Evidence record
The Cost of Concurrent Enrollment
- Jurisdiction
- Ohio
- Publishing agency
- Ohio Auditor of State
- Publication date
- March 13, 2024
- Source record
- Original document linked
Findings
7
Recommendations
5
Overall 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.
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.
Findings (7)
Each finding has a stable link.
- F-051
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.
- F-053
Estimated impact of over $209 million due to out-of-state residency among sampled enrollees.
- F-052
40% of tested capitation payments could not be confirmed as Ohio residents, indicating potential overpayments.
- F-054
The Medicaid program lacks adequate procedures for preventing, timely identifying, and resolving concurrent enrollments.
- F-055
Self-attested residency information leads to inaccuracies and potential for out-of-state enrollment.
- F-056
Federal and state requirements for residency are not sufficiently enforced or verified.
- F-057
The PARIS system and other alerts are underutilized and overwhelmed, leading to delays in resolving residency issues.
Recommendations (5)
- R-078
Request CMS to provide data matches based on T-MSIS data to identify unresolved concurrent enrollments.
Related finding F-057 - R-079
Conduct follow-up reviews of subsequent concurrent enrollment data to ensure timely resolution.
Related finding F-054 - R-075
Enhance technology use in application and enrollment processes to identify existing enrollments in other states.
Related finding F-054 - R-076
Expand application questions to proactively identify potential concurrent enrollment.
Related finding F-055 - R-077
Improve the clearing and resolution of PARIS alerts through better communication and system enhancements.
Related finding F-057