FAC Explorer

Finding 1124405 (2024-001)

Material Weakness
Requirement
E
Questioned Costs
-
Year
2024
Accepted
2025-03-31
Audit: 351887
Organization: County of El Dorado (CA)
Auditor: Lance Soll & Lunghard CPAS

AI Summary

  • Core Issue: The County did not meet the 45-day eligibility determination timeline for Medicaid, violating both federal and internal guidelines.
  • Impacted Requirements: Compliance with OMB regulations (42 CFR 435.912) mandates timely eligibility determinations, which were exceeded for selected participants.
  • Recommended Follow-Up: Address the backlog by increasing staffing and improving processes to ensure future determinations meet the 45-day requirement.

Finding Text

Reference Number 2024-001 – Delays in Eligibility Determination Evaluation of Finding Material Weakness and Noncompliance Summary of Finding The County failed to meet the eligibility determination timeline of 45 days as required by OMB compliance and its internal policy. LSL noted that for three selected participants, eligibility determinations took longer than the specified timeframe, which is a violation of the established guidelines. Federal Award Information Assistance Listing Number: 93.778 Program Title: Medical Assistance Program (Medicaid) Federal Award Year: 2024 Name of Federal Agency: U.S. Department of Health and Human Services Criteria Per OMB compliance, specifically 42 CFR 435.912, states are required to determine eligibility for Medicaid promptly and without undue delay. For applicants other than those applying based on disability, the eligibility determination must be made within 45 days. For applicants applying based on disability, the determination may not exceed 90 days. The County's internal policy mirrors this 45-day requirement. Condition LSL observed that for three selected participants, the County exceeded the 45-day eligibility determination timeframe, which is in violation of both OMB compliance and internal policy. Cause of Condition The primary cause of the delay was the continuous enrollment clause (2020-2023) implemented during the COVID-19 pandemic, which led to a backlog in enrollment updates. Additionally, staffing shortages further contributed to delays in processing eligibility determinations. Effect or Potential Effect of Condition The County’s failure to process eligibility determinations within the required 45-day timeframe could result in noncompliance with federal regulations, potentially leading to questioned costs, delays in service provision, and an inability to timely identify and address eligibility changes for participants. Questioned Costs No questioned costs identified. Context The County has faced challenges related to the COVID-19 continuous enrollment provision and a lack of sufficient staff to manage the increased workload during the pandemic. These factors contributed to a backlog and processing delays, preventing timely eligibility determinations. Repeat Finding No. Recommendation We recommend that the County take steps to address the backlog caused by the continuous enrollment clause and consider enhancing staffing levels or implementing streamlined processes to ensure eligibility determinations are completed within the required 45-day timeframe. Additionally, the County should review and improve its internal controls over the eligibility determination process to prevent delays in the future. Views of Responsible Officials We agree with the finding. The delays in eligibility determinations are primarily attributable to the COVID-19 continuous enrollment provisions and subsequent staffing shortages. The County has taken steps to address these issues and has developed a plan to reduce the backlog by increasing staffing and improving internal processes to ensure future compliance with the 45-day eligibility determination requirement.

Categories

Eligibility Material Weakness Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties Special Tests & Provisions

Other Findings in this Audit

  • 547954 2024-001
    Material Weakness
  • 547955 2024-001
    Material Weakness
  • 547956 2024-001
    Material Weakness
  • 547957 2024-001
    Material Weakness
  • 547958 2024-001
    Material Weakness
  • 547959 2024-001
    Material Weakness
  • 547960 2024-001
    Material Weakness
  • 547961 2024-001
    Material Weakness
  • 547962 2024-001
    Material Weakness
  • 547963 2024-001
    Material Weakness
  • 1124396 2024-001
    Material Weakness
  • 1124397 2024-001
    Material Weakness
  • 1124398 2024-001
    Material Weakness
  • 1124399 2024-001
    Material Weakness
  • 1124400 2024-001
    Material Weakness
  • 1124401 2024-001
    Material Weakness
  • 1124402 2024-001
    Material Weakness
  • 1124403 2024-001
    Material Weakness
  • 1124404 2024-001
    Material Weakness

