The Cost of Concurrent Enrollment
Learn how the AI-generated research projects were createdOverall Conclusion
The audit highlights significant financial waste due to unmanaged concurrent Medicaid enrollment across states, emphasizing the need for technological improvements, better inter-state communication, and proactive identification processes to safeguard public funds.
Source Document
Audit Scope
This audit covers the impact of concurrent Medicaid enrollment in Ohio during the period from January 1, 2019, through December 31, 2022, focusing on capitation payments made to enrollees who were concurrently enrolled in Ohio and at least one other state, with particular attention to the top 11 states with the highest number of shared enrollees.
Key Findings Summary
Over 124,000 recipients enrolled concurrently in Ohio and other states from 2019 to 2022, with Ohio spending over $1 billion on capitation payments for these individuals.
40% of tested capitation payments could not be confirmed as Ohio residents, indicating potential overpayments.
Estimated impact of over $209 million due to out-of-state residency among sampled enrollees.
View the Findings tab to see all 7 findings
AI-Assisted
AI Scope Summary
The audit aims to quantify the financial impact of concurrent Medicaid enrollment in Ohio, evaluate current detection and resolution procedures, and recommend improvements to prevent unnecessary expenditures.
AI-Generated Insight
This report underscores the systemic challenges in managing Medicaid residency verification and the substantial financial implications of concurrent enrollment. Implementing technological and procedural enhancements could significantly reduce waste and improve program integrity.