FAC Explorer

Finding 48768 (2022-018)

Material Weakness Repeat Finding
Requirement
ABE
Questioned Costs
$1
Year
2022
Accepted
2023-03-28
Audit: 52604
Organization: State of Ohio (OH)
Auditor: Keith Faber Auditor of State

AI Summary

  • Core Issue: The Department failed to ensure compliance with eligibility requirements for Medicaid and CHIP, leading to potential erroneous enrollments.
  • Impacted Requirements: Violations of federal regulations regarding eligibility documentation and maintenance during the public health emergency.
  • Recommended Follow-Up: Implement stronger oversight and monitoring processes to ensure accurate eligibility determinations and compliance with federal guidelines.

Finding Text

MEDICAID/CHIP ? ELIGIBILITY Finding Number: 2022-018 State Agency Number: MCD-01 Assistance Listing Numbers and Titles: 93.767 ? Children?s Health Insurance Program (CHIP) 93.767 COVID 19 ? CHIP 93.775/93.777/93.778 ? Medicaid Cluster 93.775/93.777/93.778 COVID 19 ? Medicaid Cluster Federal Award Identification Number / Year: 2105OH5021 / 2021 (CHIP) 2205OH5021 / 2022 (CHIP) 2105OH5MAP / 2021 (Medicaid) 2205OH5MAP / 2022 (Medicaid) Federal Agency: Department of Health and Human Services Compliance Requirements: Activities Allowed or Unallowed, Allowable Costs/Cost Principles, Eligibility Repeat Finding from Prior Audit? Yes Prior Audit Finding Number: 2021-019 QUESTIONED COSTS, NONCOMPLIANCE, AND MATERIAL WEAKNESS NOTE: Finding numbers 2022-001 and 2022-019 contain additional information which is integral to and should be read in conjunction with this finding. 42 C.F.R. ? 435.10, State Plan requirements, pertaining to the Medicaid Cluster states, in part A State plan must--- (a) Provide that the requirements of this part are met; and (b) Specify the groups to whom Medicaid is provided, as specified in subparts B, C, and D of this part, and the conditions of eligibility for individuals in those groups. . . 42 C.F.R. ? 435.914, Case documentation, pertaining to the Medicaid Cluster states, in part: (a) The agency must include in each applicant's case record facts to support the agency's decision on his application. . . 42 C.F.R. ? 433.400, pertaining to continued enrollment during the public health emergency states, in part: . . . (b) Definitions Validly enrolled means that the beneficiary was enrolled in Medicaid based on a determination of eligibility. A beneficiary is not validly enrolled if the agency determines the eligibility was erroneously granted at the most recent determination, redetermination, or renewal of eligibility (if such last determination was completed prior to March 18, 2020) because of agency error or fraud. . . or abuse . . . (c) General Requirements (2) Except as provided in paragraph (d) of this section, for all beneficiaries validly enrolled for benefits . . as of or after March 18, 2020, the state must maintain the beneficiary?s enrollment . . . through the end of the month in which the public health emergency for COVID-19 ends. (i)(A) For beneficiaries whose Medicaid coverage meets the definition of MEC (Minimum Essential Coverage) . . . as of or after March 18, 2020, the state must continue to provide Medicaid coverage that meets the definition of MEC . . . (d) Exceptions (1) . . . a state may terminate a beneficiary?s Medicaid enrollment prior to the first day of the month after the public health emergency for COVID-19 ends in the following circumstances: (i) The beneficiary or beneficiary?s representative requests a voluntary termination of eligibility; (ii) The beneficiary ceases to be a resident of the state; or (iii) The beneficiary dies 42 U.S.C. ? 1397bb (b), pertaining to the Children?s Health Insurance Program (CHIP) states, in part: (1) Eligibility Standards (A) The plan shall include a description of the standards used to determine the eligibility of targeted low-income children for child health assistance under the plan. . . Ohio Admin. Code 5160-26-02.1 states, in part: . . . (B) The Ohio department of Medicaid (ODM) will terminate a member from enrollment in a managed care organization for any of the following reasons: . . . (3) The member dies, in which case MCO enrollment ends on the date of death (C) All of the following apply when enrollment is terminated for any of the reasons set forth in paragraph (B) of this rule: . . . (5) ODM shall recover from the MCO any capitation paid for retroactive enrollment termination occurring as a result of paragraph (B) of this rule. The Medicaid and CHIP State Plan outlines the specific eligibility conditions and standards within Sections 2.2 ? Coverage and Conditions of Eligibility and 2.6 A ? Financial Eligibility, Eligibility Conditions and Requirements for Medicaid and Section 4 ? Eligibility Standards and Methodology for CHIP. During the Public Health Emergency (PHE), the Department issued several Medicaid Eligibility Procedure Letters (MEPLs) to Medicaid personnel, including county caseworkers, on how to address the federal rule changes put into place during the PHE. One such MEPL gave guidance on acceptable and nonacceptable transitions of benefit aid categories to maintain MEC, as described in 42 C.F.R. ? 