Corrective Action Plans

Finding 1191091 (2025-725)

Material Weakness 2025

State of Connecticut Drinking Water Fund - State Revolving Fund

CT

HUD Housing Programs § 200.303

Recommendation: The Department of Housing should strengthen internal controls to ensure that it properly calculates Section 8 Housing Choice Vouchers and Mainstream Vouchers housing assistance and utility benefit payments. Corrective Action Plan as Reported by the Department of Housing: We agree wit...

Recommendation: The Department of Housing should strengthen internal controls to ensure that it properly calculates Section 8 Housing Choice Vouchers and Mainstream Vouchers housing assistance and utility benefit payments. Corrective Action Plan as Reported by the Department of Housing: We agree with the finding. DOH did contract with a third-party entity to provide these services; however, DOH retains overall responsibility for the program. Recently, DOH established a Section 8 division within DOH to provide more oversight over the program and the contactor. We are working closely with the contractor to strengthen their internal control, develop policies and procedures. DOH will continue collaborating with the contractor to enhance system controls and minimize the risk of future issues. All identified errors in this finding have been corrected including the questionable cost, and the software now includes a new feature designed to prevent similar problems going forward. DOH remains committed to continuous improvement and effective oversight of the program and contractor. Anticipated Completion Date: April 30, 2026 Department of Housing Contact Person: Melvin Castillo, Asst. Chief Fiscal Admin. Services Natasha Khemraj, Accounting Program Manager (860) 899-6585

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Finding 1191090 (2025-350)

Material Weakness 2025

State of Connecticut Drinking Water Fund - State Revolving Fund

CT

Reporting Subrecipient Monitoring Matching / Level of Effort / Earmarking § 200.303

Recommendation: The Department of Emergency Services and Public Protection should strengthen internal controls and promptly report subawards in compliance with the Federal Funding Accountability and Transparency Act. Corrective Action Plan as Reported by the Department of Emergency Services and Publ...

Recommendation: The Department of Emergency Services and Public Protection should strengthen internal controls and promptly report subawards in compliance with the Federal Funding Accountability and Transparency Act. Corrective Action Plan as Reported by the Department of Emergency Services and Public Protection: DESPP does not agree with this finding. DESPP utilizes the federally designated FFATA reporting system (SAM.gov) for all FFATA reporting. This system does not possess the capability for any layered review or approval of information prior to upload or post submission. The system has no reporting mechanism to review information input into this system. Further, the system does not maintain capability to track the dates of changes and it records over upload dates at future submission timeframes. These issues have been repeatedly brought to the attention of both SAM.gov administrators at the federal level and DESPP’s FEMA funding agencies. In response to a similar finding by FEMA, DESPP provided the attached information, after which FEMA closed the DESPP finding. DESPP will continue to attempt to work with SAM.gov administrators to advocate for modifications to the FFATA reporting system to address these concerns, but is unable to address them unilaterally without federal agency intervention. Anticipated Completion Date: N/A Department of Emergency Services and Public Protection Contact Person: Kathleen Duffy, Fiscal Administrative Manager 2 kathleen.duffy@ct.gov Dana Conover, Emergency Management Program Supervisor dana.conover@ct.gov (860) 883-3904

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Finding 1191087 (2025-200)

Material Weakness 2025

State of Connecticut Drinking Water Fund - State Revolving Fund

CT

Cash Management Internal Control / Segregation of Duties Questioned Costs § 200.303

Recommendation: The Department of Public Health should strengthen internal controls over cash management to ensure that federal drawdowns align with the immediate cash needs to administer the program. Corrective Action Plan as Reported by the Department of Public Health: Management Assurance and Fis...

Recommendation: The Department of Public Health should strengthen internal controls over cash management to ensure that federal drawdowns align with the immediate cash needs to administer the program. Corrective Action Plan as Reported by the Department of Public Health: Management Assurance and Fiscal have worked together to identify gaps and inefficiencies in the drawdown tool. Management Assurance will periodically evaluate the drawdown tool’s usefulness and effectiveness as a cash management internal control. Fiscal will continue to monitor grant draws through the use of the improved drawdown tool. Anticipated Completion Date: Ongoing Department of Public Health Contact Person: Chuma Amechi, Fiscal Administrative Manager chukwuma.amechi@ct.gov (860) 509-7233 Ryan Wenzel, Supervising Accounts Examiner ryan.wenzel@ct.gov (860) 509-7822

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Finding 1191086 (2025-026)

Material Weakness 2025

State of Connecticut Drinking Water Fund - State Revolving Fund

CT

Questioned Costs Subrecipient Monitoring Reporting § 200.301 § 200.303 § 200.334

Recommendation: The Department of Social Services should strengthen internal controls over performance and special reporting for the Money Follows the Person Rebalancing Demonstration to ensure it maintains data to support figures reported to the Department of Health and Human Services. Corrective A...

Recommendation: The Department of Social Services should strengthen internal controls over performance and special reporting for the Money Follows the Person Rebalancing Demonstration to ensure it maintains data to support figures reported to the Department of Health and Human Services. Corrective Action Plan as Reported by the Department of Social Services: The Department agrees with this finding and is taking steps to strengthen internal controls over performance monitoring and special reporting for the Money Follows the Person (MFP) Rebalancing Demonstration. DSS is implementing a secure SharePoint repository to centrally maintain, organize, and track all documentation supporting the MFP Work Plan and the MFP Semi-Annual Report. Anticipated Completion Date: December 31, 2026 Department of Social Services Contact Person: Christine Weston, Program Division Director (860) 424-5012

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Finding 1191085 (2025-025)

Material Weakness 2025

State of Connecticut Drinking Water Fund - State Revolving Fund

CT

Eligibility Internal Control / Segregation of Duties Questioned Costs § 200.303 § 200.403

Recommendation: The Department of Social Services should strengthen internal controls to ensure that only eligible recipients receive Money Follows the Person Rebalancing Demonstration services in accordance with federal laws, award terms and conditions, and the Money Follows the Person Operational ...

