Finding Text
2023-005 Eligibility – METS
Prior Year Finding Number: 2022-002
Repeat Finding Since: 2022
Type of Finding: Internal Control Over Compliance and Compliance
Severity of Deficiency: Material Weakness and Modified Opinion
Federal Agency: U.S. Department of Health and Human Services
Program: 93.778 Medical Assistance Program
Award Number and Year: 2305MN5ADM; 2023
Pass-Through Agency: Minnesota Department of Human Services
Criteria: Title 2 U.S. Code of Federal Regulations § 200.303 states that the auditee must establish and maintain effective internal control over the federal award that provides reasonable assurance that the auditee is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award.
Condition: DHS maintains the computer system, METS, which is used by the Health and Human Services to support the eligibility determination process. While periodic supervisory case reviews are performed to monitor compliance with grant requirements for eligibility, not all documentation was available, updated, or input correctly to support participant eligibility. In the sample of 40 case files tested, four instances were noted where the category of each case file was originally classified as auto newborn. The case files were not subsequently updated to the correct category and, therefore, not verified by either METS or manually by the Health and Human Services for both social security number or citizenship.
Questioned Costs: Not applicable. The Health and Human Services administers the program, but the State of Minnesota pays benefits to program participants.
Context: The Health and Human Services performs any “intake function” needed for this program, while the state maintains METS, which supports the eligibility determination process and actually pays the benefits to the participants.
The sample size was based on the guidance from Chapter 11 of the AICPA Audit Guide, Government Auditing Standards and Single Audits.
Effect: The improper input or updating of information into METS and the lack of verification or follow-up of eligibility-determining factors increases the risk that program participants will receive benefits when they are not eligible.
Cause: The METS verification process was incomplete; the system did not indicate verification for social security number and citizenship was required.
Recommendation: We recommend Southwest Health and Human Services implement additional procedures to provide reasonable assurance that all necessary documentation to support eligibility determinations exists and is properly input, updated, or verified in METS and issues are followed up in a timely manner. In addition, Southwest Health and Human Services should consider providing further training for program personnel.
View of Responsible Official: Acknowledge