Review of Ohio's Medicaid Disproportionate Share Hospital Payments

EXECUTIVE SUMMARY:

The report points out that Ohio's State plan with regard to the disproportionate share hospital program was in compliance with Federal requirements and CMS policies, with the exception of the method for calculating the Medicaid inpatient utilization rate for institutions for mental diseases (IMDs).  Contrary to these requirements and policies, Ohio included the 22- to 64-year-old patient age group in the Medicaid inpatient utilization rate calculation for its State-owned IMDs.  As a result, Ohio made approximately $80 million ($47 million Federal share) in DSH payments to seven IMDs that did not meet the Medicaid inpatient utilization rate requirements.  We recommended that Ohio revise its State plan to exclude the 22- to 64-year-old age group in calculating the Medicaid IMD inpatient utilization rate for future DSH reporting periods, and refund the $47 million (Federal share) of payments made to seven State-owned IMDs that did not meet Medicaid inpatient utilization rate requirements.