FAC Explorer

Finding 1203116 (2025-006)

Material Weakness Repeat Finding
Requirement
ABE
Questioned Costs
-
Year
2025
Accepted
2026-03-30
Audit: 396345
Organization: Department of Human Services (HI)
Auditor: ACCUITY LLP

AI Summary

  • Core Issue: One enrollment's benefits were not terminated on time after failing to provide necessary verification, indicating a repeat compliance issue.
  • Impacted Requirements: Noncompliance with Title 42 CFR Part 435.912 and 435.916 regarding timely eligibility determinations and annual re-verifications.
  • Recommended Follow-Up: Implement training and standard operating procedures to improve compliance with eligibility determination processes.

Finding Text

Condition During our audit, we selected a non-statistical sample of 60 individuals for testing out of a population of approximately 434,000 enrollments. The enrollments selected for testing represented approximately $286,000 of payments out of a total payment population of $2.1 billion. We identified one enrollment whose benefits were not timely terminated after failing to provide verification to support revalidation. A similar finding was reported in the prior year as Finding No. 2024-014. Criteria Title 42 CFR Part 435.912 requires the timely determination of eligibility of individuals who apply for Medicaid benefits within 1) 90 days for applicants who apply for Medicaid on the basis of disability (MAGI-excepted), and 2) 45 days for all other applicants (MAGI). In addition, Title 42 CFR Part 435.916 requires annual re-verifications of participant eligibility. Effect Failure to follow the established policies and procedures in place over the Medicaid eligibility determination process represents an instance of noncompliance with the requirements of 2 CFR Part 200, resulting in questioned costs. Cause and View of Responsible Officials Although the Department has policies and procedures in place requiring the maintenance of required documentation, there was a lack of diligence in complying with the policies and procedures. Recommendation We recommend the Department implement training and standard operating procedures to ensure eligibility determinations are completed in a timely manner.

Corrective Action Plan

Views of Responsible Officials: The Department agrees with the finding and will implement corrective action. Upon review of the case, it was determined that the caseworker did not trigger a renewal in the Kauhale On-Line Eligibility Assistance System (KOLEA) when the member called to renew by phone. The member reported income to the worker and was advised to provide verification; however, the worker did not trigger a renewal in the system, which prevented an N01 notice from being sent to request verification. The case remained open because the worker did not trigger a Verification Line Item (VLI) for income for the member in KOLEA. The case was later processed through a system data fix, and the member was ex parte renewed and given a new certification period. Corrective Action Taken or Planned: The Eligibility Renewals: Processing DHS 1100B-2 Form Job Aid will be updated to provide instructions for processing non-ex parte renewals completed by phone. Steps on how to properly trigger a renewal in KOLEA will be added to the existing guidance, including detailed screenshots. These updates will enable workers to process renewals consistently, whether they are submitted via form or conducted by phone. The additions to the Job Aid will ensure that a renewal is triggered correctly in the system and that request for verification N01 notices are triggered appropriately when non-ex parte renewals are completed by phone. Expected Completion Date: March 18, 2026 Responding Official(s): Lori-Lei Aponte, Med-QUEST Eligibility and Enrollment Administrator

