COLUMBUS – More than 124,000 people enrolled in Ohio’s Medicaid Program were simultaneously enrolled in Medicaid programs in other states, according to a report released Tuesday by Ohio Auditor of State Keith Faber.

Additionally, over the four-year period examined, Ohio paid managed-care organizations (MCO) more than $1 billion to provide services to individuals enrolled in multiple states’ Medicaid programs; the Ohio residency of 40% of a sample of these individuals could not be confirmed; and the potential financial impact to Ohio of multistate enrollees was more than $200 million.

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

The findings are included in “The Cost of Concurrent Enrollment,” which describes the impact of concurrent Medicaid enrollment on Ohio’s program and recommends improved address change detection and other tracking to prevent duplicative benefits 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,” Auditor Faber said. “The Ohio Department of Medicaid (ODM) needs to do more to address these issues.”

The full report is available online here. In addition, Medicaid’s response to the report can be accessed here.

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 and 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 receives a monthly payment from the state for each enrolled recipient.

The Auditor of State’s Office has conducted multiple reviews of Ohio’s Medicaid Program and provided recommendations for ensuring public funds are being spent efficiently and effectively. A January 2022 audit, for example, found that ODM had failed to recoup $118.5 million in erroneous duplicate payments and payments on behalf of individuals in prison or who were deceased. A December 2022 audit found that ODM was not ensuring county Department and Job and Family Services caseworkers adequately processed system alerts to determine if recipients were receiving duplicative benefits from other states, potentially costing the state between $5.3 million and $24.5 million annually.

Tuesday’s report reviewed concurrent Medicaid enrollment between Jan. 1, 2019, and Dec. 31, 2022, and found 124,448 individuals who were enrolled in Ohio’s Medicaid program and at least one other state for three consecutive months. The state made monthly payments totaling more than $1 billion to managed-care organizations for those concurrently enrolled over the 4-year period. Three partnering states are conducting similar audits and the U.S. Department of Health and Human Services and Office of the Inspector General completed a similar audit of Ohio’s program.

Today’s 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.”

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The Auditor of State’s Office, one of five independently elected statewide offices in Ohio, is responsible for auditing more than 5,900 state and local government agencies. Under the direction of Auditor Keith Faber, the office also provides financial services to local governments, investigates and prevents fraud in public agencies, and promotes transparency in government.

Public Affairs

Contact: Marc Kovac

press@ohioauditor.gov