FAC Explorer

Finding 1116845 (2024-014)

Significant Deficiency
Requirement
E
Questioned Costs
$1
Year
2024
Accepted
2025-03-28
Audit: 350226
Organization: Department of Human Services (HI)
Auditor: Accuity LLP

AI Summary

  • Core Issue: One Medicaid enrollment was not terminated on time due to missing verification, leading to noncompliance with eligibility rules.
  • Impacted Requirements: Violations of Title 42 CFR Part 435.912 and 435.916 regarding timely eligibility determinations and annual re-verifications.
  • Recommended Follow-Up: Implement training and standard procedures to improve compliance and ensure timely eligibility determinations.

Finding Text

Finding No. 2024 014: Eligibility (Significant Deficiency) Questioned cost: $ 1,087 Federal Agency: Department of Health and Human Services AL Number and Title: 93.777, 93.778 and COVID-19 – 93.778 – Medicaid Cluster Award Number and Award Year: 2305HIMAP 2023 2405HIMAP 2024 Repeat Finding? No Condition During our audit, we selected a non statistical sample of 60 individuals for testing out of a population of approximately 469,538 enrollments. The enrollments selected for testing represented approximately $280,000 of payments out of a total payment population of $3.4 billion. We identified one enrollment whose benefits were not timely terminated after failing to provide verification to support revalidation. Criteria Title 42 CFR Part 435.912 requires the timely determination of eligibility of individuals who apply for Medicaid benefits within (1) 90 days for applicants who apply for Medicaid on the basis of disability (MAGI-excepted), and (2) 45 days for all other applicants (MAGI). In addition, Title 42 CFR Part 435.916 requires annual re verifications of participant eligibility. Effect Failure to follow the established policies and procedures in place over the Medicaid eligibility determination process represents an instance of noncompliance with the requirements of 2 CFR Part 200, resulting in questioned costs. Cause and View of Responsible Officials Although the Department has policies and procedures in place requiring the maintenance of required documentation, there was a lack of diligence in complying with the policies and procedures. Recommendation We recommend the Department implement training and standard operating procedures to ensure eligibility determinations are completed in a timely manner.

