Reviews of Medicaid spending across the nation indicate billions of dollars are being wasted on individuals who do not qualify for the welfare program, echoing similar findings in Oklahoma during a 2020 review.

In Ohio, a review launched by state Rep. Mike Dovilla, a Republican, identified a “troubling abdication of oversight” in Ohio’s Medicaid system following a legislative inquiry that revealed billions in potentially improper benefit payments. Preliminary findings suggest the state of Ohio may be disbursing more than $6 billion annually to ineligible recipients.

“These findings raise serious questions about the integrity of a program intended to serve the truly vulnerable,” Dovilla said in a release. “Taxpayers deserve to know if their hard-earned dollars are being spent responsibly—and right now, that answer is far from clear.”

The Ohio investigation, launched in April, began with Dovilla contacting LexisNexis Risk Solutions and other vendors tasked with verifying Medicaid eligibility. LexisNexis reported that among 371,418 individuals in the Aged, Blind, and Disabled (ABD) category in Ohio’s Medicaid program, 29 percent—over 106,000 people—held assets above the program’s income limit. Some individuals had assets exceeding $1 million.

A review in Arizona raised similar concerns.

Arizona Senate Majority Leader Janae Shamp, House Majority Leader Michael Carbone, and other Republican lawmakers released a report showing that 130,000 of 388,000 state residents who applied for Medicaid last year were not verified, suggesting up to $6 billion a year in Medicaid fraud.

The report showed that only 24 percent of Arizonans who applied for Medicaid were properly vetted, and of those who were vetted properly, 34 percent should not have been accepted into the program but received Medicaid benefits anyway.

A recent report from the Foundation for Government Accountability (FGA) concluded that waste, fraud, and abuse are “rampant” in the Medicaid program, and that the program is on track to surpass $2 trillion in improper payments nationwide over the next decade.

The FGA found that more frequent Medicaid eligibility determinations would save federal taxpayers $282 billion.

“Since the passage of ObamaCare, the Medicaid rolls have been flooded with able-bodied adults,” the FGA stated. “In total, nearly 85 percent of the enrollment increase over the last 10 years is directly attributable to able-bodied adults.

“As the Medicaid program has grown, so have the issues stemming from waste, fraud, and abuse,” the FGA continued. “Taxpayers are footing the bill for tens of billions of dollars annually in improper payments alone, the vast majority of which are due to eligibility errors.”

The FGA noted that when a four-state review was performed by the Office of the Inspector General, auditors estimated that roughly one-third of the four states’ combined 17.5 million Medicaid enrollees were ineligible or potentially ineligible.

Improper Payments in Oklahoma

Similar problems were identified in Oklahoma several years ago.

In 2020, a state audit showed that $845 million in taxpayer-funded Medicaid payments had been made in a single year by the Oklahoma Health Care Authority (OHCA) to cover treatment for potentially ineligible recipients.

“OHCA made payments on behalf of Medicaid recipients who did not meet, or may not have met, federal and state eligibility requirements,” the audit stated.

Auditors found that payments were provided to cover individuals in Oklahoma whose income-eligibility was never checked or whose income-eligibility was not verified as often as required to account for changes in earnings over time.

The state audit of the Oklahoma Health Care Authority, which was conducted at the request of Gov. Kevin Stitt, reviewed claims from a single year—those paid from July 1, 2018, through June 30, 2019.

Notably, the Oklahoma audit was conducted prior to Medicaid expansion in Oklahoma, which has added thousands of able-bodied, working-age adults to the program, a group more commonly associated with improper payments.