Finding 1169098 (2025-001)

Management Response: The Public Assistance and Employment Services (PAES) Division of Fairfax County Department of Family Services (DFS) acknowledges the audit finding regarding Medicaid renewals. These late renewals are attributed to the timing and cadence of Medicaid Unwinding requirements post pandemic. From March 2020 to March 2023, a federal waiver was issued, pausing annual renewal processes for Medicaid eligibility. During this time, changes in household financial circumstances, which rendered prior enrollee’s ineligible under traditional Medicaid criteria, were not in effect. When redetermination resumed these cases were deemed ineligible at the appropriate time, consistent with federal policy. PAES prepared for the resumption of suspended Medicaid renewals beginning in January 2023. An internal Medicaid Unwinding Steering and Implementation Committee (MUSIC) was created to oversee the reinstatement of the redetermination process and analyze the strategy for achieving redetermination of suspended renewal cases. In April 2023, PAES began the redetermination process for suspended Medicaid renewals in addition to reviewing new applications. The County faced a backlog of more than 54,000 suspended cases alongside 125,000 current active Medicaid cases for rolling renewals during the unwinding period. During this time, PAES instituted several operational strategies to manage backlogs and new cases by prioritizing a portion of suspended renewals each month, collaborating with the Virginia Department of Social Services (VDSS), providing training and IT tools for monitoring case statuses, and holding monthly progress tracking sessions. By February 2024, the County had processed 32,000 suspended renewals (62%), and by the end of May 2024, completion reached 97% of all suspended cases. During FY 2025, the number of current renewals continued to be impacted by the redirection of resources to move through the suspended pandemic-related renewals. As a result, PAES established an Overdue Medicaid Renewal Project to take action on approximately 8,000 current renewals. This effort resulted in an 80% reduction in the number of overdue renewals. As of December 2025, PAES has restructured teams with a unit dedicated to ongoing Medicaid-only renewals for more efficient work and in preparation for new legislation. The County has successfully managed its workload and ensured compliance even under exceptional challenges and policy waivers imposed by federal agencies during the pandemic. The County maintains robust processes to ensure the future timeliness of Medicaid renewals while adhering to state and federal requirements. Currently, the timeliness of Medicaid renewals is 97.7 %. The strategic measures outlined above will continue to improve our overall compliance in FY 2026.