State of Missouri Single Audit Corrective Action Plan Year Ended June 30, 2024 State Agency: Department of Social Services (DSS) – MO HealthNet Division (MHD) and Family Support Division (FSD) Audit Finding Number: 2024-002 - Medicaid and CHIP Participant Eligibility Terminations Name of the contact...
State of Missouri Single Audit Corrective Action Plan Year Ended June 30, 2024 State Agency: Department of Social Services (DSS) – MO HealthNet Division (MHD) and Family Support Division (FSD) Audit Finding Number: 2024-002 - Medicaid and CHIP Participant Eligibility Terminations Name of the contact person responsible for corrective action: Stacy Kaylor Anticipated completion date for corrective action: September 1, 2025 Recommendation: The DSS through the MHD and the FSD continue to review, strengthen, and enforce internal controls to ensure ineligible participant cases are closed when necessary and resume the DHSS vital records death match in the MEDES. DSS Response: The DSS partially agrees with this finding. DSS has controls in place to close coverage when a customer requests closure; however, the procedures were not followed. During the audit period, the FSD Call Center had processes in place to accept calls for applications, renewals, change in circumstance, enter evidence and inquiries. However, contracted staff are unable to authorize any action that results in a case closing and that authorization must be completed by a DSS employee. There were procedures in place for contracted staff to submit a form that will create a task for DSS staff to finalize the actions. For the case cited in the finding, the task was not created, resulting in DSS staff not receiving the request to voluntarily close the case. Although call center staff noted in the electronic case file the purpose of the call, there are not systematic controls in place to take action or create tasks for DSS employees from the case notes. Currently, a death match with Department of Health and Senior Services (DHSS) vital records is functional in the Family Assistance Management Information System (FAMIS) eligibility system currently used for Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and MO HealthNet for Aged, Blind, and Disabled (MHABD) individuals. When the match is received into FAMIS from DHSS, that information is included on the eligibility file submitted to the Medicaid Management Information System (MMIS) to ensure that the death date is captured in MMIS to prohibit any payments after the death of the individual. This control ensures that no improper payments are made on a beneficiary’s behalf after the date of death. DSS has processes in place to close eligibility when death information is received from family members and providers during the certification period. Additionally, in compliance with 42 CFR 435.949, DSS administers an electronic verification match with the federal hub at application and during the annual review process to inquire about death. DSS is continuing to evaluate necessary steps to reinstate the death match with DHSS vital records, but do not have an anticipated completion date. Regarding the questioned costs, eligibility errors are governed by section 1903(u) of the Social Security Act. Therefore, questioned costs identified in the single statewide audit should not be subject to recoupment. Corrective action planned is as follows: DSS is strengthening controls by revising the procedures of the contracted FSD Call Center to ensure case actions are completed timely. DSS will use a system action to close cases with out of state address evidence in the Missouri Eligibility and Enrollment System (MEDES).