FAC Explorer

Finding 1168188 (2024-007)

Material Weakness Repeat Finding
Requirement
E
Questioned Costs
-
Year
2024
Accepted
2026-01-07
Audit: 379965
Organization: County of Humboldt (CA)
Auditor: CLIFTONLARSONALLEN LLP

AI Summary

  • Core Issue: Two out of 60 cases had eligibility redeterminations done outside the required 12-month period, leading to potential non-compliance with federal regulations.
  • Impacted Requirements: States must renew eligibility for MAGI and non-MAGI beneficiaries at least once every 12 months as per 42 CFR 435.916.
  • Recommended Follow-Up: Implement tracking procedures for supervisor reviews and provide refresher training on renewal timelines to improve compliance and oversight.

Finding Text

Federal agency: Centers for Medicare and Medicaid Services Federal program title: Medical Assistance Program Assistance Listing Number: 93.778 Pass-Through Agency: State of California, Department of Health Care Services Pass-Through Number(s): N/A Award Period: July 1, 2023 to June 30, 2024 Type of Finding: Significant deficiency in Internal Control over Compliance, Other Matters Criteria: As required at 42 CFR 435.916, states must renew MAGI-based determinations of eligibility once every 12 months and no more frequently than once every 12 months. For non-MAGI beneficiaries, states must renew eligibility at least once every 12 months as described in the Medicaid state plan. Condition: During the review of 60 sampled cases, 2 cases were found where redeterminations were performed outside the required 12-month window, indicating non-compliance with federal renewal timing requirements. And one of the two cases were deemed ineligible during the re-evaluation. Questioned costs: None Context: Out of 60 sampled cases, 2 cases had redeterminations performed outside the federally required 12-month window. And one of the two cases were deemed ineligible during the re-evaluation. Additionally, of the 60 cases scheduled for lead or supervisor-level review, 6 were not completed in accordance with the review requirements. This gap in oversight may contribute to procedural inconsistencies and potential noncompliance with Medicaid renewal protocols. Cause: The delay in performing redeterminations beyond the required 12-month window was due to understaffing, which limited the team's capacity to process eligibility renewals in a timely manner. Additionally, the failure to complete scheduled lead/supervisor reviews in 6 cases was attributed to ineffective internal controls, including insufficient tracking and oversight mechanisms to ensure that supervisory reviews were consistently executed. Effect: Failure to perform redeterminations within the required 12-month timeframe may result in individuals retaining Medicaid coverage beyond their eligibility period, potentially leading to inaccurate benefit payments and noncompliance with federal regulations. Additionally, the absence of scheduled lead/supervisor reviews weakens oversight and quality assurance processes, increasing the risk of procedural errors, inconsistent eligibility determinations, and reduced program integrity. Repeat Finding: This is not a repeat finding. Recommendation: CLA recommends that the County implement or reinforce tracking procedures, such as a monitoring checklist, to ensure lead and supervisor reviews are completed and accountability is maintained. Additionally, CLA recommends that the County conduct targeted refresher training for staff and supervisors on renewal timelines and review protocols to strengthen procedural compliance and minimize errors. Views of responsible officials: There is no disagreement with the audit finding.

Corrective Action Plan

Condition: During the review of 60 sampled cases, 2 cases were found where redeterminations were performed outside the required 12-month window, indicating non-compliance with federal renewal timing requirements. And one of the two cases were deemed ineligible during the re-evaluation. Recommendation: CLA recommends that the County implement or reinforce tracking procedures, such as a monitoring checklist, to ensure lead and supervisor reviews are completed and accountability is maintained. Additionally, CLA recommends that the County conduct targeted refresher training for staff and supervisors on renewal timelines and review protocols to strengthen procedural compliance and minimize errors. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action planned in response to finding: Retrain supervisory staff and line-staff regarding the importance of timely redetermination. Increase reporting, especially exceptions reporting, on the status of outstanding redeterminations. Commitment to continued periodic trainings. Name(s) of the contact person(s) responsible for corrective action: Connie Beck Planned completion date for corrective action plan: Fiscal year ended June 30, 2026

