Finding 1238605 (2025-003)

2025-003 Eligibility - MAXIS Prior Year Finding Number: 2024-004 Year of Finding Origination: 2024 Type of Finding: Internal Control Over Compliance and Compliance Severity of Deficiency: Material Weakness and Modified Opinion Federal Agency: U.S. Department of Health and Human Services Program: 93.778 Grants to States for Medicaid Award Number and Year: 2205MN5ADM; 2025 Pass-Through Agency: Minnesota Department of Human Services 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. Title 42 U.S. Code of Federal Regulations §§ 435.911 and 435.945 require the state Medicaid agency to determine and verify eligibility of enrollees in Medicaid. The Minnesota Department of Human Services provides the Minnesota Health Care Programs Eligibility Policy Manual. The manual contains the Minnesota Department of Human Services eligibility policies for the Minnesota Health Care Programs, including the eligibility requirements of Grants to States for Medicaid. Specific eligibility requirements are included for recipients’ citizenship verification, income limits, applications, and asset verification. Minnesota Statutes, Section 256B.05, requires county agencies to administer Grants to States for Medicaid. Condition: The Minnesota Department of Human Services maintains the computer system, MAXIS, which is used by Ramsey County to support the eligibility determination process. In the recipient files reviewed for eligibility, not all documentation to support recipient eligibility was available, updated, or input correctly. The following exceptions were noted in the sample of 40 MAXIS recipient files tested: • Two recipients’ files in which the application was not documented; • One recipient file in which the verification of citizenship was not documented; • Three recipients’ files in which the verification of income was not documented, or documentation did not agree with MAXIS; • Six recipients’ files in which the verification of assets was not documented, or documentation did not agree with MAXIS; and • One recipient was incorrectly enrolled in a specific program type in MAXIS. Questioned Costs: Not applicable. The County administers the program, but the State of Minnesota pays benefits to recipients in this program. Context: The State of Minnesota and the County split the eligibility determination process. Pursuant to Minnesota statutes, Ramsey County performs the “intake function” needed for this program, while the State maintains the MAXIS system, which supports the eligibility determination process. Recipients receive benefit payments from the State. The population consisted of 30,409 active MAXIS recipients enrolled in Grants to States for Medicaid in 2025; the sample size was 40 recipients. The sample size was based on guidance from Chapter 11 of the AICPA Audit Guide, Government Auditing Standards and Single Audits. Effect: The improper input or updating of information in MAXIS and lack of verification or follow-up of eligibility determining factors increase the risk that program recipients will receive benefits when they are not eligible. Cause: Program personnel entering recipient file information into MAXIS did not ensure all required information was input correctly, supported, and retained. Recommendation: We recommend Ramsey County implement additional procedures to provide reasonable assurance that all documentation needed to support eligibility determinations exists, the program personnel properly input or update the documentation in MAXIS, and the program personnel follow up on issues in a timely manner. In addition, Ramsey County should consider providing further training to program personnel. View of Responsible Official: Concur