Senate Medicaid Committee favors reporting Scott Partika to Rules and Reference after questioning on eligibility and fraud controls

Scott Partika, the governor’s appointee to serve as director of the Department of Medicaid, told the Senate Medicaid Committee that he is seeking confirmation and intends to focus on fiscal prudence and program integrity during his remaining year in the administration.

“My name is Scott Partika,” he said in opening remarks, tracing his career from a page in the senate to staff roles in legislative offices and work in managed care before joining the DeWine administration as a health policy adviser.

Partika highlighted two policy areas that shaped his approach: targeted rate increases intended to raise wages for direct-care workers after a statewide workforce report, and a 2018 joint oversight review of pharmacy benefit managers that led to legislative direction in 2019 toward a single pharmacy benefit manager. He said the pharmacy changes have yielded lower administrative expenses for the program.

Partika said the department is running “about 60 different project work streams” to review eligibility processes, program rules and controls to identify opportunities to reduce fraud, waste and abuse. He described those reviews as potential rule, practice or legislative changes that could be brought back to lawmakers.

Senator Huffman questioned Partika about a recent report on presumptive eligibility that, the senator said, showed an error rate decline from about 40% in 2019 to roughly 20% in the new report and asked how the department will reach a federal benchmark of 7.5% and whether improperly paid funds can be recovered. Partika said presumptive eligibility is one of the department’s active work streams and that corrective action plans and tools for hospitals and other qualified entities are being considered. He also warned the committee about limits imposed by federal law on the department’s ability to require verification during presumptive eligibility determinations.

Senator Ingram asked how often people who should have been eligible are denied and whether the department later recovers funds in those circumstances. Partika said denials, where made, are generally appropriate, but incomplete paperwork and missed annual redeterminations contribute to churn: he cited an internal data point that about 10% of people who fall off the rolls later return.

When asked by the chair what concrete measures he would pursue in the next 10 months to demonstrate fiscal prudence, Partika said the department is tightening forecasting and closely reviewing case-load and expenditure projections. He said adjustments to ex parte processing that require more complete applications have contributed to a downward trend in caseload projections and that the department is examining administrative contracts and rate structures where savings may be available.

During his remarks Partika referenced a prior review that, in his words, found “more administrative costs than I think most folks would have expected,” and the transcript renders the figure he cited in that moment as “$6.07, $89 per prescription;” the committee packet and official report should be consulted for the precise number.

After the questioning, Senator Huffman moved that the committee favorably report the governor’s appointment of Scott Partika to the Senate Committee on Rules and Reference. The clerk took the roll and the motion received a majority to report the nomination favorably.

The committee thanked Partika, reminded him to sign the roll and adjourned. The nomination will move to the Rules and Reference Committee for further action.