Recommendation: The Department of Social Services should strengthen internal controls to ensure that only eligible recipients receive Money Follows the Person Rebalancing Demonstration services in accordance with federal laws, award terms and conditions, and the Money Follows the Person Operational Protocol. Corrective Action Plan as Reported by the Department of Social Services: The Department agrees in part with this finding. Condition #1: DSS agrees that participation end dates were not updated timely due to cross-system manual entry limitations. Reconciliation procedures and supervisory oversight will be strengthened. Condition #2: DSS agrees that participation suspensions were not consistently reflected across systems due to timing delays. Monitoring and real-time reconciliation controls will be enhanced. Condition #3: DSS agrees approved costs exceeded institutional thresholds in limited cases. Variances were clinically justified, reviewed, and authorized. DSS will strengthen documentation and internal protocols to ensure clearer policy alignment. Condition #4: DSS agrees that the documentation was incomplete in one instance. Internal review standards will be reinforced to ensure comparative cost analyses are consistently documented. Please note, the Department will not be returning the questioned costs associated with this finding. According to federal regulations, recoveries based on eligibility errors can only be pursued when identified by programs operating under Centers for Medicare and Medicaid Services’ (CMS) Payment Error Rate Measurement program, per section 1903(u) of the Social Security Act and regulations at Title 42 CFR Part 431, Subpart Q. Anticipated Completion Date: December 31, 2026 Department of Social Services Contact Person: Christine Weston, Program Division Director (860) 424-5012

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Finding 1191084 (2025-024)

Material Weakness 2025

State of Connecticut Drinking Water Fund - State Revolving Fund

CT

Internal Control / Segregation of Duties Questioned Costs Cash Management § 200.303 § 200.403

Recommendation: The Department of Developmental Services should strengthen internal controls to ensure it obtains the required signatures for the individual plan for all Money Follows the Person Rebalancing Demonstration recipients. The Department of Social Services should conduct an audit of the me...

Recommendation: The Department of Developmental Services should strengthen internal controls to ensure it obtains the required signatures for the individual plan for all Money Follows the Person Rebalancing Demonstration recipients. The Department of Social Services should conduct an audit of the medical provider in accordance with Section 17b-99 of the Connecticut General Statutes to ensure integrity of the Money Follows the Person Rebalancing Demonstration program. Corrective Action Plan as Reported by the Department of Developmental Services: DDS agrees with the finding. The errors were attributed to current manual processes and case management oversight regarding documenting signatures when individual plan (IP) meetings are held remotely rather than in-person. Most of the deficiencies (5 of 6) were isolated to one case manager. The MFP division is small with 3-4 case managers, causing a higher error rate when extrapolated against the sample size. The missing support service records have been forwarded to the Department of Administrative Services for research. There are plans to improve the individual plan process to enhance internal controls through automation. In the interim, case managers and case manager supervisors will be reminded of the IP signature requirements. Department of Developmental Services Anticipated Completion Date: June 30, 2026 Department of Developmental Services Contact Person: Krista Ostaszeski, Health Management Administrator (860) 418-6066 Wayne Siedel, Director of Service Development and Support (860) 418-6041 Corrective Action Plan as Reported by the Department of Social Services: The Department agrees with this finding and the response provided by the Department of Developmental Services. Additional research is needed to determine whether the missing documentation was the provider's responsibility or was due to a billing issue. The Department of Developmental Services is coordinating with the Department of Administrative Services to research this further. Department of Social Services Anticipated Completion Date: December 31, 2026 Department of Social Services Contact Person: Christine Weston, Program Division Director (860) 424-5012

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Finding 1191046 (2025-575)

Material Weakness 2025

State of Connecticut Drinking Water Fund - State Revolving Fund

CT

Subrecipient Monitoring Matching / Level of Effort / Earmarking § 200.303 § 200.306 § 200.332

Recommendation: The Judicial Branch should strengthen internal controls to ensure it complies with federal subrecipient monitoring requirements for the Crime Victim Assistance program. Corrective Action Plan as Reported by the Judicial Branch: The Judicial Branch Office of Victim Services (OVS) agre...

Recommendation: The Judicial Branch should strengthen internal controls to ensure it complies with federal subrecipient monitoring requirements for the Crime Victim Assistance program. Corrective Action Plan as Reported by the Judicial Branch: The Judicial Branch Office of Victim Services (OVS) agrees to strengthen its internal controls as described below to comply with federal subrecipient monitoring requirements for the Victims of Crime Act Assistance (VOCA) Program. In 2025, OVS performed site visits for four VOCA-funded programs and completed financial-desk reviews of monthly or quarterly financial reports for all programs. That year, OVS experienced personnel turnover in its three-employee Fiscal Services Unit, notably the separation from state service of a Program Manager and a Court Planner, who together performed OVS’ programmatic site visits of VOCA-funded programs. Also, there was a significant increase in workload resulting from OVS’ contributions to the 2024-2025 VOCA request-for-proposal process. In response, staff outside the unit contributed while managing other assigned duties, a Program Manager and Grants and Contract Specialist were hired to restore the unit to its three-employee configuration, the new employees received training on subrecipient monitoring policies and procedures, and a revised subrecipient site visit plan was developed and has begun being implemented. To strengthen internal controls, OVS has developed a revised site visit plan for the remaining VOCA-funded programs scheduled to receive site visits in 2025. April 15, 2026, is the anticipated date for OVS to complete the site visits. OVS has completed sending letters to the subrecipients operating the VOCA-funded programs. The letters request supporting documentation, which is programmatic and financial in nature, in accordance with OVS administrative policy and procedure. Also, the letters inform subrecipients that site visits will commence in accordance with a revised site visit plan. Anticipated Completion Date: April 15, 2026 Judicial Branch Contact Person: Marc Pelka, Office of Victim Services Director marc.pelka@jud.ct.gov (860) 263-2760

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Finding 1191035 (2025-028)

Material Weakness 2025

State of Connecticut Drinking Water Fund - State Revolving Fund

CT

Questioned Costs Special Tests & Provisions Equipment & Real Property Management § 200.303

Recommendation: The Department of Social Services should strengthen internal controls to ensure that it consistently secures, tracks, and records returned cards for the Summer EBT program. Corrective Action Plan as Reported by the Department of Social Services: The Department agrees with this findin...

