Finding 1224495 (2025-002)

Medicaid Eligibility Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Medicaid Assistance Listing Number: 93.778 Federal Award Identification Number and Year: 2505MN5ADM - 2025 Award Period: January 1, 2025 – December 31, 2025 Type of Finding: Material Weakness in Internal Control over Compliance Criteria or specific requirement: A nonfederal entity must: (i) Establish, document, and maintain effective internal control over the Federal award that provides reasonable assurance that the recipient or subrecipient is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should align with the guidance in “Standards for Internal Control in the Federal Government” issued by the Comptroller General of the United States or the “Internal Control-Integrated Framework” issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO); (ii) Comply with the U.S. Constitution, Federal statutes, regulations, and the terms and conditions of the Federal award; (iii) Evaluate and monitor the recipient's or subrecipient's compliance with statutes, regulations, and the terms and conditions of Federal awards; (iv) Take prompt action when instances of noncompliance are identified; and (v) Take reasonable cybersecurity and other measures to safeguard information including protected personally identifiable information (PII) and other types of information. This also includes information the Federal agency or pass-through entity designates as sensitive or other information the recipient or subrecipient considers sensitive and is consistent with applicable Federal, State, local, and tribal laws regarding privacy and responsibility over confidentiality. Condition: The County’s control over Medicaid eligibility casefile reviews requires supervisors to identify errors and ensure corrections are made. However, in instances where casefile reviews identified required corrections, documentation was not maintained to support that follow-up procedures were performed and that the corrections were completed. Questioned costs: None Context: During testing, four of forty casefiles lacked documentation demonstrating that supervisory follow-up was performed to verify that identified corrections were completed. Cause: The County has had significant turnover and new staff over the past few years as well as increases in caseloads. There was also changing guidance as waivers from the pandemic expired. All of this provided more opportunities for errors to occur. Effect: Improper input or updating of information in MAXIS and lack of verification or follow-up of eligibility determining factors increase the risk that a program participant will receive benefits when they are not eligible. Repeat Finding: No. Recommendation: We recommend the County strengthen its supervisory review control over Medicaid eligibility casefile reviews by implementing procedures to ensure that identified errors or required corrections are documented, followed up on, and verified as completed in a timely manner. Views of responsible officials: Management does not disagree with the finding.