A state audit found $145 million in contract overruns and no strategic plan at the Ohio Department of Medicaid. State Rep. Jennifer Gross, a West Chester Republican who chairs the House Medicaid Committee, is calling for tighter controls on the $40 billion program.
The Ohio Auditor of State's performance audit, released Oct. 15, examined ODM's Next Generation initiative, a multi-year project to modernize the agency's systems. Auditors found nonexistent strategic and operational plans, inconsistent contract management and minimal program evaluation.
The agency had no strategic plan.
Auditors described what they called "a culture of compliance" focused on meeting minimum federal guidelines rather than improving outcomes. In a sample of contracts reviewed, auditors found discrepancies between planned and actual costs totaling more than $145 million in unplanned expenses.
Gross said in a statement that the audit "confirms what we have been saying for years: Ohio's Medicaid program is too big, too expensive, and too poorly managed."
"Medicaid consumes nearly half of our state operating budget, more than $40 billion a year, yet the Department operates without basic strategic plans … and with contract overruns exceeding $145 million in just the sample reviewed," Gross said. "That is unacceptable."
The audit was required by House Bill 96, the biennial state budget. Auditors also found that ODM staff identified as subject matter experts "were unable to answer questions about programs," and that divisions within the department had "institutional knowledge gaps, functional silos, and information retention issues."
On eligibility oversight, auditors flagged that ODM reviews just 800 cases out of roughly 850,000 processed applications every three years. The audit stated that "limited and inconsistent data obtained through current quality control efforts cannot be used to confirm the accuracy or effectiveness of" county Job and Family Services operations statewide.
Auditor of State Keith Faber said his office has "sounded the alarm about Medicaid for the past eight years, and our calls for action have not been adequately addressed."
An Ohio Medicaid spokesperson told the Dayton Daily News the department takes the findings "seriously" and has "undergone significant transformation" in recent years.
The Oct. 15 audit is the latest in a series of Medicaid reviews. In a Sept. 23 statement responding to a separate auditor review of the Aged, Blind and Disabled benefits program, Gross said benefits flowing to ineligible and deceased recipients take help away from those still waiting.
Gross said she plans to push for stronger eligibility verification, tighter vendor accountability and performance metrics focused on outcomes. The Ohio House passed the Medicaid Program Integrity and Fraud Prevention Act in June, a package Gross co-sponsored that targets fraud, waste and abuse in the program.
Gross noted that a new state administration taking office in 2027 presents an opportunity to implement the auditor's nine recommendations.