Recommendation: The Department of Social Services should strengthen internal controls to ensure that it consistently secures, tracks, and records returned cards for the Summer EBT program. Corrective Action Plan as Reported by the Department of Social Services: The Department agrees with this finding. However, the Department believes that there are proper internal controls to ensure the security of returned cards. There was no log maintained by the Department but the controls in place reduced the risk of benefits being used incorrectly to an acceptable level. The returned cards were destroyed, and all unused benefits were expunged. Anticipated Completion Date: N/A Department of Social Services Contact Person: Andy Davis, Fiscal Administrative Manager 2 860-424-5709

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Finding 1191034 (2025-027)

Material Weakness 2025

State of Connecticut Drinking Water Fund - State Revolving Fund

CT

Internal Control / Segregation of Duties Questioned Costs Eligibility § 200.303

Recommendation: The Department of Social Services should strengthen internal controls to identify the agency responsible for each client’s eligibility determination and document benefit iteration approvals for the Summer Electronic Benefits Transfer Program for Children. Corrective Action Plan as Re...

Recommendation: The Department of Social Services should strengthen internal controls to identify the agency responsible for each client’s eligibility determination and document benefit iteration approvals for the Summer Electronic Benefits Transfer Program for Children. Corrective Action Plan as Reported by the Department of Social Services: The Department disagrees with this finding. Condition #1: Eligibility for the Summer EBT program is established through multiple pathways: receipt of Supplemental Nutrition Assistance Program (SNAP) benefits, Temporary Family Assistance (TFA), or HUSKY A coverage, and through applying for and receiving an eligibility determination for either the National School Lunch Program or the Summer EBT program itself. Determining eligibility is a shared responsibility between DSS and the State Department of Education (SDE), and children qualify through multiple pathways simultaneously. DSS maintains a record within its eligibility system and compiles reports of all eligible children. When eligibility is established through any additional means, the child’s record is then analyzed against all previous issuances to ensure duplicate participation and double issuance does not occur. Title 7 CFR Part 292.16 (a)(5)(i) requires the Summer EBT agency to establish a master issuance file which contains all information needed to identify eligible children, issue Summer EBT benefits, record the participation activity for each household and supply all information necessary to fulfill reporting requirements. The agency is not required to specify which program(s) were used to determine eligibility, which is reasonable given that there may be multiple overlapping avenues of eligibility. The implication that DSS is somehow not compliant or able to identify the source of eligibility is inaccurate. DSS can identify this information on an individual basis through reviewing the child’s receipt of SNAP, TFA, HUSKY A, or through its ongoing coordination and communication with SDE. Condition #2: It is not a requirement of the business systems division to request approval for each issuance. Each year the Department issues benefits for this program in a consistent manner. Since there were no changes to the process during the audit period, approval was not sought for the issuances. Business systems would only seek approval if there was a change to the process. Anticipated Completion Date: N/A Department of Social Services Contact Person: Dan Giacomi, Program Division Director 860-424-5080

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Finding 1191021 (2025-027)

Material Weakness 2025

State of Delaware

DE

Reporting Internal Control / Segregation of Duties § 200.303

Reference Number: 2025-027 Prior Year Finding: 2024-026 Federal Agency: U.S. Department of Health and Human Services State Agency: Department of Health and Social Services State Division: Division of Substance Abuse and Mental Health Federal Program: Block Grants for Substance Use Prevention, Treatm...

Reference Number: 2025-027 Prior Year Finding: 2024-026 Federal Agency: U.S. Department of Health and Human Services State Agency: Department of Health and Social Services State Division: Division of Substance Abuse and Mental Health Federal Program: Block Grants for Substance Use Prevention, Treatment, and Recovery Services, COVID-19 - Block Grants for Substance Use Prevention, Treatment, and Recovery Services Assistance Listing Number: 93.959 Award Number and Year: SAI000006426 (10/1/2023 – 9/30/2025) SAI000005888 (10/1/2022 – 9/30/2024) SAI000005101 (9/1/2021 – 9/30/2025) Compliance Requirement: Reporting – Federal Funding Accountability and Transparency Act (FFATA) Type of Finding: Significant Deficiency in Internal Control Over Compliance, Other Matters Recommendation: We recommend that the Division develop internal controls and procedures to ensure that FFATA reporting requirements are met. We further recommend the Division develop controls and procedures to ensure that all required subawards are reported accurately and timely to FSRS. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Regarding the subaward identified as not timely reported, the Division confirms that the subaward was submitted in SAM.gov on December 9, 2024. In accordance with FFATA reporting requirements, the subaward should have been reported no later than the end of the month following the month in which the subaward was issued. The delay in reporting was the result of administrative oversight. Since the prior finding, the Division has reviewed and strengthened its internal controls related to FFATA reporting to ensure compliance with federal requirements. Updated procedures have been implemented to formally track all subawards subject to FFATA reporting, including documentation of subaward issuance dates, calculation of reporting due dates, and verification of submission in SAM.gov within the required timeframe. In addition, the Division has implemented a secondary review process to monitor FFATA reporting on an ongoing basis. This includes periodic review of subaward activity and confirmation that all required reports have been submitted timely. These enhanced controls are intended to prevent recurrence of late reporting and to ensure full compliance with FFATA requirements going forward. Name(s) of the contact person(s) responsible for corrective action: Amy Herb – Chief of Grant Operations Planned completion date for corrective action plan: April 1, 2026.