433.400. It is management?s responsibility to implement policies and procedures to provide reasonable assurance they have complied with these requirements. As the lead agency responsible for administering the CHIP and Medicaid federal grant awards for the State of Ohio, the Department is responsible for providing reasonable assurance only eligible individuals receive assistance and documentation maintained is accurate, complete, and properly recorded in the Ohio Benefits system to ensure appropriate eligibility determinations. It is also the Department?s responsibility to implement sufficient controls, systems, processes, and procedures to reasonably ensure compliance with the rules and regulations associated with these programs and only eligible recipients receive benefits. The Department is responsible for overall program compliance and must have appropriate oversight and monitoring procedures in place to ensure those they rely on are operating in accordance with all expectations, guidelines, and requirements related to their tasks. During state fiscal year (SFY) 2022, the Department disbursed a combined total of $28.5 billion in public assistance payments to recipients processed through the Ohio Benefits system related to the following programs: Assistance Listing Number & Title Benefits Paid # of Recipients* 93.767 - CHIP $667,281,191 222,243 93.7775/93.777/93.778 ? Medicaid Cluster $27,883,701,444 2,965,523 Combined Total $28,550,982,635 3,187,766 *We did not separately identify recipients who could be covered under both programs. These programs are administered using a multi-agency approach, as follows: overall compliance and administration of CHIP and the Medicaid Cluster fall under the Department, and programming and administration of the State?s eligibility determination computer system, Ohio Benefits, falls under the Ohio Department of Administrative Services (DAS). The Ohio Benefits system contains the eligibility and benefit information/determinations for these programs, including the Income Eligibility Verification System (IEVS) functionality which compares reported recipient income to income information maintained by outside data sources (Social Security Administration (SSA), Internal Revenue Services (IRS), etc.). The Department also, through a Memorandum of Understanding with the Ohio Department of Job & Family Services (JFS), utilizes the 88 Ohio counties in the eligibility determination process to work with applicants, receive/enter eligibility documentation into the Ohio Benefits system, and follow up on alerts issued by the system. SYSTEM/CONTROL ISSUES Currently, individuals applying to receive public assistance benefits complete an application through various methods. The County Departments of Job & Family Services (CDJFS) collect and maintain any documentation provided by the individual either in a paper case file or in the OnBase Enterprise Documentation Management System (EDMS) maintained under contract by DAS and utilized by the Department. After collecting documentation, the county caseworker enters the individual?s information into the Ohio Benefits system which determines the initial eligibility benefit amount and assigns the benefit aid category, where applicable. This process is also used to perform eligibility redeterminations on an annual basis or when prompted through a system alert. Once the determination is made, the Ohio Benefits system uploads the eligibility information to the Department?s payment system, Medicaid Information Technology System (MITS), to process the payment. The Ohio Benefits system is designed to issue alerts to county caseworkers for a variety of items which require review, evaluation, follow-up, and a determination about the impact on the related case and/or program benefits. However, we noted the following weaknesses/defects in the eligibility process: ? Alerts ?During SFY 2022, more than 15.5 million alerts were issued related to all public assistance programs that utilize Ohio Benefits, including the CHIP and Medicaid Cluster programs, according to DAS records (3.4 million IEVS alerts and 12.1 million non-IEVS alerts). Ongoing enhancements to the Ohio Benefits alerts process were made in coordination with personnel from the Department, JFS, and DAS throughout the audit period. These enhancements addressed design weaknesses to work on solutions for filtering duplicate alerts, including those across multiple programs. However, the volume of incoming IRS alerts/matches issued remained high: these alerts affect a change in recipient income and could possibly have an impact on eligibility or the benefit amount. These design weaknesses created a large volume of information being sent to the counties, resulting in an increased workload and ineffective application of the alert process. ? Caseworker Reliance/Training - The current process relies heavily on the knowledge and judgement of county caseworkers in the eligibility