Programs in Audit

ALN Program Name Expenditures
10.766 Community Facilities Loans and Grants $49.25M
21.027 Coronavirus State and Local Fiscal Recovery Funds $14.50M
14.239 Home Investment Partnerships Program $7.13M
93.558 Temporary Assistance for Needy Families $5.60M
14.228 Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii $4.03M
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $3.77M
93.563 Child Support Services $2.67M
21.019 Coronavirus Relief Fund $1.85M
93.658 Foster Care Title IV-E $1.69M
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $1.23M
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $915,801
21.032 Local Assistance and Tribal Consistency Fund $862,142
10.665 Schools and Roads - Grants to States $821,416
10.690 Lake Tahoe Erosion Control Grant Program $468,525
90.401 Help America Vote Act Requirements Payments $459,782
14.871 Section 8 Housing Choice Vouchers $453,348
93.268 Immunization Cooperative Agreements $425,952
93.045 Special Programs for the Aging, Title Iii, Part C, Nutrition Services $411,783
93.044 Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers $388,235
20.616 National Priority Safety Programs $277,320
20.205 Highway Planning and Construction $263,771
93.667 Social Services Block Grant $257,212
93.659 Adoption Assistance $248,428
93.569 Community Services Block Grant $180,028
93.977 Sexually Transmitted Diseases (std) Prevention and Control Grants $175,625
66.956 Targeted Airshed Grant Program $164,893
16.738 Edward Byrne Memorial Justice Assistance Grant Program $152,681
93.958 Block Grants for Community Mental Health Services $152,378
93.889 National Bioterrorism Hospital Preparedness Program $152,164
16.922 Equitable Sharing Program $150,000
97.067 Homeland Security Grant Program $146,506
15.514 Reclamation States Emergency Drought Relief $144,320
14.231 Emergency Solutions Grant Program $139,645
93.053 Nutrition Services Incentive Program $135,142
90.404 Hava Election Security Grants $135,000
93.568 Low-Income Home Energy Assistance $132,952
93.556 Marylee Allen Promoting Safe and Stable Families Program $131,015
16.588 Violence Against Women Formula Grants $125,268
93.052 National Family Caregiver Support, Title Iii, Part E $122,050
93.645 Stephanie Tubbs Jones Child Welfare Services Program $109,748
93.994 Maternal and Child Health Services Block Grant to the States $103,366
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $95,173
16.575 Crime Victim Assistance $78,352
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $76,653
14.879 Mainstream Vouchers $72,699
93.603 Adoption and Legal Guardianship Incentive Payments Program $56,497
93.767 Children's Health Insurance Program $56,475
93.069 Public Health Emergency Preparedness $49,657
93.590 Community-Based Child Abuse Prevention Grants $44,124
21.016 Equitable Sharing $42,237
93.747 Elder Abuse Prevention Interventions Program $41,107
93.967 Centers for Disease Control and Prevention Collaboration with Academia to Strengthen Public Health $38,474
93.042 Special Programs for the Aging, Title Vii, Chapter 2, Long Term Care Ombudsman Services for Older Individuals $36,678
93.671 Family Violence Prevention and Services/domestic Violence Shelter and Supportive Services $32,687
20.106 Airport Improvement Program, Infrastructure Investment and Jobs Act Programs, and Covid-19 Airports Programs $19,852
93.043 Special Programs for the Aging, Title Iii, Part D, Disease Prevention and Health Promotion Services $19,706
93.499 Low Income Household Water Assistance Program $18,743
10.025 Plant and Animal Disease, Pest Control, and Animal Care $18,047
15.507 Watersmart (sustain and Manage America’s Resources for Tomorrow) $15,495
97.042 Emergency Management Performance Grants $14,110
97.039 Hazard Mitigation Grant $11,827
14.267 Continuum of Care Program $11,435
10.576 Senior Farmers Market Nutrition Program $8,000
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $6,819
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $5,000
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $4,660
93.090 Guardianship Assistance $4,550
93.150 Projects for Assistance in Transition From Homelessness (path) $3,102
16.U01 Edward Byrne Memorial State and Local Law Enforcement Assistance Discretionary Grants Program - Dcesp $2,951
93.778 Medical Assistance Program $2,816
93.566 Refugee and Entrant Assistance State/replacement Designee Administered Programs $2,107
93.959 Block Grants for Prevention and Treatment of Substance Abuse $2,034
97.046 Fire Management Assistance Grant $-1,457