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Finding 1191019 (2025-026)

Material Weakness 2025

State of Delaware

DE

Subrecipient Monitoring Questioned Costs Procurement, Suspension & Debarment § 200.303

Reference Number: 2025-026 Prior Year Finding: 2024-025 Federal Agency: U.S. Department of Health and Human Services State Agency: Department of Health and Social Services State Division: Division of Substance Abuse and Mental Health Federal Program: Opioid STR Assistance Listing Number: 93.788 Awar...

Reference Number: 2025-026 Prior Year Finding: 2024-025 Federal Agency: U.S. Department of Health and Human Services State Agency: Department of Health and Social Services State Division: Division of Substance Abuse and Mental Health Federal Program: Opioid STR Assistance Listing Number: 93.788 Award Number and Year: H79TI085764 (9/30/2022 – 9/29/2024) 6H79TI085764 (9/30/2023 – 9/29/2025) 5H79TI083305 (9/30/2024 – 9/29/2027) Compliance Requirement: Reporting – Federal Funding Accountability and Transparency Act (FFATA) Type of Finding: Material Weakness in Internal Control Over Compliance, Material Noncompliance Recommendation: We recommend that the Division develop internal controls and procedures to ensure that FFATA reporting requirements are met. We further recommend the Division develop controls and procedures to ensure that all required subawards are reported accurately and timely to FSRS. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Division has reviewed the FFATA reporting requirements and evaluated the procedures in place for identifying and reporting subawards in SAM.gov. During the audit period, the Division relied on existing processes that did not include a formalized secondary review to ensure all reportable subawards were submitted within the required timeframe. In response to this finding, the Division has implemented enhanced internal controls and monitoring procedures to ensure compliance with FFATA reporting requirements. These actions include: • Development of a standardized FFATA tracking log to monitor all subawards issued under applicable federal programs. • Implementation of a secondary review process to verify that all reportable subawards meeting FFATA thresholds are identified and submitted in SAM.gov within required deadlines. • Coordination between program and fiscal staff to confirm subaward execution dates, amounts, and reporting applicability prior to the reporting deadline. • Periodic review of SAM.gov submissions to ensure completeness and accuracy. These corrective actions are intended to strengthen internal controls over FFATA reporting and ensure timely and accurate submission of required subaward reports going forward. Name(s) of the contact person(s) responsible for corrective action: Sherry Szczuka – Chief of Program Integrity Planned completion date for corrective action plan: April 1, 2026.

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Finding 1191018 (2025-025)

Material Weakness 2025

State of Delaware

DE

Allowable Costs / Cost Principles § 200.303 § 200.430

Reference Number: 2025-025 Prior Year Finding: 2024-024 Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division: Division of Substance Abuse and Mental Health Federal Program: Opioid-STR Assistance Listing Number: 93...

Reference Number: 2025-025 Prior Year Finding: 2024-024 Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division: Division of Substance Abuse and Mental Health Federal Program: Opioid-STR Assistance Listing Number: 93.788 Award Number and Year: H79TI085764 (9/30/2022 – 9/29/2024) 6H79TI085764 (9/30/2023 – 9/29/2025) 5H79TI083305 (9/30/2024 – 9/29/2027) Compliance Requirement: Allowable Costs/Cost Principles – Time and Effort Reporting Type of Finding: Material Weakness in Internal Control Over Compliance Recommendation: The Division should enhance procedures, implement proper controls, and perform additional training over time and effort reporting. The Division should not seek federal reimbursement unless it can substantiate that the time and effort was dedicated to the federal program. Documentation should be readily available for audit. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Division evaluated the developed process and implemented controls for completion of the process within 60 days with added monitoring roles for accuracy and timeliness. The Division will be performing training for assigned staff, monitoring completion and will continue to improve the process for efficiency and compliance. Name(s) of the contact person(s) responsible for corrective action: Brook Meadow, Fiscal Administrator II, Office of the Secretary Administration Planned completion date for corrective action plan: June 30, 2026

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Finding 1191017 (2025-024)

Material Weakness 2025

State of Delaware

DE

Eligibility Questioned Costs Significant Deficiency § 200.303

Reference Number: 2025-024 Prior Year Finding: No Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division Name: Division of Medicaid and Medical Assistance Federal Program: Medicaid Cluster Assistance Listing Number:...

Reference Number: 2025-024 Prior Year Finding: No Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division Name: Division of Medicaid and Medical Assistance Federal Program: Medicaid Cluster Assistance Listing Number: 93.775, 93.777, 93.778 Award Number and Year: 2405DE5MAP (10/1/2023 – 9/30/2024) 2505DE5MAP (10/1/2024 – 9/30/2025) Compliance Requirement: Eligibility Type of Finding: Significant Deficiency in Internal Control Over Compliance, Other Matters Recommendation: The Division should implement procedures and controls to ensure that it maintains documentation supporting participant eligibility and this documentation should be readily available for audit. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Division of Medicaid and Medical Assistance (DMMA) in partnership with the Division of Social Services (DSS) will provide training for determination member eligibility. DSS will also ensure supporting participant eligibility documentation is properly maintained. Name(s) of the contact person(s) responsible for corrective action: Kathleen Mahoney, Social Service Sr. Administrator, DMMA Carolyn Kincaid, Social Service Chief Administrator, DSS Marcella Spady, Deputy Principal Assist, DSS Planned completion date for corrective action plan: September 2026

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Finding 1191013 (2025-023)

Material Weakness 2025

State of Delaware

DE

Questioned Costs Special Tests & Provisions Significant Deficiency § 200.303

Reference Number: 2025-023 Prior Year Finding: 2024-022 Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division Name: Division of Medicaid and Medical Assistance Federal Program: Children’s Health Insurance Program, ...

