10/22/2026

Audit Finds Planning and Oversight Gaps in Ohio Medicaid

A new performance audit of the Ohio Department of Medicaid (ODM) identified shortcomings in strategic planning, program evaluation, transparency and coordination with other state agencies.

The audit, conducted by Auditor of State Keith Faber’s office at the direction of lawmakers through House Bill 96, examined Ohio’s Next Generation Medicaid managed care system, which launched in early 2023 following delays and litigation.

Auditors concluded that ODM often focuses on meeting minimum state and federal requirements rather than evaluating program outcomes and identifying opportunities for improvement.

“Overall, we found that the department operates on a culture of compliance, rather than one that is concerned with improving and optimizing program outcomes,” the report states.

As an example, auditors noted that ODM reviews a sample of 800 Medicaid eligibility determinations every three years. In 2025, Ohio processed approximately 850,000 Medicaid applications, meaning the review covered less than 1% of applications processed in a given year.

The report also questioned whether some ODM staff identified as subject matter experts had sufficient knowledge of the programs they oversaw, particularly regarding evaluation and outcome measurement.

Auditors criticized ODM’s process for responding to information requests, reporting that an internal coordination group sometimes delayed access to information and made follow-up questions more difficult.

The audit makes nine recommendations, including:

• Aligning strategic plans and program evaluations with operational strategies.
• Improving transparency in enrollment and financial forecasting.
• Strengthening vendor contract management and tracking of claims payment timeliness.
• Coordinating eligibility policies with the Ohio Department of Job and Family Services and the Department of Children and Youth.
• Addressing more than 20 recurring functionality issues with Ohio Benefits, the state’s public-benefit eligibility and enrollment system.
• Improving data collection on application-processing delays.
• Expanding quality-control reviews of eligibility determinations.
• Developing a department-wide stakeholder engagement plan.

The report also flagged passive, or ex parte, eligibility renewals for further review. Some county job and family services agencies told auditors that individuals they believed were no longer eligible had been automatically renewed, potentially resulting in Medicaid managed care payments for ineligible individuals.

Faber’s office said the findings warrant attention from the gubernatorial administration taking office in 2027, particularly because some improvements require coordination among multiple agencies.

“We've sounded the alarm about Medicaid for the past eight years, and our calls for action have not been adequately addressed,” Faber said in a statement accompanying the report. “There's too much at stake for the Ohioans who rely on these services for ODM to continue business as usual.”

The audit’s recommendations focus on strengthening program oversight, improving eligibility processes and increasing accountability across state agencies.

Find the full Auditor of State report here.