The Ohio House Medicaid Committee this week examined concerns surrounding “waste, fraud and abuse” within Ohio Medicaid, with significant attention focused on home- and community-based services (HCBS), provider oversight, and managed care accountability. During invited testimony, Niklas Kleinworth, State Health Reform Director with Paragon Health Institute, argued that gaps in oversight, verification, and reimbursement structures have contributed to vulnerabilities within Medicaid-funded services both nationally and in Ohio.
Discussion centered heavily on HCBS programs, including personal care, transportation, and other community-based supports. Testimony raised concerns about electronic visit verification systems, provider enrollment practices, managed care organization transparency, and reimbursement rates tied to certain Medicaid services. Lawmakers also discussed proposals aimed at increasing oversight, including additional eligibility verification requirements, reassessment standards, auditing practices, and stronger tracking mechanisms for service delivery.
Several committee members pushed back on portions of the testimony, noting the importance of distinguishing between intentional fraud and operational realities facing providers and families. Rep. Crystal Lett specifically raised concerns about workforce shortages and the role family caregivers often play in helping individuals remain safely in community settings. Other lawmakers questioned how proposed reforms could affect Medicaid recipients and whether additional restrictions could unintentionally reduce access to needed supports.
The hearing also included discussion around Ohio’s Medicaid spending growth, the role of managed care organizations in overseeing services, and the effectiveness of the state’s current electronic visit verification system. The committee later heard testimony from members of the Ohio Occupational Therapy Association, who emphasized the role occupational therapy services play in helping Medicaid recipients maintain independence and improve quality of life.
A recording of the committee hearing can be found here. Paragon’s presentation slides can be found here.