Reference Number: 2025-023 Prior Year Finding: 2024-022 Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division Name: Division of Medicaid and Medical Assistance Federal Program: Children’s Health Insurance Program, Medicaid Cluster Assistance Listing Number: 93.767, 93.775, 93.777, 93.778 Award Number and Year: 2405DE5021 (10/1/2023 – 9/30/2025) 2505DE5021 (10/1/2024 – 9/30/2026) 2405DE5MAP (10/1/2023 – 9/30/2024) 2505DE5MAP (10/1/2024 – 9/30/2025) Compliance Requirement: Special Tests and Provisions – Managed Care Financial Audit Type of Finding: Significant Deficiency in Internal Control Over Compliance, Other Matters Recommendation: The Division should implement procedures and controls to ensure that it posts the results of independent audits to its website once completed, as required. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: DMMA will revirew the procedures and provide additional training for staff to ensure each MCO has had an audit, obtain copies of the audit, reviews the results, and post the results of the audit on the website. Name(s) of the contact person(s) responsible for corrective action: Colleen Yezek, Chief of Admin. MCO Ops. Donna O’Hanlon, Soc. Service Sr. Admin. Planned completion date for corrective action plan: September 2026

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Finding 1191009 (2025-022)

Material Weakness 2025

State of Delaware

DE

Questioned Costs Special Tests & Provisions Eligibility § 200.303

Reference Number:2025-022 Prior Year Finding:2024-023 Federal Agency:U.S. Department of Health and Human Services State Department Name:Department of Health and Social Services State Division Name:Division of Medicaid and Medical Assistance Federal Program:Medicaid Cluster Assistance Listing Number:...

Reference Number:2025-022 Prior Year Finding:2024-023 Federal Agency:U.S. Department of Health and Human Services State Department Name:Department of Health and Social Services State Division Name:Division of Medicaid and Medical Assistance Federal Program:Medicaid Cluster Assistance Listing Number:93.775, 93.777, 93.778 Award Number and Year: 2405DE5MAP (10/1/2023 – 9/30/2024) 2505DE5MAP (10/1/2024 – 9/30/2025) Compliance Requirement:Special Tests and Provisions – Provider Health and Safety Standards Type of Finding: Material Weakness in Internal Control over Compliance, Material Noncompliance Recommendation: The Division should reevaluate its current process and perform additional training to ensure documentation is maintained in accordance with program requirements and that all providers are compliant with required health and safety standards. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: DMMA will review the process of storing all data for provider’s screening and credentialing information. In addition, when a provider enrolls or revalidates into DMAP, they will be required to submit updated credentials and license information. Name(s) of the contact person(s) responsible for corrective action: Mei Johnson, Chief of Admin. IT Unit Planned completion date for corrective action plan: September 2026

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Finding 1191004 (2025-021)

Material Weakness 2025

State of Delaware

DE

Subrecipient Monitoring Allowable Costs / Cost Principles Questioned Costs § 200.303 § 200.308 § 200.309 § 200.403

Reference Number: 2025-021 Prior Year Finding: No Federal Agency: U.S. Department of Health and Human Services State Agency: Department of Health and Social Services State Division: Division of Medicaid and Medical Assistance Federal Program: Children’s Health Insurance Program Assistance Listing Nu...

Reference Number: 2025-021 Prior Year Finding: No Federal Agency: U.S. Department of Health and Human Services State Agency: Department of Health and Social Services State Division: Division of Medicaid and Medical Assistance Federal Program: Children’s Health Insurance Program Assistance Listing Number: 93.767 Award Number and Period: SAI000005399 (10/1/2023 – 9/30/2024) Compliance Requirement: Period of Performance Type of Finding: Material Weakness in Internal Control over Compliance, Material Noncompliance Recommendation: The Division should review and enhance its procedures and internal controls to ensure that it maintains documentation that expenditures charged to the program are incurred within an award’s allowable period of performance. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: To prevent recurrence, we are implementing the following actions: 1. Enhanced Monitoring Controls o Establish a centralized tracking system for all awards, including start and end dates. 2. Staff Training and Accountability o Conduct mandatory training for program and finance staff on compliance with period of performance requirements. o Assign clear responsibility for monitoring award timelines to designated personnel. 3. Pre-Closeout Review Process o Introduce a formal pre-closeout review 60 days before the award end date to identify and resolve outstanding obligations. o Require certification from both program and finance leads confirming that all expenditures fall within the allowable period. 4. Post-Expenditure Review o Perform monthly reconciliation of expenditures against the period of performance. o Immediately flag and correct any discrepancies identified. Name(s) of the contact person(s) responsible for corrective action: Joel Riley – Program Integrity Chief Anthony Yeager – Fiscal Manager Planned completion date for corrective action plan: July 31, 2026

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Finding 1190994 (2025-017)

Material Weakness 2025

State of Delaware

DE

Allowable Costs / Cost Principles § 200.303 § 200.430

Reference Number: 2025-017 Prior Year Finding: No Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division: Division of Social Services Federal Program: Temporary Assistance for Needy Families Assistance Listing Numbe...

