Ohio’s Medicaid books are in such rough shape that state auditors say as much as $4 billion in spending may be tied to people who should not have been getting benefits, including some who had already died.
The warning comes in the State of Ohio Single Audit for fiscal year 2025, where questioned Medicaid costs are flagged as potentially reaching $4 billion if test results are projected across the full program. Auditors say about 15.6% of sampled participants may be ineligible, linking those concerns to messy eligibility records, duplicate enrollments and services billed after death, and recommending tougher data matching and follow up. As posted by the Ohio Auditor of State, the review is part of the state’s annual Single Audit of federally funded programs.
“What we found is a continuing problem in the Medicaid system where the state is not actively cleaning up it’s books and records,” Auditor Keith Faber told WTOV9. He said even small eligibility errors translate into losses for taxpayers and warned that the sampling gap could grow into billions of dollars if it is not addressed. Faber added that auditors expect the Department of Medicaid to put corrective action plans on paper and go after recoveries where appropriate.
Audit findings in plain terms
The audit takes aim at capitation and claims paid for deceased enrollees, weak or inconsistent cross matches with death and out of state records, and gaps in eligibility verification at both state and county levels. Recommendations include improving automated data matches, tightening how caseworkers respond to system alerts and errors, and pursuing recovery of improper payments. As outlined by the Ohio Auditor of State, the office is also pressing the Department of Medicaid for clearer timelines on when those fixes will be in place.
Why it matters locally
Medicaid covers roughly 2.9 million people in Ohio, so even a modest error rate can ripple into huge dollar figures for the state budget and for payments to managed care plans and local hospitals, clinics and doctors. When eligibility records are not cleaned up, county job and family services offices and local health systems are often the first to feel the strain, from back office headaches to delayed corrections in the field. Data from the Commonwealth Fund highlight how large the program looms in Ohio’s health care landscape, which helps explain why auditors are sounding the alarm.
Legal and budget implications
The problems flagged in this latest report are not new. Previous audits have turned up millions in improper Medicaid payments, including capitation and claims tied to prisoners and deceased people, then recommended that the money be clawed back. Coverage of those earlier findings by the Dayton Daily News shows how long eligibility cleanup has been an issue. Typically the auditor calls for repayment, while the Department of Medicaid and, if needed, the Ohio Attorney General decide whether to seek money from providers or managed care organizations…