Categories

Eligibility Internal Control / Segregation of Duties Subrecipient Monitoring Significant Deficiency

Other Findings in this Audit

  • 1168175 2024-006
    Material Weakness Repeat
  • 1168176 2024-006
    Material Weakness Repeat
  • 1168177 2024-006
    Material Weakness Repeat
  • 1168178 2024-006
    Material Weakness Repeat
  • 1168179 2024-006
    Material Weakness Repeat
  • 1168180 2024-007
    Material Weakness Repeat
  • 1168181 2024-007
    Material Weakness Repeat
  • 1168182 2024-007
    Material Weakness Repeat
  • 1168183 2024-007
    Material Weakness Repeat
  • 1168184 2024-007
    Material Weakness Repeat
  • 1168185 2024-007
    Material Weakness Repeat
  • 1168186 2024-007
    Material Weakness Repeat
  • 1168187 2024-007
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
93.558 Temporary Assistance for Needy Families (CEC) $15.51M
20.106 COVID-19 Airport Improvement Program (COVID) $15.05M
14.239 HOME - Outstanding Loans $13.73M
93.659 Adoption Assistance (CA 800) $9.80M
93.778 Medical Assistance Program (CEC) $8.92M
93.658 Foster Care Title IV-E (CEC) $8.25M
10.561 STATE ADMINISTRATIVE MATCHING GRANTS FOR THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM $8.22M
20.205 Emergency Relief $6.88M
93.558 Temporary Assistance for Needy Families (CA 800) $5.83M
20.205 Highway Bridge Replacement & Rehabiliitation $5.80M
20.205 Active Transportation Program $3.91M
93.563 Child Support Enforcement $2.80M
21.027 COVID-19 Coronavirus State and Local Fiscal Recovery Funds $2.77M
14.228 CDBG - Outstanding Loans $2.29M
97.036 DISASTER GRANTS - PUBLIC ASSISTANCE $2.21M
93.658 Foster Care Title IV-E (CA 800) $1.74M
10.578 Special Supplemental Nutrition Program for Women, Infants, and Children $1.18M
15.226 Federal in Lieu - Public Land $1.12M
93.778 Medi-Cal Administrative Activities $1.12M
93.959 Substance Abuse Block Grant (SABG) $1.08M
93.090 Guardianship Assistance (CA 800) $913,548
93.958 Community Mental Health Services Block Grant (MHBG) $856,832
97.036 FEMA - COVID-19 Assistance project #684142 $765,189
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Enhancing Detection Expansion $754,279
97.036 FEMA - COVID-19 Assistance project #684343 $740,508
93.747 Elder Abuse Prevention Interventions Program (CEC) $698,799
97.036 FEMA - COVID-19 Assistance project #684350 $594,896
10.664 Flash USDA Clearinghouse Grant $565,011
93.667 Social Services Block Grant (CA 800) $482,302
97.036 FEMA - COVID-19 Assistance project #181067 $464,463
10.665 Secure Rural Schools Title III $430,146
93.268 COVID-19 California Immunization Program Covid-19 $423,995
17.258 Workforce Investment and Opportunity Act (WIOA) Adult $421,082
16.575 Victim Witness Assistance Program - VW $371,067
93.069 Federal Reimbursement Grant (Public Health Emergency Preparedness Lab) $345,728
17.278 Workforce Investment and Oppurtunity Act (WIOA) Additional Assistance Offshore Wind $345,508
93.778 California Childrens Services $325,806
97.036 FEMA - COVID-19 Assistance project #168652 $314,806
93.994 Maternal Child And Adolescent Health $303,429
93.667 Social Services Block Grant (CEC) $253,484
10.551 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM $243,623
97.056 Port Security Grant Program $236,250
16.803 Byrne JAG State $233,495
93.659 Adoption Assistance (CEC) $227,579
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Enhancing Detection $219,876
93.958 American Rescue Plan Act (ARPA) (MHBG supplemental) $201,855
93.778 Targeted Case Management $179,523