Reference Number: 2025-017 Prior Year Finding: No Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division: Division of Social Services Federal Program: Temporary Assistance for Needy Families Assistance Listing Number: 93.558 Award Number and Year: 2501DETANF (10/1/2024 – 9/30/2025) 2401DETANF (10/1/2023 – 9/30/2024) 2301DETANF (10/1/2022 – 9/30/2023) Compliance Requirement: Allowable Costs/Cost Principles – Time and Effort Reporting Type of Finding: Material Weakness in Internal Control Over Compliance, Material Noncompliance Recommendation: The Division should enhance procedures, implement proper controls, and perform additional training over time and effort reporting. The Division should not seek federal reimbursement unless it can substantiate that the time and effort was dedicated to the federal program. Documentation should be readily available for audit. Explanation of disagreement with audit finding: There is no disagreement with the audit findings. Action taken in response to finding: The following action will be taken to improve the current process. • The Fiscal unit is implementing procedures to serve as the central repository for all Time and Effort records, replacing the current practice of storing these forms at the program manager level. • Implement internal controls for Time and Effort Reporting. • Confirm that T&E information submitted is accurate and reconciled. • Provide training for Time & Effort certification. Name(s) of the contact person(s) responsible for corrective action: Joanne Sunga – Fiscal Administrator Tracey Rogers-Mitchell – OSEC Chief of Administration Secil Onat – DSS Chief of Administration Planned completion date for corrective action plan: June 30, 2026

View Audit 395248

Finding 1190993 (2025-016)

Material Weakness 2025

State of Delaware

DE

Allowable Costs / Cost Principles § 200.303 § 200.430

Reference Number: 2025-016 Prior Year Finding: No Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division: Division of Public Health Federal Program: Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)...

Reference Number: 2025-016 Prior Year Finding: No Federal Agency: U.S. Department of Health and Human Services State Department Name: Department of Health and Social Services State Division: Division of Public Health Federal Program: Epidemiology and Laboratory Capacity for Infectious Diseases (ELC), COVID-19 - Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Assistance Listing Number: 93.323 Award Number and Year: NU50CK000497 (8/1/2019 – 7/31/2027) NU51CK000334 (8/1/2024 – 7/31/2029) Compliance Requirement: Allowable Costs/Cost Principles – Time and Effort Reporting Type of Finding: Significant Deficiency in Internal Control Over Compliance, Other Matters Recommendation: The Division should reevaluate its current process, implement proper controls, and perform additional training over time and effort reporting. The Division should not seek federal reimbursement unless it can substantiate that the time and effort was dedicated to the federal program. Documentation should be readily available for audit. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: • ELC Financial Lead will work with DPH Support Services to track all recoded time against grant. • As recodes are identified, time certifications for affected staff will need to be revised and filed appropriately. Name(s) of the contact person(s) responsible for corrective action: Teresa Reed, Wes Holleger, Deborah Fisher Planned completion date for corrective action plan: April 1, 2026.

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Finding 1190991 (2025-015)

Material Weakness 2025

State of Delaware

DE

Questioned Costs Subrecipient Monitoring Reporting § 200.303

Reference Number: 2025-015 Prior Year Finding: No Federal Agency: U.S. Department of the Treasury State Department Name: Office of the Governor Federal Program: COVID-19 – Coronavirus Capital Projects Fund Assistance Listing Number: 21.029 Award Number and Year: CPFFN0144 (2/4/2022 – 12/31/2026) Com...

Reference Number: 2025-015 Prior Year Finding: No Federal Agency: U.S. Department of the Treasury State Department Name: Office of the Governor Federal Program: COVID-19 – Coronavirus Capital Projects Fund Assistance Listing Number: 21.029 Award Number and Year: CPFFN0144 (2/4/2022 – 12/31/2026) Compliance Requirement: Reporting Type of Finding: Significant Deficiency in Internal Control Over Compliance, Other Matters Recommendation: We recommend that the Office enhance its procedures and internal controls to ensure that reported square footage agrees with supporting documentation. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The ARPA team acknowledges that the discrepancy in reported square footage resulted from a data entry error and insufficient controls to ensure that updates to project data were reflected in subsequent reporting periods. To address this, the team has implemented enhanced data validation procedures, including reconciliation of reported data to supporting documentation each reporting period, formal tracking of changes to project data, and a secondary review of key data elements prior to submission. Ongoing monitoring will be performed to ensure continued accuracy and consistency across reporting periods. Name(s) of the contact person(s) responsible for corrective action: John Celatka and Greg Sweeney Planned completion date for corrective action plan: June 30, 2026

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Finding 1190990 (2025-014)

Material Weakness 2025

State of Delaware

DE

Procurement, Suspension & Debarment § 200.303 § 200.317

Reference Number: 2025-014 Prior Year Finding: No Federal Agency: U.S. Department of the Treasury State Department Name: Division of Libraries Federal Program: COVID-19 – Coronavirus Capital Projects Fund Assistance Listing Number: 21.029 Award Number and Year: CPFFN0144 (2/4/2022 – 12/31/2026) Comp...

Reference Number: 2025-014 Prior Year Finding: No Federal Agency: U.S. Department of the Treasury State Department Name: Division of Libraries Federal Program: COVID-19 – Coronavirus Capital Projects Fund Assistance Listing Number: 21.029 Award Number and Year: CPFFN0144 (2/4/2022 – 12/31/2026) Compliance Requirement: Procurement Type of Finding: Significant Deficiency in Internal Control Over Compliance, Other Matters Recommendation: The Division should review and enhance controls and procedures to ensure that it follows the State’s procurement policies for all contracts charged to the program. Explanation of disagreement with audit finding: The Department of State, Division of Libraries disputes the audit finding of “significant deficiency in internal control over compliance, other matters” on the basis that Title 29, Chapter 69 of the Delaware Code is inapplicable and exempts the purchase of services by libraries from the State procurement process, including construction. Without admission to any deficiency in the Division’s “internal control over compliance, other matters,” the Division of Libraries will review all internal controls and procedures to ensure compliance with the State’s procurement process. Action taken in response to finding: Legal review of the Department of State, Division of Libraries internal controls and procedures to ensure compliance with State procurement process. Name(s) of the contact person(s) responsible for corrective action: Michelle Strauss, Chief of Staff, Department of State Planned completion date for corrective action plan: No later than six (6) months from the date of submission of this response, or September 16, 2026.

