States Failing to Verify Medicaid Eligibility, Leading to Potential Fraud and Waste

A recent investigation by Ohio state Rep. Mike Dovilla reveals significant gaps in how states verify Medicaid eligibility, raising concerns about fraud and waste. Dovilla’s inquiry into Ohio’s Medicaid program found that Lexis-Nexis, a contractor tasked with eligibility checks, reviewed only 56% of traditional Medicaid recipients in 2023. Of those tested, nearly 29% exceeded asset limits, with some reporting assets over $1 million.
The Ohio Department of Medicaid’s response to Dovilla was unhelpful, deflecting responsibility to county caseworkers and offering little transparency on how ineligible individuals are identified or removed from the program. The state’s reluctance to address these issues highlights a broader problem: states have little incentive to enforce program integrity, as federal funding covers most Medicaid costs.
Dovilla estimates that 20% of Medicaid enrollees nationwide may exceed income and asset limits, potentially wasting billions annually. This underscores the need for congressional reform. The House-passed reconciliation bill links state payments to food stamp fraud rates, a model that could be applied to Medicaid. If states were held financially accountable for improper payments, they might prioritize eligibility verification and fraud prevention.
The investigation demonstrates the urgent need for federal action to ensure Medicaid dollars are spent responsibly and equitably.

Published: 6/4/2025