A state lawmaker said the Ohio Department of Medicaid’s response to questions about how the agency complies with federal law and proper stewardship of Ohio’s Medicaid funds is “troubling.”
In a letter to the agency, state Rep. Mike Dovilla, R-Berea, indicated that at least one in five Medicaid enrollees may not be eligible, possibly resulting in more than $6.3 billion in “improperly disbursed benefits.”
The Ohio Press Network surfaced the letters and published them on their website.
In April, Dovilla sent a letter to Haywood Talcove, CEO of LexisNexis Risk Solutions – Government, “to confirm that our Medicaid eligibility determination and redetermination processes align with best practices and fiscal responsibility.” Ohio uses LexisNexis’ Accuity Asset Verifications solution.
Dovilla also sought Talcove’s “perspective on any directives or policy changes that may have created obstacles in properly verifying Medicaid eligibility and addressing fraudulent activity.”
“The Ohio General Assembly is dedicated to ensuring that only eligible individuals receive benefits under Medicaid, and I am concerned about any guidance—whether from federal agencies or third-party contractors—that may hinder these efforts,” the lawmaker wrote in the letter.
According to Talcove’s April 25 response, LexisNexis performed 371,418 Ohio Medicaid asset verifications of recipients in the Aged, Blind and Disabled category in 2023. Over half (56%) of the estimated Ohio Medicaid ABD Beneficiaries were checked in 2023.
According to the numbers provided, nearly a third — 106,549 or 29% — of those tested “exceeded asset eligibility thresholds.”
“Using public expenditure figures and ABD capitation rates, this translates to a projected loss of over $6.3 billion in improperly disbursed benefits,” Dovilla said in the May 15 letter to Corcoran.
In a May 12 letter to Dovilla, Corcoran said Accuity is not the only way county caseworkers verify resources and assets. A final determination would be made based on materials supplied by the applicant in response to the findings at the local level, and an individual could not be disenrolled based solely on LexisNexis’ findings, Corcoran said.
“LexisNexis does not evaluate how the asset is treated in an eligibility determination: Accuity’s sole function is to identify the existence of such an asset,” Corcoran wrote. “The asset may be non-countable, in an exempt trust, a home occupied by a dependent, belong to a spouse not on Medicaid, be non-saleable real property, be exempt savings for MBIWD members, etc.
“...Unless LexisNexis gives us the list of individuals they say were flagged in [2023], ODM cannot identify the enrollment outcomes of these cases because the local county Department of Job and Family Services is making the determination,” Corcoran added.
The letter did not assuage Dovilla’s concerns.
In a follow-up letter to Ohio Department of Medicaid Director Maureen Corcoran, Dovilla said that after speaking with Eric Vinyard, the agency’s assistant deputy legislative director, the department’s response was “troubling.” He said it “fails to provide even basic clarity on how [the] agency ensures compliance with federal law and proper stewardship of Ohio’s Medicaid funds.”
“I am not convinced ODM is systematically ensuring that Medicaid dollars are going only to individuals who are legally eligible for them,” Dovilla said in the May 15 letter to Corcoran.
“Your letter also attempts to explain away the 44 percent of Aged, Blind, or Disabled (ABD) beneficiaries who did not undergo asset verification by citing Ohio’s status as a Supplemental Security Income (SSI) state,” Dovilla wrote. “However, you concede that even among non-SSI populations, you cannot identify how many individuals were actually verified or what percentage may be duplicate counts between contractors. This opaque and fragmented system of eligibility review defies accountability.”
