Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.
Reference Number
2024-001 – Delays in Eligibility Determination
Evaluation of Finding
Material Weakness and Noncompliance
Summary of Finding
The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines.
Federal Award Information
Assistance Listing Number: 93.778
Program Title: Medical Assistance Program (Medicaid)
Federal Award Year: 2024
Name of Federal Agency: U.S. Department of Health and Human Services
Criteria
Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement.
Condition
LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy.
Cause of Condition
The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations.
Effect or Potential Effect of Condition
The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants.
Questioned Costs
No questioned costs identified.
Context
The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations.
Repeat Finding
No.
Recommendation
We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future.
Views of Responsible Officials
We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.