US
Office of Inspector General, Department of Health and Human Services
Published April 2025

Audit Of Ohio Adult Day Health Care Services

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Overall Conclusion

The Ohio Department of Medicaid did not fully comply with Federal waiver and State requirements in overseeing providers serving adults in the ADS program; inspections were insufficient to ensure a continuously safe and nonhazardous environment, placing adults at risk.

Source Document

Audit Scope

The audit assessed the Ohio Department of Medicaid's oversight of the Ohio Home and Community-Based Services Waiver's Adult Day Support/Adult Day Health Care facilities. From June 5 to June 23, 2023, OIG conducted unannounced site visits at 19 of the 20 selected ADS providers (one provider had closed). The sample was drawn from 575 Ohio providers as of June 30, 2022. The audit evaluated compliance with Federal waiver requirements (Section 1915(c)) and State requirements for health and safety and administration, based on applicable Ohio Administrative Code rules and waivers. The inspection period analyzed covered May 19, 2016 through June 20, 2023, during which ODM conducted inspections of the selected providers. The objectives included assessing whether inspections ensured a continuously safe environment and whether providers met participant needs, staffing, training, and licensing requirements.

Key Findings Summary

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18 of the 19 ADS providers reviewed did not comply with one or more health and safety requirements; 9 providers did not comply with one or more administrative requirements; total of 117 noncompliance instances across all providers.

AI-Assisted

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AI Scope Summary

To determine whether Ohio's Medicaid program complied with Federal waiver and State requirements in overseeing adult day services facilities that participate in the Home and Community-Based Services Waiver, focusing on health and safety and administrative compliance and evaluating ODM's oversight mechanisms.

AI-Generated Insight

This audit reveals a systemic oversight gap in Ohio's administration of Adult Day Services waivers, with widespread noncompliance across providers and a total of 117 noncompliance instances. The findings underscore the need for stronger regulatory oversight, standardized inspection protocols, and targeted provider support to meet health, safety, and staffing standards. The results have broader implications for policy reform and for evaluating risk in similar state Medicaid waiver programs.