Report: State spent $1B on Medicaid for people enrolled twice

More than 124,000 people enrolled in Ohio’s Medicaid program were also enrolled in Medicaid programs in other states, a new report from state Auditor Keith Faber said.

The audit that examined four years’ worth of data also showed the state paid more than $1 billion to medical providers for services to people enrolled in multiple states.

Faber said 40% of those enrolled in more than one state most likely live in Ohio, but the potential financial impact to the state was more than $200 million.

“While this financial impact is based on Ohio’s payments, the waste of public funds is greater when considering the payments made by other states,” auditors said. “For each concurrently enrolled individual, there is at least one state making an unnecessary payment.”

The Cost of Concurrent Enrollment audit recommends improved address change detection and other tracking to curb duplicate payments.

“Every dollar spent for individuals not eligible to receive Ohio Medicaid services is a dollar that’s not going to residents who should be receiving assistance,” Faber said. “The Ohio Department of Medicaid needs to do more to address these issues.” The report reviewed duplicate enrollments between Jan. 1, 2019, and Dec. 31, 2022, and found 124,488 people were enrolled in Ohio’s program and at least one other state for three consecutive months.

The report concluded the Medicaid program “lacks adequate procedures to prevent concurrent enrollment from occurring, to timely identify concurrent enrollment, or to resolve concurrent enrollment between states in an efficient manner… (T)he data (show) that public dollars were misspent due to concurrent enrollment. All taxpayers are impacted when each State is not making every effort to guard against misspent public dollars.”

The Ohio Department of Medicaid said it could not validate the audit’s conclusions and questioned the methodology. It also said most of the audit period came during the COVID-19 pandemic and did not account for new federal requirements.

“These requirements significantly affected the ability of states to remove individuals from Medicaid rolls,” the department said in its response.

The department also said some of the audit’s recommendations would require changes to federal law and the same efforts to update, improve or work with the current system in all other states.

“The recommendations that involve changes to national systems, other states and the federal government would need to be agreed upon by external parties,” the response said. “Ohio is committed to continuing the hard work of the past several years to reduce the volume of alerts and continue to improve the accuracy of eligibility determinations.”

Ohio’s Medicaid Program provides health care and other services to about 3 million lower-income residents, older adults, individuals with disabilities, pregnant women, infants, children and others. Spending for the program reached about $28.5 billion in state fiscal year 2022.

Most Ohioans receive Medicaid services through a managed care provider, which gets a monthly payment from the state for each enrolled recipient.

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