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HRD-78-98 1 (1978-10-23)

handle is hein.gao/gaobaaydi0001 and id is 1 raw text is: DOCUMENT RESUBE 07424 - [C29780623 Improved administration Could Reduce the Costs of Ohio's Medicaid Program. HRD-78-98; B-164031(3). October 23, 1978. 146 pp. + appendix (3 pp.). Report to Governor, Ohio; Speaker of the House, Ohio: House of Representatives; President, Ohio: Senate- by PImer B. Staats, Comptroller General. Issue Area: Health Programs: Compliance With Financing Laws and Regulat .as (1207). Contact: Henan Resources Div. Budget Function: Health: General Health Financing Assistance (555). A Orqanization Concerned: Department of Health, Education, and Welfare: Social Security Administration. Congressional Relevance: House Committee on Interstate and Foreign Commerce; Senate Committee on Finance. Authority: Social Security Act, as amended, title ZIX; Social Security Amendments of 1965 (P.L. 89-87). Social Security Amendments of 1972 (P.L. 92-603). Social Security Aendpints of 1967. P.L. 95-142. Ohio began its medicail pro4ra on July 1, 1966. During 1967, the State spent $50.6 million to provide medical servicer to a monthly average of about 300,000 eligible individuals. In its 11-year existence, Ohio's medicaid program costs increased tenfold, and the number of eligibles increesed 143%. Over the same period, medicaid costs increased about 1,500% nationwide. Findings/Conclusions: Ohio has limiteO many of its beaefits in efforts to contain the large yearly increases in medicaid costs, but these limitations have not always resulted in sufficient !-1vings to balance medicaid Ludgets. The State has occasionally t..ied to temporarily cut medicaid benefits and reimbursement rates for providers; these efforts have been only partially successful. Ohio used incorrect eligibility criteria and procedures which resulted in about 26,000 ineligibles receiving medicaid, and many who should have been eligible were denied benefits. Reports which were used to set nursing home payment rates included unallowable costs which inflated payments to nursing homes. While the State was overpaying nursing &omes for services they provided, Ohio's ceilings on nursing home payments were inadenate for the costs incurre4 by patients neping skilled nursing. Because of a lack of controls, Ohio paid some providers ia excess of the amounts allowed for Federal sharing. Recommendations: The State of Ohio should revise its mediceid eligibility requirements and deterninatioit procedures to comply with Federal regulations. It should: assess the usefulness of nedicaid eligibility requirements for allowable personal resources, strengthen the control procedures developed to ensure correction of errors, and examine the administration of nedicaid and other welfare programs by county welfare departments. The

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