Finding 1202931 (2025-001)

Federal Agency: U.S. Department of Health and Human Services Program/Cluster: Medicaid Cluster Federal Assistance Listing Number: 93.778 Pass‐through: California Department of Health Care Services Award No. and Year: 2305CA5MAP, 2505CA5MAP,1946001347 A7, 2024/2025 Compliance Requirement: Eligibility Type of Finding: Material Weakness in Internal Control over Compliance, Material Noncompliance Views of Responsible Officials and Corrective Action Plan: Solano County agrees that eligibility determinations and redeterminations including obtaining documentation and verifications should be performed annually to determine if individuals are eligible in accordance with the compliance requirements of the program. Medicaid Cluster – In-Home Supportive Services (IHSS) There are overdue redeterminations in our system due to the increasing need for IHSS services in Solano County and prioritization of the CDSS IHSS July 1, 2025 compliance mandate for 100% timely redeterminations for Community First Choice Option (CFCO) IHSS clients to prevent fiscal penalties. While we have reached 99% compliance for the IHSS CFCO clients, this has resulted in delays evaluating non-CFCO IHSS clients. In addition, we experienced uncovered caseloads related to Social Worker job transition or leave, more fair hearings and the growing complexity of our client population requiring more case management and re-evaluations throughout the year. We continue to review our IHSS workflow to develop efficiencies to maximize client service delivery. We monitor the performance of our IHSS Social Workers with a standard expectation of monthly client eligibility determinations and redeterminations. This performance management plan has contributed to successfully meeting several of our state compliance markers. Lastly, we continue to participate in State level discussions related to advocacy and increased IHSS administrative funding to support the growing number of IHSS clients. Medicaid Cluster – Medical Assistance The Employment and Eligibility division continues to monitor the performance of eligibility staff and build efficiencies into processes to increase processing timeliness. We recently developed a Customer Reporting Status dashboard that monitors all incomplete redeterminations and periodic reports for timeliness, which will be an effective tool for staff to monitor redetermination processing in order to meet our mandated compliance timelines. In addition, we are in the process of transitioning to a new business model for eligibility staff that perform annual redeterminations. We anticipate that this updated model will streamline workflows and enable staff to complete redeterminations with greater efficiency and timeliness. Responsible Individual(s): Dr. Cameron Kaiser, Chief Deputy Director, Health Officer Gwendolyn Gill, Health Services Administrator Alicia Jones, Deputy Director Health and Social Services Employment and Eligibility Programs Daniel Horel, Employment and Eligibility Administrator Anticipated Completion Date: July 1, 2026