Finding 1174991 (2025-001)

months and ensure verification of information through appropriate systems such as the Income and Eligibility Verification System (IEVS). For non-MAGI beneficiaries, states must renew eligibility at least once every 12 months as described in the Medicaid state plan. Condition: During review of 40 eligibility determinations and redeterminations, we identified two exceptions: one case lacked documentation of IEVS reports required to verify income and eligibility information, and another case had a redetermination completed more than 12 months prior to the active eligibility date, which does not comply with the annual redetermination requirement under 42 CFR 435.916. Questioned costs: None Context: The Medical Assistance Program requires counties to maintain robust eligibility controls to ensure benefits are provided only to qualified individuals. These controls include verifying income and eligibility through systems such as the Income and Eligibility Verification System (IEVS) and conducting annual redeterminations within 12 months of the active eligibility date. Out of 40 eligibility determinations and redeterminations, there are two cases where these controls were not properly implemented, indicating a significant deficiency in internal control. Cause: The deficiencies occurred due to inadequate monitoring and enforcement of established eligibility control procedures by program staff. Effect: Failure to properly implement eligibility controls increases the risk that ineligible individuals may receive benefits under the Medical Assistance Program, potentially resulting in noncompliance with federal requirements and questioned costs. Repeat Finding: This is not a repeat finding. Recommendation: CLA recommends that the County strengthen monitoring procedures to ensure that Income and Eligibility Verification System (IEVS) reports are obtained and retained for all eligibility determinations, implement controls to verify that redeterminations are completed within the required 12- month timeframe prior to the active eligibility date, and provide staff training on compliance requirements and proper documentation standards to reinforce adherence to established policies. Views of responsible officials: There is no disagreement with the audit finding.