Finding 1096300 (2023-010)

Federal Assistance Listing Number: 93.778 Federal Program Name: Medicaid Cluster Federal Agency: U.S. Department of Health and Human Services Pass-Through Name: Wisconsin Department of Health Services Pass-Through Identification Number (Year): 2023 Repeat Finding: This is a repeat finding of 2022-004. Criteria: According to the Wisconsin School-Based Services Medicaid Cost Report and Cost Settlement Training Guide, the IEP ratio is reported within the General and Statistical Information section of the online annual cost report and is used to apportion Medicaid allowable costs versus total special education costs for direct medical services. The IEP ratio is made up of the Number of Unique Medicaid Eligible with a prescribed Medical Service in the IEP (numerator) and the Number of Unique SPED Students with a prescribed Medical Service in the IEP. Condition: The numerator of the IEP ratio reported in the FY22 annual cost report was not supported by the list of Medicaid-eligible students and was overstated by 57 students. The ratio reported in the annual cost report was 32.29% and the ratio calculated based on the number of Medicaid-eligible students should have been 31.59%. The District was able to resubmit the FY22 IEP ratio and did so once it was brought to their attention. Context: The numerator and denominator of the IEP ratio were compared to the student listing. No sampling occurred for this test. Cause: The numerator was based on a calculation rather than a list of Medicaid-eligible students. Effect: Since the IEP Ratio is used to apportion Medicaid allowable costs versus total special education costs for direct medical services, the Medicaid apportionment could be incorrect. Questioned Costs: Could not be determined. Recommendation: We recommend the IEP ratio be supported by a list of Medicaid-eligible students and a list of the total number of IEP students that receive a medical service. Views of Responsible Officials: Management concurs with the finding.