Ohio's Medicaid Program:

Problems Identified Can Have National Importance

HRD-78-98A: Published: Oct 23, 1978. Publicly Released: Oct 23, 1978.

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A comprehensive review of Ohio's Medicaid program identified two issues that may have national importance: (1) the misleading statistics reported by the Medicaid quality control program which overstate potential savings available from eliminating eligibility determination errors; and (2) the unavailability of skilled nursing services to medicaid patients which results in unnecessary hospital expenditures.

Ohio uses a quality control system developed by the Department of Health, Education, and Welfare (HEW) to help ensure proper and correct expenditures of public assistance funds by identifying unacceptable performance and ineffective policies and taking corrective action. A review of cases found ineligible by Ohio's quality control review showed that determinations were generally correct, but that the procedures HEW requires the states to use do not differentiate between technical and substantive errors. Therefore, true program losses due to ineligibility and potential savings available from eliminating eligibility determination errors are overstated. The availability of skilled nursing facility (SNF) services to Medicaid and Medicare patients in Ohio has been adversely affected because of the state's relatively low limits on SNF reimbursement.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Administrator of the Health Care Financing Administration should: (1) revise Medicaid quality control study procedures to include, in reporting results of these studies, an estimate of potential savings available from elimination of Medicaid eligibility determination errors; (2) assist Ohio in improving its reimbursement system for skilled nursing services in order to increase their availability; and (3) determine if other states' reimbursement systems for SNF's are resulting in problems like those in Ohio and assist any state with these problems in improving their skilled nursing services program.

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