Medicaid Payments for Beneficiaries with Concurrent Eligibility in Ohio and Michigan, Ohio Department of Job and Family Services

EXECUTIVE SUMMARY:

The objective of our audit was to determine the appropriateness of Medicaid payments made by the State of Ohio for beneficiaries who were concurrently listed as Medicaid eligible in both Ohio and Michigan.  We found that the Ohio Medicaid program inappropriately paid $333,716 for 471 Medicaid beneficiaries who had established eligibility in both States but should only have been eligible in Michigan.  We did not determine the appropriateness of an additional $56,171 of payments made during the first month of concurrent eligibility because Ohio considers the beneficiary eligible for the full month once eligibility is established any time during the month.  We recommended that the Ohio Department of Job and Family Services (State agency):  (1) seek recovery of inappropriate payments, estimated to be $333,716 ($196,325 Federal share), and refund the Federal share of recovered amounts; (2) review claims made in the first month of concurrent eligibility and determine whether the payments are allowable; and (3) consider additional procedures for identifying beneficiaries moving out of State, including participation in the  Public Assistance Reporting Information System (PARIS) project and increased sharing of eligibility information with the other State Medicaid programs.  Ohio officials agreed to perform additional work to determine the allowability of reported inappropriate payments.  The State agency will consider additional procedures and participation in PARIS based on the results of their review.