Finding 480996 (2023-001)

-
Requirement
E
Questioned Costs
-
Year
2023
Accepted
2024-08-13

AI Summary

  • Core Issue: Indiana University Health's paperless system limits our ability to verify WIC eligibility compliance, leading to a qualified opinion.
  • Impacted Requirements: Eligibility criteria outlined in 7 CFR sections 246.7 are not fully verifiable due to lack of documentation.
  • Recommended Follow-Up: No corrective action is planned, as the current system aligns with state and federal guidance.

Finding Text

Finding 2023-001 (Scope Limitation – E. Eligibility) Identification of the federal program: Federal Agency: United States Department of Agriculture Assistance Listing No.: 10.557 – Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Pass-through Entity and Award Periods: Indiana Department of Health – October 1, 2022 through September 30, 2023 and October 1, 2023 through September 30, 2024 Criteria or specific requirement (including statutory, regulatory or other citation): Applicants for WIC Program benefits are screened at WIC clinic sites to determine their WIC eligibility. To be a certified eligible, they must meet various eligibility criteria as outlined in 7 CFR sections 246.7(c), (d), (e), (g), and (l). When an applicant meets all eligibility criteria, he/she is determined by WIC clinic staff to be eligible for program benefits. Certification periods are assigned to each participant based on categorical status for women, infants, and children (7 CFR section 246.7(g)). A WIC local agency assigns each eligible person a priority classification according to the classification system described in 7 CFR section 246.7(e)(4). A person’s priority assignment reflects the severity of his/her nutritional risk. If the local agency cannot immediately place the person on the program for lack of an available caseload slot, the person is placed on a waiting list. Caseload vacancies are filled from the waiting list in priority classification order. State agencies are expected to target program outreach and caseload management efforts toward persons at greatest nutritional risk (i.e., those in the highest priority classifications). Condition: Indiana University Health, Inc. and Subsidiaries screen applicants for eligibility by following the State of Indiana guidelines as provided through the INWIC system used to enter, track, and store information about applicants. Based on guidance from the Department of Agriculture, states were encouraged to move to a paperless system. The State of Indiana has followed that guidance and does not require participating entities to retain copies of an applicant’s proof of residence, income, etc. regarding eligibility. Therefore, we were not able to test internal controls over compliance or compliance over the eligibility compliance requirement and have issued a qualified opinion based on the scope limitation. Cause: Indiana University Health, Inc. and Subsidiaries follow a paperless system as supported by the State of Indiana and the U.S. Department of Agriculture. Effect or potential effect: A scope limitation qualified opinion was issued for Assistance Listing No. 10.557 as we were unable to obtain sufficient documentation supporting the compliance of Indiana University Health, Inc. and Subsidiaries regarding eligibility. Questioned costs: None. Context: Federal expenditures reported in the schedule of expenditures of federal award for Assistance Listing No. 10.557 totaled $1,733,429 for the year ended December 31, 2023. Identification as a repeat finding, if applicable: This is a repeat of finding 2020-001. Recommendation: Not practical. Views of responsible officials: As Indiana University Health, Inc. and Subsidiaries follows the state of Indiana’s paperless system, as described above, which is also supported by 7 CFR 24, no further corrective action will be taken.

Corrective Action Plan

Finding 2023-01 Scope Limitation – Eligibility (ALN 10.557) Indiana University Health utilizes a paperless system in accordance with U.S. Department of Agriculture and State of Indiana guidelines. As such, no corrective action will be taken. Contact Person(s) Responsible for Corrective Action: Christine Smith Anticipated Completion Date: N/A

Categories

Subrecipient Monitoring Eligibility Reporting Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties

Other Findings in this Audit

Programs in Audit

ALN Program Name Expenditures
93.498 Provider Relief Fund $15.94M
93.917 Hiv Care Formula Grants $2.65M
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $1.73M
14.241 Housing Opportunities for Persons with Aids $1.20M
93.767 Children's Health Insurance Program $698,726
93.253 Poison Center Support and Enhancement Grant $605,947
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $488,487
93.866 Aging Research $423,834
93.940 Hiv Prevention Activities_health Department Based $409,083
93.211 Telehealth Programs $348,722
14.267 Continuum of Care Program $297,072
32.006 Covid-19 Telehealth Program $249,879
93.243 Substance Abuse and Mental Health Services_projects of Regional and National Significance $201,317
93.914 Hiv Emergency Relief Project Grants $188,985
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $147,634
16.560 National Institute of Justice Research, Evaluation, and Development Project Grants $144,574
93.959 Block Grants for Prevention and Treatment of Substance Abuse $128,200
93.994 Maternal and Child Health Services Block Grant to the States $105,199
93.889 National Bioterrorism Hospital Preparedness Program $94,495
16.575 Crime Victim Assistance $88,532
93.461 Covid-19 Testing for the Uninsured $64,002
93.969 Pphf Geriatric Education Centers $43,333
93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research $32,896
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $32,500
93.270 Adult Viral Hepatitis Prevention and Control $16,026
93.838 Lung Diseases Research $10,100
93.941 Hiv Demonstration, Research, Public and Professional Education Projects $5,726
93.837 Cardiovascular Diseases Research $200