Categories

Eligibility Reporting

Other Findings in this Audit

  • 1203108 2025-009
    Material Weakness Repeat
  • 1203109 2025-010
    Material Weakness Repeat
  • 1203110 2025-007
    Material Weakness Repeat
  • 1203111 2025-008
    Material Weakness Repeat
  • 1203112 2025-011
    Material Weakness Repeat
  • 1203113 2025-012
    Material Weakness Repeat
  • 1203114 2025-013
    Material Weakness Repeat
  • 1203115 2025-006
    Material Weakness Repeat
  • 1203117 2025-014
    Material Weakness Repeat
  • 1203118 2025-014
    Material Weakness Repeat
  • 1203119 2025-014
    Material Weakness Repeat
  • 1203120 2025-003
    Material Weakness Repeat
  • 1203121 2025-004
    Material Weakness Repeat
  • 1203122 2025-005
    Material Weakness Repeat
  • 1203123 2025-003
    Material Weakness Repeat
  • 1203124 2025-004
    Material Weakness Repeat
  • 1203125 2025-005
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
93.778 MEDICAL ASSISTANCE PROGRAM $2.15B
10.551 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM $694.52M
93.558 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES $65.98M
93.767 CHILDREN'S HEALTH INSURANCE PROGRAM $59.50M
10.561 STATE ADMINISTRATIVE MATCHING GRANTS FOR THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM $36.81M
10.646 SUMMER ELECTRONIC BENEFIT TRANSFER PROGRAM FOR CHILDREN $32.44M
21.027 CORONAVIRUS STATE AND LOCAL FISCAL RECOVERY FUNDS $24.00M
93.575 CHILD CARE AND DEVELOPMENT BLOCK GRANT $21.36M
93.658 FOSTER CARE TITLE IV-E $19.10M
93.667 SOCIAL SERVICES BLOCK GRANT $16.55M
84.126 REHABILITATION SERVICES VOCATIONAL REHABILITATION GRANTS TO STATES $15.12M
93.659 ADOPTION ASSISTANCE $14.73M
93.596 CHILD CARE MANDATORY AND MATCHING FUNDS OF THE CHILD CARE AND DEVELOPMENT FUND $14.33M
96.001 SOCIAL SECURITY DISABILITY INSURANCE $7.86M
93.568 LOW-INCOME HOME ENERGY ASSISTANCE $7.75M
97.088 DISASTER ASSISTANCE PROJECTS $5.87M
93.090 GUARDIANSHIP ASSISTANCE $4.11M
14.231 EMERGENCY SOLUTIONS GRANT PROGRAM $1.74M
93.777 STATE SURVEY AND CERTIFICATION OF HEALTH CARE PROVIDERS AND SUPPLIERS (TITLE XVIII) MEDICARE $1.30M
93.556 MARYLEE ALLEN PROMOTING SAFE AND STABLE FAMILIES PROGRAM $940,051
93.671 FAMILY VIOLENCE PREVENTION AND SERVICES/DOMESTIC VIOLENCE SHELTER AND SUPPORTIVE SERVICES $736,396
93.464 ACL ASSISTIVE TECHNOLOGY $683,572
93.747 ELDER ABUSE PREVENTION INTERVENTIONS PROGRAM $594,270
93.645 STEPHANIE TUBBS JONES CHILD WELFARE SERVICES PROGRAM $571,294
93.669 CHILD ABUSE AND NEGLECT STATE GRANTS $517,826
94.011 AMERICORPS SENIORS FOSTER GRANDPARENT PROGRAM (FGP) 94.011 $416,327
84.177 REHABILITATION SERVICES INDEPENDENT LIVING SERVICES FOR OLDER INDIVIDUALS WHO ARE BLIND $396,635
14.241 HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS $298,741
93.497 FAMILY VIOLENCE PREVENTION AND SERVICES/ SEXUAL ASSAULT/RAPE CRISIS SERVICES AND SUPPORTS $257,427
94.016 AMERICORPS SENIORS SENIOR COMPANION PROGRAM (SCP) 94.016 $216,950
93.603 ADOPTION AND LEGAL GUARDIANSHIP INCENTIVE PAYMENTS PROGRAM $206,000
93.369 ACL INDEPENDENT LIVING STATE GRANTS $185,836
93.643 CHILDREN'S JUSTICE GRANTS TO STATES $151,193
16.540 JUVENILE JUSTICE AND DELINQUENCY PREVENTION $136,367
93.674 JOHN H. CHAFEE FOSTER CARE PROGRAM FOR SUCCESSFUL TRANSITION TO ADULTHOOD $104,863
84.187 SUPPORTED EMPLOYMENT SERVICES FOR INDIVIDUALS WITH THE MOST SIGNIFICANT DISABILITIES $104,639
93.599 CHAFEE EDUCATION AND TRAINING VOUCHERS PROGRAM (ETV) $90,544
93.968 STATES ADVANCING ALL-PAYER HEALTH EQUITY APPROACHES AND DEVELOPMENT (AHEAD) MODEL $57,137
93.791 MONEY FOLLOWS THE PERSON REBALANCING DEMONSTRATION $36,428
93.566 REFUGEE AND ENTRANT ASSISTANCE STATE/REPLACEMENT DESIGNEE ADMINISTERED PROGRAMS $17,218