process. While statewide trainings and individual trainings for counties to assist them in working IEVS alerts continues, system enhancements have not fully addressed the issue of excessive alerts. Additionally, these trainings are typically optional and/or attended by a representative of the county who is expected to relay the information to others. We also noted the following weaknesses/issues related to the Ohio Benefits system in Finding Number 2022-001 for DAS. ? Contract and Monitoring ? Although operating protocols were available defining DAS? responsibilities, a signed interagency agreement has not been finalized to define the roles and responsibilities of each agency and naming DAS as the administrator for Ohio Benefits. ? Data Governance ? No data governance structure was in place to ensure reliability over the data for management. Therefore, it was not clear how program objectives were being met/monitored and how program compliance was being achieved. NONCOMPLIANCE ISSUES The following noncompliance was noted related to eligibility for the Medicaid and CHIP programs, which included questioned costs for Medicaid totaling $34,781 and CHIP totaling $410,211: ? Three of 80 (3.8%) Medicaid recipients and eight of 80 (10%) CHIP recipients selected for testing were not eligible to receive benefits on the date services were performed as they were not validly enrolled beneficiaries based on information in Ohio Benefits, the State?s official eligibility determination system. Therefore, these items will result in questioned costs for all claims paid for services provided for these individuals during the time they were ineligible, totaling $34,781 for Medicaid and $410,211 for CHIP. The items noted included issues such as: o The recipient failed to timely report an increase in income and/or new employment. o The caseworker failed to timely update Ohio Benefits with an increase in income. o U.S. Citizenship was not properly verified. o The recipient was covered by other health insurance. o The recipient was not a resident of Ohio at the time benefits were paid. o Assets were not properly accounted by the caseworker when determining eligibility. ? Three of 80 (3.8%) Medicaid recipients and eight of 80 (10%) CHIP recipients selected for testing were not placed in the correct benefit aid category. All the Medicaid and CHIP recipients were included in the preceding bullet as being deemed ineligible. ADDITIONAL QUESTIONED COSTS: In January 2022, the Auditor of State?s Medicaid Contract Audit (MCA) section released a Public Interest Report regarding Improper Capitation Payments to managed care providers covering SFY 2018 through SFY 2020 for the Medicaid program. The objectives were to identify duplicate payments for recipients, payments for individuals not eligible for managed care due to their incarceration, and payments for recipients in the months following their death. Utilizing the results from the MCA report, we performed additional procedures, specifically focused on duplicate recipient payments and payments made after a recipient?s death, to see if these issues continued during our audit period and if additional payments were made on behalf of these individuals during SFY 2022 from the Medicaid and CHIP programs. We noted the following: ? The Department made 605 payments, totaling $304,610, on behalf of 97 Medicaid recipients where a Social Security Number was associated with multiple recipient IDs within MITS. This amount includes both the allowable payments and the unallowable duplicate payments and represents the entire payment for the recipient, not only the federal share of the payment. We selected 25 of the 97 Medicaid recipients for further testing to determine if the Department took appropriate action to identify and recover the duplicate payments. Five of 25 (20%) Medicaid recipients tested did not appear to include any recovery efforts related to the duplicate payment made on their behalf, totaling $4,082. However, without reviewing the support within each individual case file, we were unable to identify exactly how much was improperly paid. Due to this fact, these errors were not the result of a representative sample of the population, the errors were not projected to the population. As a result, we will question costs for these payments, totaling $4,082 for the Medicaid program. ? Per Ohio Admin. Code ? 