Medicaid exclusion screening requirements in Ohio
What Ohio Medicaid requires of the organizations that take part in it: whether the state keeps its own exclusion list, how often it expects you to check, what the penalties are, and how an action taken in another state reaches you here. Every claim on this page links to the source it came from.
What Exclia screens for this state
Ohio’s own Medicaid exclusion list is rolling out to Exclia. The federal lists (OIG LEIE and SAM.gov) are screened today.
What the state requires
Ohio requires managed care entities to check at least monthly.
Paragraph (C)(1) applies to managed care entities and their employees and contracted providers. It names the federal OIG list, ODM’s provider page and professional discipline resources. This draft does not extend that interval to every Ohio provider.
Why monthly, and where the exposure comes from
The HHS Office of Inspector General publishes the federal exclusion list (the LEIE) monthly, and its guidance to providers is that screening staff and contractors each month is what best limits the risk of overpayment and civil monetary penalty liability. State Medicaid agencies are themselves required to check the LEIE no less frequently than monthly (42 C.F.R. § 455.436(c)(2)), which is the rhythm the lists move on.
The state’s own list
Medicaid Provider Exclusion and Suspension List
Ohio keeps its own Medicaid exclusion list, separate from the federal OIG list. Searching one does not cover the other.
The official rule identifies ODM’s provider web page. The referenced portal returned 404 during verification; Exclia has not obtained its provider artifact or activated this source.
- Published by
- Ohio Department of Medicaid (ODM)
- Refreshed
- Publisher cadence not verified; monthly below concerns managed care checks, per the publishing agency.
What happens if it is not done
Participation actions can affect payment; reinstatement is a separate status.
- Paragraph (E) makes payment unavailable from the effective date of specified licensing actions. Paragraph (L) allows ODM to deny twelve months of claim retroactivity after reinstatement following termination for cause.
The federal exposure behind the state requirement
Where a federal health care program pays for an item or service furnished, ordered, or prescribed by a person on an exclusion list, the OIG can seek repayment of what was paid, civil monetary penalties for each item or service claimed (a statutory $10,000, adjusted annually for inflation), and an assessment of up to three times the amount claimed. The standard is what the organization knew or should have known — which is why the date of your last check is the fact that matters.
How another state’s action reaches you here
Section 6501 of the Affordable Care Act (42 U.S.C. § 1396a(a)(39), implemented at 42 C.F.R. § 455.416(c)) requires a state Medicaid agency to deny or end the enrollment of any provider that was terminated for cause on or after January 1, 2011 under Medicare, or under the Medicaid or CHIP program of any other state, and that appears in the federal termination database. In practice that means an action taken against a provider in one state reaches their participation in every other — so the list that matters to you is not only your own state's.
Common questions
No Ohio activation is claimed. The official list portal returned 404 on October 4, 2026; a complete original artifact remains necessary.
No. The cited managed care rule specifies a screening interval. The publisher’s refresh schedule has not been verified.
Check one name against the federal lists, free
One name, no account, and the result states which sources it covered and which it did not. It is a spot check rather than monitoring — it does not satisfy a monthly requirement on its own.
Run a free checkOr do it for the whole roster, every month
Exclia screens every person and vendor on your roster each month against the sources we cover, and keeps the dated audit trail that shows you did it.
See pricingEvery published state in one printable table, with the source for each row and a publication date you can check. Get the state-by-state requirements table
This states what each state publishes and links to where it says it. It is not legal advice, and where your own obligations are unclear your counsel is the right reader of these sources.