Medicaid applications, the state took steps in January to reduce the number pending more than 45 days.
While the auditor's report found Ohio had reduced its backlog, it remains above the national average with more than 24,000 applications pending more than 45 days.
“We've had computer system failures all across state government at all levels,” Faber said. “But this is probably the worst example.”
State Medicaid officials, who told auditors they would be hiring an outside company to review the system, have not responded to a request for comment on the report.
On Monday, the Cleveland-based Center for Community Solutions released a survey of Medicaid beneficiaries who reported they, too, find the Ohio Benefits system difficult to use. A self-serve online portal is so difficult to use that many said it was simply easier to call their county Job and Family Services office to speak to a caseworker.
Faber said Medicaid officials were not always cooperative with state auditors.
“We had a tough time getting records from (Medicaid) to begin with,” Faber said. “We spent six months trying to get records that apparently were present and right there when they were writing a report to the governor flagging the problems they knew we were going to identify.” ccandisky@dispatch.com @ccandisky