Audit 407527

Federal Agency: U.S Department of Health and Human Services Federal Program Name: Medicaid Cluster Assistance Listing Number: 93.778 State ID: WIMCR & 435.877 Federal Award Identification Number and Year: WIMCR & 877 Pass-Through Agency: Wisconsin Department of Health Services Pass-Through Number(s): WIMCR Award Period: January 1, 2025 – December 31, 2025 Type of Finding: Significant Deficiency in Internal Control over Compliance Criteria or specific requirement: Medical Assistance is partially funded through the Wisconsin Medicaid Cost Reporting (WIMCR) Tool and Children’s Long-Term Support. State single audit guidelines for the WIMCR program state that “each cost report documents costs incurred only by that program with no overlap or double counting” and “cost reports are supported by agency financial records.” The County is required to file an annual reconciliation by March 31st of the subsequent year. Condition: The County files WIMCR annually with the State of Wisconsin. During testing of the 2024 cost reports submitted in 2025, the report was not reviewed prior to submission. In addition during testing, it was noted that there was not review over the annual CLTS reconciliation. Due to the lack of a documented review control, an error in a reported percentage was not identified, resulting in an immaterial overreporting of costs. Questioned costs: None Context: During reporting testing, it was noted that the County does not have review process in place for the WIMCR annual cost report or the CLTS annual reconciliation. Cause: The County does not have a review process to identify errors in WIMCR or CLTS reporting, or to verify that the amount claimed matches supporting documentation. Effect: Reported expenditures may not reconcile to the County’s recorded general ledger expenditures and amounts may be over or under claimed. Repeat finding: No Recommendation: We recommend that there is an appropriate reviewer of the WIMCR cost report and CLTS annual reconciliation. Views of responsible officials: There is no disagreement with the audit finding.