Finding Text
2025-005 Medical Assistance Eligibility Federal Agency: U.S. Department of Health and Human Services Program Name: Grants to States for Medicaid (Medical Assistance) ALN: 93.778 Award Number and Year: 2505MN5ADM, 2505MN5MAP, 2025 Pass-Through Agency: Minnesota Department of Human Services Type of Finding; Material Weakness in Internal Control over Compliance and Compliance Criteria: Title 2 U.S. Code of Federal Regulations § 200.303 states that the auditee must establish, document, and maintain effective internal control over the federal award that provides reasonable assurance that the auditee is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. Federal regulations require that eligibility determinations for Medical Assistance participants be supported by adequate documentation maintained in participant case files. Documentation supporting eligibility factors, including income and other information used to determine eligibility, should be retained and available for review. Condition: During our testing of Medical Assistance eligibility determinations, we identified two instances in which eligibility information was not adequately supported by documentation maintained by the County. In one case, income used in the eligibility determination did not agree to the supporting source documentation contained within the case file. In another case, an income source used in the eligibility determination was not supported by documentation maintained in the case file. Additionally, the County has not implemented internal control procedures designed to verify that documentation supporting eligibility factors is obtained, reviewed, and retained prior to approval of eligibility determinations. As a result, unsupported eligibility information was not detected and corrected in a timely manner. Questioned Costs: None. Context: We tested 60 participant case files for compliance with eligibility requirements. Two of the 60 case files tested contained documentation deficiencies related to the support maintained for eligibility determinations. In addition, our review of internal controls determined the County did not have sufficient review controls in place to ensure documentation supporting eligibility determinations was consistently obtained, reviewed, and retained. The sample was not intended to be and was not statistically valid. Cause: County personnel did not consistently ensure that all required eligibility documentation was properly obtained, reviewed, and retained in participant case files. Effect: Without effective internal controls and adequate supporting documentation, the County cannot demonstrate compliance with federal eligibility requirements. This increases the risk that eligibility determinations may be based on inaccurate, incomplete, or unsupported information and increases the risk of noncompliance with federal program requirements. Recommendation: The County should strengthen internal controls over the eligibility determination process to ensure supporting documentation is obtained, reviewed, and retained for all eligibility factors used in determining participant eligibility. Supervisory reviews should include verification that required documentation is present and supports information entered into the eligibility system Repeat Finding: No. Management Response: County management agrees with the finding and will review current procedures, provide additional staff training as necessary, and implement monitoring procedures designed to ensure that eligibility determinations are adequately supported by documentation maintained in participant case files.