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Finding 1190989 (2025-013)

Material Weakness 2025

State of Delaware

DE

Questioned Costs Reporting Significant Deficiency § 200.303

Reference Number: 2025-013 Prior Year Finding: 2024-013 Federal Agency: U.S. Department of the Treasury State Department Name: Office of the Governor Federal Program: COVID-19 – Coronavirus State and Local Fiscal Recovery Funds Assistance Listing Number: 21.027 Award Number and Year: SLFRP0139 (3/3/...

Reference Number: 2025-013 Prior Year Finding: 2024-013 Federal Agency: U.S. Department of the Treasury State Department Name: Office of the Governor Federal Program: COVID-19 – Coronavirus State and Local Fiscal Recovery Funds Assistance Listing Number: 21.027 Award Number and Year: SLFRP0139 (3/3/2021 – 12/31/2024) SLFRP2629 (3/3/2021 – 12/31/2024) Compliance Requirement: Reporting Type of Finding: Significant Deficiency in Internal Control Over Compliance, Other Matters Recommendation: We recommend that the Office enhance procedures and internal controls to ensure that it reports and/or maintains in project files capital project justifications that contain all required elements. The Office should provide training of State agency personnel and conduct periodic reviews of written capital project justifications to ensure that they comply with program requirements. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The ARPA team acknowledges that the repeat finding related to capital project justifications resulted from gaps in enforcement and follow-up procedures with state agencies. While guidance was provided, the team did not consistently ensure that complete and compliant capital project justifications were obtained and reviewed prior to reporting. Contributing factors included limited staffing resources also impacted agencies’ ability to provide complete historical information for projects initiated in prior reporting periods. In several cases, agency personnel responsible for original project justifications were no longer available, making it more difficult to obtain sufficient documentation to meet Treasury requirements. However, the ARPA team recognizes that these challenges do not mitigate the responsibility to ensure compliance with reporting requirements. To address this, the ARPA team will implement enhanced controls to ensure compliance with capital project justification requirements. These include requiring complete justifications prior to reporting, use of a standardized template and review checklist, and a formal second-level review process to verify completeness and accuracy. In addition, the team will maintain centralized tracking of all submissions, implement formal escalation procedures for nonresponsive agencies, and provide ongoing training and guidance, including support for new agency personnel. Periodic compliance reviews will also be conducted to ensure continued adherence to program requirements. These actions are designed to strengthen internal controls, improve accountability, and ensure that all reported capital project justifications fully comply with Treasury requirements. Name(s) of the contact person(s) responsible for corrective action: John Celatka and Greg Sweeney Planned completion date for corrective action plan: June 30, 2026

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Finding 1190988 (2025-012)

Material Weakness 2025

State of Delaware

DE

Matching / Level of Effort / Earmarking Questioned Costs Special Tests & Provisions § 200.303

Reference Number: 2025-012 Prior Year Finding: 2024-006 Federal Agency: U.S. Department of Labor State Agency: Department of Labor State Division: Division of Unemployment Insurance Federal Program: Unemployment Insurance, COVID-19 – Unemployment Insurance Assistance Listing Number: 17.225 Award Num...

Reference Number: 2025-012 Prior Year Finding: 2024-006 Federal Agency: U.S. Department of Labor State Agency: Department of Labor State Division: Division of Unemployment Insurance Federal Program: Unemployment Insurance, COVID-19 – Unemployment Insurance Assistance Listing Number: 17.225 Award Number and Period: UI372152255A10 (10/1/2021 – 12/31/2024) UI393142355A10 (10/1/2022 – 12/31/2025) 24A55UI000067 (10/1/2023 – 12/31/2026) 25A55UI000116 (1/1/2024 – 12/31/2027) Compliance Requirement: Special Tests and Provisions – Employer Experience Rating Type of Finding: Significant Deficiency in Internal Control over Compliance, Other Matters Recommendation: The Division should review and enhance procedures and controls to ensure that employer experience rates are properly calculated and applied. Explanation of disagreement with audit finding: Disagreement with Finding-New Employer Rate Assignment Action taken in response to finding: We disagree with the finding as we believe the employer’s account effective date and liability status were established in accordance with the applicable state UI laws and regulations. Documentation can be provided to substantiate this determination. Account# 69821 was established in November of 2024 with a liability date of 04/2013 per employer’s application on file, which gave the employer a new employer rate of 2.8. After my discussion with the auditor on 3/19/26, I pulled the folder to further investigate. Based on this review, we conclude that the rate assignment was accurate and compliant, and therefore the finding appears to be based on a misunderstanding of the employer’s account status or the applicable rate criteria. The business already implemented a corrective action plan in 2025 which entailed changing how the calculation is performed. This calculation is now done outside of the Mainframe system in compliance with Title 19 rules with results uploaded into the system after calculation. The UI program successfully provided an auditable population for calendar year 2025 Name(s) of the contact person(s) responsible for corrective action: Angela Hackett, Administrator Planned completion date for corrective action plan: We have internal controls in place to mitigate the risk of an incorrect rate being assigned to a new employer. This issue was corrected in 2025 when finding was first originally presented.

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Finding 1190986 (2025-011)

Material Weakness 2025

State of Delaware

DE

Questioned Costs Reporting Significant Deficiency § 200.303

Reference Number: 2025-011 Prior Year Finding: 2024-012 Federal Agency: U.S. Department of Labor State Department Name: Department of Labor State Division Name: Division of Unemployment Insurance Federal Program: Unemployment Insurance, COVID-19 – Unemployment Insurance Assistance Listing Number: 17...

