Audit 353335

Finding 2022-002 Information on the Federal Program: Medical Assistance Program (Medicaid, Title XIX), ALN # 93.778, Grant Period 1/1/22 – 12/31/22. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only medically needy individuals, or families whose incomes and resources are insufficient to meet the costs of necessary medical services may receive Medicaid to cover the claims supported by medical records. Condition: There were multiple instances where eligibility files selected for review were either incomplete, ineligible for benefits, or unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Compliance Supplement, each individual who receives benefits under the Medicaid program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving Medicaid benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documentation were on file and available for audit review. Management’s Response: Electronic records for all disbursement are created by PCBSS employees on the state Medicaid Portal that records the issuance of benefits and ensure that the information recorded accords with state eligibility regulations. The decision as to whether to maintain paper copies of all pertinent documents is left by regulation to local decision. At 10:90-7.2 the contents of the case file are described in more detail. There is no requirement that hard copies of documents be placed in each case file. Caseworkers are required to note the inspection of case files and in local practice those notes are maintained in the locally operated GUMP system. Medicaid assistance cases are tracked and recorded in the locally operated GUMP system and a permanent record of each is maintained in case files to be Dimmed. Paper records are not required by the Division of Family Development.

Finding 2022-003 Information on the Federal Program: Temporary Assistance for Needy Families (TANF), ALN # 93.558, Grant Period 1/1/22 – 12/31/22. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only a financially needy family that consists of, at a minimum, a minor child living with a parent or other caretaker relative, or a pregnant woman may receive TANF “assistance” or most maintenance-of-effort (MOE)-funded benefits, services, or “assistance” regardless of the TANF purpose that the expenditure is reasonably calculated to accomplish. Condition: There were multiple instances where eligibility files selected for review were either incomplete, ineligible for benefits, or unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Circular Compliance Supplement, each individual who receives benefits under the TANF program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving TANF benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documents were on file and available for audit review. Management’s Response: Electronic records for all disbursement are created by PCBSS employees on the state operated systems commonly referred to as FAMIS and GAAS that record the issuance of benefits and ensure that the information recorded accords with state eligibility regulations. The decision as to whether to maintain paper copies of all pertinent documents is left by regulation to local decision. At 10:90-7.2 the contents of the case file are described in more detail. There is no requirement that hard copies of documents be placed in each case file. Caseworkers are required to note the inspection of case files and in local practice those notes are maintained in the locally operated GUMP system. TANF assistance cases are tracked and recorded in the locally operated GUMP system and a permanent record of each is maintained in case files to be Dimmed. Paper records are not required by the Division of Family Development.

Finding 2022-002 Information on the Federal Program: Medical Assistance Program (Medicaid, Title XIX), ALN # 93.778, Grant Period 1/1/22 – 12/31/22. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only medically needy individuals, or families whose incomes and resources are insufficient to meet the costs of necessary medical services may receive Medicaid to cover the claims supported by medical records. Condition: There were multiple instances where eligibility files selected for review were either incomplete, ineligible for benefits, or unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Compliance Supplement, each individual who receives benefits under the Medicaid program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving Medicaid benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documentation were on file and available for audit review. Management’s Response: Electronic records for all disbursement are created by PCBSS employees on the state Medicaid Portal that records the issuance of benefits and ensure that the information recorded accords with state eligibility regulations. The decision as to whether to maintain paper copies of all pertinent documents is left by regulation to local decision. At 10:90-7.2 the contents of the case file are described in more detail. There is no requirement that hard copies of documents be placed in each case file. Caseworkers are required to note the inspection of case files and in local practice those notes are maintained in the locally operated GUMP system. Medicaid assistance cases are tracked and recorded in the locally operated GUMP system and a permanent record of each is maintained in case files to be Dimmed. Paper records are not required by the Division of Family Development.

Finding 2022-003 Information on the Federal Program: Temporary Assistance for Needy Families (TANF), ALN # 93.558, Grant Period 1/1/22 – 12/31/22. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only a financially needy family that consists of, at a minimum, a minor child living with a parent or other caretaker relative, or a pregnant woman may receive TANF “assistance” or most maintenance-of-effort (MOE)-funded benefits, services, or “assistance” regardless of the TANF purpose that the expenditure is reasonably calculated to accomplish. Condition: There were multiple instances where eligibility files selected for review were either incomplete, ineligible for benefits, or unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Circular Compliance Supplement, each individual who receives benefits under the TANF program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving TANF benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documents were on file and available for audit review. Management’s Response: Electronic records for all disbursement are created by PCBSS employees on the state operated systems commonly referred to as FAMIS and GAAS that record the issuance of benefits and ensure that the information recorded accords with state eligibility regulations. The decision as to whether to maintain paper copies of all pertinent documents is left by regulation to local decision. At 10:90-7.2 the contents of the case file are described in more detail. There is no requirement that hard copies of documents be placed in each case file. Caseworkers are required to note the inspection of case files and in local practice those notes are maintained in the locally operated GUMP system. TANF assistance cases are tracked and recorded in the locally operated GUMP system and a permanent record of each is maintained in case files to be Dimmed. Paper records are not required by the Division of Family Development.