Summary: 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.
