An Ohio lawmaker says his investigation into the state’s Medicaid program found failures in verifying enrollee eligibility, potentially resulting in over $6 billion in wasteful taxpayer spending.
Ohio State Rep. Mike Dovilla (R-Berea), who launched a probe into Ohio’s Medicaid system last month, contacted LexisNexis Risk Solutions, a firm that verifies Medicaid eligibility in Ohio, requesting 2023 data to see if Ohio had been enrolling ineligible Medicaid recipients.
LexisNexis analyzed 371,418 Medicaid beneficiaries in the Aged, Blind, and Disabled (ABD) category (which accounts for 56 percent of that category’s enrollees), finding that 29 percent (106,549 recipients) had assets above $2,000, according to documents obtained by The Ohio Press Network.
Importantly: the Ohio Department of Medicaid (ODM) stipulates that Medicaid recipients cannot have more than $2,000 in liquid assets.
Even more shocking: over 4,000 Ohio Medicaid beneficiaries were found to be holding $100,000 to $999,999 in assets, while 12 recipients had assets over $1 million, LexisNexis reported to Dovilla.
In 2023, Ohio’s Medicaid program notably skyrocketed to over 3.5 million, with an estimated associated cost being $31.85 billion, of which approximately 69 percent is derivied from federal funding, while 31 percent is directly subsidized by Ohio taxpayers.
LexisNexis reportedly informed Dovilla that taxpayers would save $2.555 billion — including $773 million from the state budget — if the ineligible beneficiaries the company found so far were to be removed from Ohio’s Medicaid rolls.
Notably, removing ineligible enrollees from the Ohio Medicaid rolls would not require passing new legislation, it would simply mean enforcing an ODM rule that already exists.
Dovilla contacted ODM and informed the agency of his findings, asking how it handled the 106,549 cases flagged by LexisNexis, among other inquiries.
ODM failed in providing appropriate responses and gave insufficient answers to Dovilla’s questions about how the agency uses third-party vendors and the U.S. Social Security Administration (SSA) to audit Medicaid rolls, the State Rep. said.
Moreover, ODM seemingly admitted that it does not follow-up on flagged cases, as the agency argued that LexisNexis does not determine ineligibility, it only identifies assets.
Meanwhile, the SSA — which covers an abundance of Medicaid beneficiaries — only audits 18 percent of its recipients nationwide, a person familiar with LexisNexis’s asset verification tool told Dovilla.
This suggests a major audit gap, given that “without line-by-line insight into vendor and SSA data, ODM’s oversight is effectively blind,” Ohio Press Network noted.
After that, Dovilla reportedly questioned ODM Assistant Deputy Legislative Director Eric Vinyard, but did not receive any direct answers.
The State Rep. told Ohio Press Network that Vinyard replied, “We have no idea” after he was asked if the more than 300,000 Ohio residents who fell off the rolls in 2023 were ruled ineligible due to a job, family support, death, or other reasons.
The next day, Dovilla sent a second letter to ODM requesting a breakdown of 2023 dis-enrollments by reason, the exact number of Medicaid beneficiaries whose assets were not verified, and what ODM or county caseworkers did with the flagged recipients, among other inquires.
In response to a question from Dovilla asking if the agency or county caseworkers “investigated each flagged case, reclassified flagged assets as exempt,” or “disenrolled any individuals,” ODM replied that the “sole function” of LexisNexis’ verification tool “is to identify the existence of assets, not to ‘test’ them.”
“Moreover, this test does not mean any individual flagged was ineligible for the program,” the agency continued in its letter, obtained by Breitbart News.
“The way the process works is every individual flagged with assets has their case sent to a county caseworker to manually examine and make a final eligibility determination,” ODM added. “During CY23, 6,023 individuals were disenrolled from Medicaid for having more assets than permissible.”
Shannon Burns, Senior Advisor at Patient First Coalition, told Breitbart News that the amount of ineligible Medicaid beneficiaries ODM says it removed is insufficient and “sharply contrasts with the 29 percent failure rate documented by LexisNexis Risk Solutions.”
“It’s important to point out that while they provide an unnecessarily verbose and confusing response, they seem to lack an understanding of what their vendor truly offers,” Burns said.
“LexisNexis Risk Solutions reports on ABD Medicaid qualification solely based on liquid assets in U.S. accounts,” Burns continued. “Non-liquid assets such as primary or secondary residences, vehicles, and stocks — which could also disqualify a recipient — are not included in this failure rate.”
“Therefore, this leads us to believe that the actual failure rate is likely higher,” Burns warned, adding that ODM should have, at the very least, removed the 29 percent of Medicaid recipients that LexisNexis said to be holding assets over the stated limit.
“But they chose to remove only 0.08 percent, resulting in significantly more than $6.3 billion in improper payments in CY2023,” Burns said.
Dovilla told Breitbart News, “We can immediately secure our Medicaid safety net for those who truly need it by simply kicking millionaires off the rolls. It’s that straightforward — and it’s time to follow President Trump’s lead and put hardworking Ohio taxpayers first.”
The shocking indications of Dovilla’s findings may prompt lawmakers in other states to investigate their own potential Medicaid waste, fraud, and abuse, as one can safely surmise that similar scenarios are likely transpiring nationally.
Verifying enrollee income and assets is crucial in proving Medicaid integrity and ensuring that only those eligible receive the program’s benefits.
As Breitbart News reported, President Donald Trump’s “big beautiful bill” seeks to root out waste, fraud, and abuse in Medicaid by increasing verification checks to twice per year, among other cost-saving efforts.
One study found that Medicaid has doled out a staggering $1.1 trillion in improper payments over the last decade.
Polls, meanwhile, show that an overwhelming majority of Americans support eliminating Medicaid waste, fraud, and abuse.
Alana Mastrangelo is a reporter for Breitbart News. You can follow her on Facebook and X at @ARmastrangelo, and on Instagram.
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