Reference Number: 2025-011 Prior Year Finding: 2024-012 Federal Agency: U.S. Department of Labor State Department Name: Department of Labor State Division Name: Division of Unemployment Insurance Federal Program: Unemployment Insurance, COVID-19 – Unemployment Insurance Assistance Listing Number: 17.225 Award Number and Year: UI372152255A10 (10/1/2021 – 12/31/2024) UI393142355A10 (10/1/2022 – 12/31/2025) 24A55UI000067 (10/1/2023 – 12/31/2026) 25A55UI000116 (1/1/2024 – 12/31/2027) Compliance Requirement: Reporting – ETA 9130, Financial Status Report, UI Programs Type of Finding: Significant Deficiency in Internal Control Over Compliance, Other Matters Recommendation: We recommend the Division review and enhance procedures and internal controls to ensure that ETA 9130 reports agree with supporting documentation and that documentation is maintained and is readily available for audit. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: We acknowledge the audit finding that several ETA 9130 reports did not agree with the supporting documentation. Procedures have been implemented to ensure documentation used to complete the ETA 9130 reports are reviewed by both the Certifying and Approving Officials before final sign off. Procedures will be documented and saved for ease of retrieval and use. Backup will be saved in clearly marked folders on our Fiscal drive for ease of retrieval. Name(s) of the contact person(s) responsible for corrective action: Michael Soper, Fiscal Management Planned completion date for corrective action plan: Procedures are in use for QE 03/31/2026 ETA 9130 reports. Procedures will be documented by QE 06/30/2026 for ETA 9130 reports with revisions as needed.

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Finding 1190984 (2025-010)

Material Weakness 2025

State of Delaware

DE

Eligibility Questioned Costs Significant Deficiency § 200.303

Reference Number: 2025-010 Prior Year Finding: 2024-004 Federal Agency: U.S. Department of Labor State Department Name: Department of Labor State Division Name: Division of Unemployment Insurance Federal Program: Unemployment Insurance, COVID-19 – Unemployment Insurance Assistance Listing Number: 17...

Reference Number: 2025-010 Prior Year Finding: 2024-004 Federal Agency: U.S. Department of Labor State Department Name: Department of Labor State Division Name: Division of Unemployment Insurance Federal Program: Unemployment Insurance, COVID-19 – Unemployment Insurance Assistance Listing Number: 17.225 Award Number and Year: UI372152255A10 (10/1/2021 – 12/31/2024) UI393142355A10 (10/1/2022 – 12/31/2025) 24A55UI000067 (10/1/2023 – 12/31/2026) 25A55UI000116 (1/1/2024 – 12/31/2027) Compliance Requirement: Eligibility Type of Finding: Significant Deficiency in Internal Control Over Compliance, Other Matters Recommendation: The Division should review and enhance procedures and controls to ensure that claimant eligibility is properly determined, that documentation supporting claimant eligibility is retained, and that documentation is readily available for audit. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: For 3 of 60 claimants, the Division was unable to provide documentation that the claimant provided weekly updates. These cases (sample 2,7 and 36) relate to claimant weekly certifications and their responses to required eligibility questions for the applicable benefit weeks. Due to existing mainframe system limitations, the Division does not have the ability to directly view all claimant responses within the system interface. In preparation for the CLA review, Application Support generated a comprehensive report capturing weekly certification responses for all sampled claimants, based on Social Security Numbers. However, three claimants did not appear on this report, and therefore their responses could not be verified at the time of review. The Division has identified both short-term and long-term corrective actions to address this discrepancy:  Short-term solution: A service ticket has been submitted to the Application Support team to investigate and resolve the issue that caused these claimants to be excluded from the report. Once resolved, future reports are expected to consistently capture all claimant responses associated with weekly certifications. * Long-term solution: The Division recognizes the need for a modernized system to improve the efficiency and reliability of claims processing and adjudication. Current case management systems are outdated and have limited functionality. Implementation of an updated system will allow for automated capture of weekly certification responses, improved data accessibility, and enhanced identification of potential compliance issues requiring investigation. Name(s) of the contact person(s) responsible for corrective action: Rachael Griffith, UI Administrator Planned completion date for corrective action plan: March 31, 2027

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Finding 1190982 (2025-009)

Material Weakness 2025

State of Delaware

DE

Allowable Costs / Cost Principles Matching / Level of Effort / Earmarking § 200.303 § 200.403

Reference Number: 2025-009 Prior Year Finding: 2024-011 Federal Agency: U.S. Department of Labor State Department Name: Department of Labor State Division Name: Division of Unemployment Insurance Federal Program: Unemployment Insurance, COVID-19 – Unemployment Insurance Assistance Listing Number: 17...

Reference Number: 2025-009 Prior Year Finding: 2024-011 Federal Agency: U.S. Department of Labor State Department Name: Department of Labor State Division Name: Division of Unemployment Insurance Federal Program: Unemployment Insurance, COVID-19 – Unemployment Insurance Assistance Listing Number: 17.225 Award Number and Year: 24A55UI000067 (10/1/2023 – 12/31/2026) 25A55UI000116 (10/1/2024 – 12/31/2027) Compliance Requirement: Allowable Cost/Cost Principles Type of Finding: Significant Deficiency in Internal Control Over Compliance, Other Matters Recommendation: The Division should reevaluate its procedures and controls regarding general disbursements to ensure that supporting documentation is readily available upon audit request. Explanation of disagreement with audit finding: We acknowledge that audit ready evidence was not produced in a timely fashion but respectfully disagree that the Division did not maintain this evidence. The lack of timely production can be attributed to lack of awareness of the proper repository where such audit evidence was maintained and/or could be easily retrieved, as opposed to no maintenance at all. We also maintain that the division was able to substantiate all expenses queried. Action taken in response to finding: The business will continue to refine its process for maintaining audit ready evidence to improve response time in future engagements. Name(s) of the contact person(s) responsible for corrective action: Michael Soper, Fiscal Management Planned completion date for corrective action plan: March 31, 2027

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