Audit 396191

Program: Medicaid Cluster - Grants to States for Medicaid, Medicaid Cluster - In-Home Supportive Services (IHSS)) Federal Financial Assistance Listing No.: 93.778 Federal Agency: U.S. Department of Health and Human Services Passed-through: California Department of Health Care Services Award Number and Year: 2305CA5MAP, 2505CA5MAP, 1946001347 A7, 2024/2025 Compliance Requirement: Eligibility Type of Finding: Material Instance of Noncompliance and Material Weakness in Internal Control over Compliance Criteria: Per the 2025 OMB Compliance Supplement, agencies are required to maintain documentation to support the agency’s eligibility determination, and to redetermine eligibility at least every 12 months to determine if individuals continue to be eligible in accordance with the compliance requirements of the program. In addition, the State of California Department of Social Services (CDSS) regulations also state that County’s social services staff are to have a face-to-face contact at least once every 12 months, except as provided in MPP section 30-761.215 through 30-761.217, to adequately determine that the recipient continues to reside safely in their home with the IHSS services provided (MPP Section 30-761.13). Condition: Medicaid Cluster – Grants to States for Medicaid • Of the 60 case files sampled, we noted 1 (one) case where the recipient eligibility redetermination was not performed timely and exceeded the 12-month requirement. Medicaid Cluster – In-Home Supportive Services (IHSS) • Of the 60 case files sampled, we noted 23 (twenty-three) cases where the recipient eligibility redetermination was not performed timely and exceeded the 12-month requirement. • 1 case in which the redetermination form was missing the appropriate signatures. Cause: The County’s policies and procedures did not ensure that timely redeterminations are performed for all program recipients. Effect: The lack of performance of timely eligibility redetermination and by not retaining supporting documentation for applications could result in ineligible individuals receiving benefits and increase the risk of noncompliance with the program. Questioned Costs: None reported. Context/Sampling: A nonstatistical sample of 60 in-home supportive services case files were selected out of 6,960 case files. A nonstatistical sample of 60 medical assistance case files were selected out of 157,262 case files. Repeat Finding from Prior Year(s): Yes. See prior year finding 2024-005. Recommendation: We recommend that County implement policies and procedures to ensure eligibility redeterminations are performed on a timely basis and that proper documentation is maintained in case files. Views of Responsible Officials: Management agrees with the finding. See separate corrective action plan.