93.767 Children's Health Insurance Program (CHIP)
93.778 Medical Assistance Program (Medicaid; Title XIX)
Eligibility
2023-024 Strengthen Controls to Ensure Compliance with Eligibility Requirements of the
Children's Health Insurance Program (CHIP) and the Medical Assistance Program
DOM Response:
Use...
93.767 Children's Health Insurance Program (CHIP)
93.778 Medical Assistance Program (Medicaid; Title XIX)
Eligibility
2023-024 Strengthen Controls to Ensure Compliance with Eligibility Requirements of the
Children's Health Insurance Program (CHIP) and the Medical Assistance Program
DOM Response:
Use of Tax Return Resources
Seven MAGI beneficiaries - DOM did not verify self-employment income reported on tax
return
DOM Does Not Concur. OSA compared eligibility data to state income tax returns.
DOM is prohibited from accessing state income tax records per Mississippi Code Annotated
§27-3-73 and currently, is not allowed to have access to federal income tax records. DOM
maintains that for determining eligibility, it has complied with the CMS-approved state plan.
Using the approved CMS MAGI Based Verification plan in effect during the audit time period,
the state sought to verify the reported income to the standard of reasonable compatibility, as
defined by CMS, through all available electronic data sources.
Further, DOM is required to accept the information provided by the applicant and utilize the
available verification methods as detailed in the CMS-approved state plan to evaluate the
accuracy of the information provided. If an applicant does not report self-employment income,
and the tools available to DOM do not reveal such, DOM has performed its due diligence in the
eligibility process and complied with the requirements of CMS, DOM's federal regulatory and
oversight agency. Additionally, tax return information is outdated and not deemed applicable to
DOM.
Four of the 180 MAGI beneficiaries - Income was not verified through Mississippi
Department of Employment Security
DOM Concurs. This oversight was reviewed with the employees. Additionally, DOM
Eligibility staff will be reminded of the MOES response time to ensure that when a MOES request is
generated the adequate response time is waited prior to processing an application.
Two of the 300 beneficiaries - The beneficiary's case file did not contain a completed
application.
DOM Concurs. This file could not be located. One of the 300 beneficiaries - DOM could not provide a case file.
DOM Concurs. This file could not be located.
Fifteen ABD beneficiaries - Resources were not verified through A VS at the time of
redetermination.
DOM Concurs. This was a previous finding that DOM concurred with. In June 2022,
the eligibility system change request list was updated to include asset checks within the system
processing workflow to eliminate the manual request process and facilitate asset verification
through A VS. This process was implemented June of 2022 for redetermination contacts.
Application contacts are a manual process. DOM did not perform resource verification through
A VS for the beneficiaries in question prior to this implementation. However, after being notified
DOM ran A VS for all applicants, which resulted in no change in the eligibility determination.
One hundred ninety-five beneficiaries were not included on all of the required quarterly
Public Assistance Reporting Information System (PARIS) me transmissions for fiscal year
2023. Of the 195 beneficiaries, one beneficiary was not included on any quarterly PARIS
me transmissions during fiscal year 2023.
DOM Does not Concur. PARIS jobs run on February 1, May 1, August 1, and
November 1. PARIS will not be pulled on a beneficiary if the case is closed at the time the file is
generated or if there is no SSN on file. Additionally, while the records are sent, not all the cases
return a match. Our vendor confirmed that a PARIS request was sent for the open cases with
SSN numbers on file with one exception. One case was in COE 29-Family Planning. The
omission was identified in a previous audit and was corrected in late 2023.
DOM Corrective Action Plan:
a. All issues identified will be reviewed with regional office staff. Examples of these issues
will be included in annual training sessions performed by Eligibility staff. Further, DOM
is implementing an electronic storage system to house all documents associated with
applicants/beneficiary files.
b. Cindy Bradshaw
c. December 31, 2024