Press Release • Ohio Auditor of State

COLUMBUS — The Ohio Department of Medicaid (ODM) is doing little to ensure a multi-year project to modernize the systems it uses to deliver support and services to needy Ohioans is working efficiently and effectively.

Instead, state auditors who recently reviewed the agency’s operations found nonexistent strategic and operational plans, minimal program evaluation, inconsistent contract management, inadequate use of data to make improvements, and other poor management practices.

“We’ve sounded the alarm about Medicaid for the past eight years, and our calls for action have not been adequately addressed,” said Auditor of State Keith Faber. “There’s too much at stake for the Ohioans who rely on these services for ODM to continue business as usual.”

The conclusions were included in a performance audit of ODM’s Next Generation initiative, a multi-year project to update and modernize Medicaid systems and operations. Lawmakers included language in the most-recent biennial budget requiring the review of the Next Generation effort, including ODM’s strategic planning, county oversight, claim processing, and other areas.

Medicaid makes up a large percentage of the state’s annual budget, providing over $40 billion in needed health care and related services for lower-income residents, older adults, individuals with disabilities, pregnant women, infants and children, and others.

Since 2019, the Auditor of State’s Office has released multiple reports (https://ohioauditor.gov/medicaid.html) spotlighting issues with ODM, including payments routinely made for services to dead people or residents who were not eligible to receive public support.

Thursday’s performance audit outlines additional concerns about ODM, with auditors finding the department operates in “a culture of compliance rather than one that is concerned with improving and optimizing program outcomes,” with officials focused on meeting minimum federal and state guidelines.

ODM also displayed “a lack of institutional knowledge” of its operations, with “staff members who were identified as subject matter experts” but “were unable to answer questions about programs. In particular, several individuals (who) were identified as owning a program were generally unable to speak to the evaluation and measurement outcomes of the program.”

Thursday’s report generally calls for better coordination and collaboration among the various agencies that administer Medicaid programs, rather than maintaining inconsistent procedures and practices for public assistance applications and renewals.

Among specific recommendations:

• Auditors urged ODM to implement organization-wide strategic, operational, and staffing plans. Auditors noted, “the divisions and offices within ODM are not operationally aligned and have institutional knowledge gaps, functional silos, and information retention issues. This makes it difficult for ODM to properly evaluate the effectiveness of programs and ensure the program is effective and efficient.”

• Auditors recommended ODM improve its contract management practices, given that a large portion of its total spending is facilitated by third-party vendors. In a sample of contacts reviewed, auditors found significant discrepancies between planned and actual costs, amounting to more than $145 million in unplanned expenses. Better contract management would lead to fewer unplanned costs and better delivery of support and services.

• Auditors urged ODM to make use of existing county-level and other data and leverage additional information to determine ways to improve application processing and other operational issues.

• Auditors recommended beyond-the-minimum reviews of eligibility determinations to better identify issues. Currently, ODM conducts a triennial review of 800 cases out of about 850,000 processed applications. Auditors noted, “The limited and inconsistent data obtained through current quality control efforts cannot be used to confirm the accuracy or effectiveness of (county Job and Family Services) operations across the state…. ODM should expand, standardize, and communicate quality-control efforts to improve the accuracy of eligibility determinations and redeterminations throughout the state.”

The full performance audit is available online at ohioauditor.gov/auditsearch/search.aspx.

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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.

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press@ohioauditor.gov