Categories

Questioned Costs Eligibility Reporting Significant Deficiency

Other Findings in this Audit

  • 540389 2024-008
    Material Weakness Repeat
  • 540390 2024-008
    Material Weakness Repeat
  • 540391 2024-006
    Material Weakness Repeat
  • 540392 2024-006
    Material Weakness Repeat
  • 540393 2024-007
    Material Weakness Repeat
  • 540394 2024-007
    Material Weakness Repeat
  • 540395 2024-010
    Material Weakness Repeat
  • 540396 2024-011
    Significant Deficiency Repeat
  • 540397 2024-012
    Significant Deficiency Repeat
  • 540398 2024-013
    Significant Deficiency Repeat
  • 540399 2024-013
    Significant Deficiency Repeat
  • 540400 2024-013
    Significant Deficiency Repeat
  • 540401 2024-014
    Significant Deficiency
  • 540402 2024-014
    Significant Deficiency
  • 540403 2024-014
    Significant Deficiency
  • 540404 2024-003
    Significant Deficiency Repeat
  • 540405 2024-003
    Significant Deficiency Repeat
  • 540406 2024-003
    Significant Deficiency Repeat
  • 540407 2024-004
    Material Weakness Repeat
  • 540408 2024-004
    Material Weakness Repeat
  • 540409 2024-004
    Material Weakness Repeat
  • 540410 2024-005
    Material Weakness Repeat
  • 540411 2024-005
    Material Weakness Repeat
  • 540412 2024-005
    Material Weakness Repeat
  • 540413 2024-009
    Significant Deficiency
  • 1116831 2024-008
    Material Weakness Repeat
  • 1116832 2024-008
    Material Weakness Repeat
  • 1116833 2024-006
    Material Weakness Repeat
  • 1116834 2024-006
    Material Weakness Repeat
  • 1116835 2024-007
    Material Weakness Repeat
  • 1116836 2024-007
    Material Weakness Repeat
  • 1116837 2024-010
    Material Weakness Repeat
  • 1116838 2024-011
    Significant Deficiency Repeat
  • 1116839 2024-012
    Significant Deficiency Repeat
  • 1116840 2024-013
    Significant Deficiency Repeat
  • 1116841 2024-013
    Significant Deficiency Repeat
  • 1116842 2024-013
    Significant Deficiency Repeat
  • 1116843 2024-014
    Significant Deficiency
  • 1116844 2024-014
    Significant Deficiency
  • 1116846 2024-003
    Significant Deficiency Repeat
  • 1116847 2024-003
    Significant Deficiency Repeat
  • 1116848 2024-003
    Significant Deficiency Repeat
  • 1116849 2024-004
    Material Weakness Repeat
  • 1116850 2024-004
    Material Weakness Repeat
  • 1116851 2024-004
    Material Weakness Repeat
  • 1116852 2024-005
    Material Weakness Repeat
  • 1116853 2024-005
    Material Weakness Repeat
  • 1116854 2024-005
    Material Weakness Repeat
  • 1116855 2024-009
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $2.37B
10.551 Supplemental Nutrition Assistance Program $745.53M
93.558 Temporary Assistance for Needy Families $82.28M
93.767 Children's Health Insurance Program $54.79M
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $29.27M
93.575 Child Care and Development Block Grant $26.75M
21.027 Coronavirus State and Local Fiscal Recovery Funds $24.92M
93.658 Foster Care Title IV-E $15.63M
93.667 Social Services Block Grant $14.83M
93.659 Adoption Assistance $14.65M
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $13.95M
10.542 Pandemic Ebt Food Benefits $13.09M
84.126 Rehabilitation Services Vocational Rehabilitation Grants to States $12.15M
93.568 Low-Income Home Energy Assistance $10.74M
96.001 Social Security Disability Insurance $7.11M
93.090 Guardianship Assistance $4.11M
10.649 Pandemic Ebt Administrative Costs $2.12M
93.556 Marylee Allen Promoting Safe and Stable Families Program $1.14M
93.777 State Survey and Certification of Health Care Providers and Suppliers (title Xviii) Medicare $1.10M
93.671 Family Violence Prevention and Services/domestic Violence Shelter and Supportive Services $734,258
93.464 Acl Assistive Technology $485,000
93.497 Family Violence Prevention and Services/ Sexual Assault/rape Crisis Services and Supports $384,682
93.369 Acl Independent Living State Grants $377,457
97.088 Disaster Assistance Projects $369,040
94.011 Americorps Seniors Foster Grandparent Program (fgp) 94.011 $364,552
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $361,517
93.747 Elder Abuse Prevention Interventions Program $312,366
14.241 Housing Opportunities for Persons with Aids $298,340
93.669 Child Abuse and Neglect State Grants $282,703
93.645 Stephanie Tubbs Jones Child Welfare Services Program $276,140
14.231 Emergency Solutions Grant Program $242,657
94.016 Americorps Seniors Senior Companion Program (scp) 94.016 $235,809
93.603 Adoption and Legal Guardianship Incentive Payments Program $206,000
16.540 Juvenile Justice and Delinquency Prevention $155,408
93.599 Chafee Education and Training Vouchers Program (etv) $104,083
84.177 Rehabilitation Services Independent Living Services for Older Individuals Who Are Blind $97,509
93.643 Children's Justice Grants to States $91,803
84.187 Supported Employment Services for Individuals with the Most Significant Disabilities $80,551
93.566 Refugee and Entrant Assistance State/replacement Designee Administered Programs $37,222
10.537 Supplemental Nutrition Assistance Program (snap) Employment and Training (e&t) Data and Technical Assistance Grants $3,629