17.258 Workforce Investment and Oppurtunity Act (WIOA) Adult $178,024
93.959 American Rescue Plan Act (ARPA) (SABG supplemental) $167,241
97.067 Homeland Security Grant Program FY21 $162,210
93.674 Chafee Foster Care Independence Program $159,826
93.889 NATIONAL BIOTERRORISM HOSPITAL PREPAREDNESS PROGRAM $158,346
93.917 HIV CARE Program X07 $151,798
93.069 Public Health Emergency Preparedness $150,610
93.778 CHDP - Health Care Program for Children in Foster Care $144,331
17.259 Workforce Investment and Opportunity Act (WIOA) Youth $134,336
17.277 Workforce Investment and Opportunity Act (WIOA) NDWG $129,760
14.228 CDBG Redwood Rural Hospital Roads (COVID) $123,400
14.241 Housing Opportunities for Persons with AIDS (HOPWA) $121,411
93.323 COVID-19 ELC Detection & Mitigation of COVID-19 in Confinement Facilities Funding $118,545
93.556 Promoting Safe and Stable Families (CEC) $116,009
16.588 Probation Specialized Units (PU) Program $111,346
17.278 Workforce Investment and Oppurtunity Act (WIOA) Dislocated Worker $109,000
93.778 CHDP - HCPCFC Foster Care Administration $108,476
93.354 COVID-19 Public Health Workforce Supplemental Funding $107,656
17.278 Workforce Investment and Oppurtunity Act (WIOA) Rapid Response $104,220
11.473 Intertidal Coastal Marsh Restoration and Transportation Corridor Protection in Humboldt Bay $103,042
93.645 STEPHANIE TUBBS JONES CHILD WELFARE SERVICES PROGRAM $102,068
97.042 Emergency Management Performance Grant FY23 $101,205
16.575 Victim Witness Assistance Program -VW $99,057
14.267 Continuum of Care Program (HART) $97,143
20.205 Highway Safety Improvement Program $79,405
93.323 LAB Advanced Molecular Detection (AMD) $73,110
10.664 Clearinghouse 2021 Phase III $72,443
16.202 Domestic Cannabis Eradication/Suppression Program (DCE/SP) FY22 $69,696
16.588 Violence Against Women Vertical Prosecution $66,768
93.778 CHDP - HCPCFC Caseload Realief $66,679
93.069 Pandemic Flu $61,606
14.228 CDBG Redwood Rural Hospital Sidewalks (COVID) $56,559
97.042 Emergency Management Performance Grant FY22 $47,655
16.575 Child Advocacy Center Program - KC $45,945
97.067 Homeland Security Grant Program FY22 $45,348
93.778 Child Health and Disability Prevention $41,098
14.239 HOME Program Income Expenses $34,577
16.202 Domestic Cannabis Eradication/Suppression Program (DCE/SP) FY21 $32,475
93.090 Guardianship Assistance (CEC) $31,190
10.555 NATIONAL SCHOOL LUNCH PROGRAM $30,751
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases SHARP $29,375
16.606 Criminal Alien Assistance Program (SCAAP) $28,094
16.738 Byrne JAG Local Grant 2023 $23,071
16.738 Edward Bryne Memorial Justice Assistance Grant Program $20,000
97.067 Homeland Security Grant Program FY20 $19,263
17.278 Workforce Investment and Oppurtunity Act (WIOA) Rapid Response Layoff Aversion $18,693
10.025 Phytophthora Ramorum $18,561
93.276 Drug Free Communities $18,329
66.818 Brownfield Grant $14,069
93.778 CHDP - HCPCFC PMM&O $10,589
10.704 USDA Forest Services Campground/Patrol $7,619
93.603 Adoptions Incentives (CEC) $6,481
93.566 Refugee and Entrant Assistance State Administered Program $6,394
16.607 Bulletproof Vest Program (BVP) $5,650
16.804 Byrne JAG Local Grant 2022 $4,375
10.025 Asian Defoliating Moth Survey $3,060
10.025 PDCP/GWSS/Bio Control $2,135
97.039 Hazard Mitigation Grant Program $1,117
14.228 CDBG Microenterprise Program $292
14.228 CDBG Humboldt Inn - Elevator (COVID) $253
14.228 CDBG Boyd Road Homeless Shelter Improvements (COVID) $179