5160-26-02.1, the Department will terminate a member?s enrollment in manage care upon the date of death. The Department shall recover from the Managed Care Organization any capitation payments paid for retroactive enrollment termination. The Department can become aware of a recipient?s death through various means. The managed care provider agreement requires the Managed Care Organization to notify the Department when it becomes aware of a recipient?s death. The recipient?s death may also be reported to the County caseworkers by a family member, other adults on the same case, caregivers, or facilities. The Ohio Benefits system is designed to generate alerts to notify the County caseworkers of a deceased match. The Department has 10 calendar days to process a re-determination when a change has been reported that could affect a recipient?s ongoing eligibility. When the Department has been notified of a potential death of a recipient, the recipient is to be removed from managed care and placed in fee for service until confirmation of the death is received. The Department made 651 payments, totaling $617,207, on behalf of 88 deceased individuals receiving Medicaid benefits. We selected 25 of the 88 deceased individuals for further testing to determine if the Department took appropriate action to identify and recover the payments. Nine of 25 (36%) Medicaid recipients tested had an unallowable capitation payment made on behalf of these deceased individuals which was not recovered by the Department, resulting in questioned costs, totaling $142,445. We also noted the following regarding these nine recipients: o Capitation payments were made on behalf of eight recipients for all 12 months of the audit period. o The caseworker obtained the necessary verification for one recipient?s death and ran the Eligibility Determination Benefit Calculator in May 2020 to discontinue Medicaid benefits. However, capitation payments were made on behalf of this recipient for six months of the audit period. o The system indicated caseworkers sent death inquiries to family members, caretakers, and/or facilities in December 2021 to verify the date of death for five recipients (date of deaths ranged from November 2018 ? April 2020). However, no responses were received, and no further follow-up actions were taken. o The Department started the recoupment process for one of the recipients; the questioned costs above include only the outstanding amount. The items noted above under Noncompliance and Additional Questioned Costs resulted in questioned costs for both the Medicaid Cluster and CHIP, as summarized in the table below: Summary of Questioned Costs by Category Medicaid Cluster CHIP Ineligible Recipients $34,781 $410,211 Duplicate Managed Care Payments 4,082 0 Managed Care Payments for Deceased Individuals 142,445 0 Total Questioned Costs: $181,308 $410,211 Without proper controls for entering, processing, and maintaining recipient information and correcting system alerts and weaknesses, there is an increased risk that benefits paid to or on behalf of recipients will be inaccurate or unallowable. This risk is substantially increased if the State?s eligibility determination system, Ohio Benefits, is not designed to properly identify changes to recipient information and generate relevant alerts when those changes could impact a recipient?s eligibility. These weaknesses could allow undue subjective decisions, jeopardize accurate eligibility processing, and/or result in improper payments or federal reimbursements. Overpayments or payments to or on behalf of ineligible recipients may subject the Department to penalties or sanctions which may jeopardize future funding and limit its ability to fulfill program requirements to provide benefits to those in need. Based on discussions with management, oversight and systemic issues led to the issues identified. Additionally, the Ohio Benefits filtering logic was not working as intended upon receipt of the interface file from the IRS creating duplicate alerts; therefore, sending a high volume of alerts to county caseworkers. In addition to staffing issues at the counties, this high volume of alerts created an unmanageable number of alerts to be worked timely. Throughout the audit period, several enhancements were made to the Ohio Benefits system that reduced the number of alerts sent to county caseworkers and a solution to reduce the IRS matches/alerts is scheduled for release in April 2023. RECOMMENDATIONS We recommend the Department evaluate and seek reimbursement for all claims that were incorrectly paid. We also recommend management continue to work collectively with the related state agencies to implement/update robust processes, procedures, and system programming to address the weaknesses in the overall eligibility process, including those associated with the Ohio Benefits system. These changes/updates should include, but not be limited to: ? Continuing to redesign the alert process to be more effective and efficient. This could include a more centralized evaluation of alert activity and/or better use of automated tools to vet and prioritize items requiring follow-up. This would allow Department level personnel to become more experienced and adept at identifying and investigating anomalies and help focus the resources of both Department and county personnel. ? Requiring mandatory training for all CDJFS employees who are entering the assistance group information into Ohio Benefits to help ensure proper and complete information is being collected, entered, and verified prior to an individual?s eligibility determination being made. This training should continue to be provided initially to ensure all users are knowledgeable of the process, procedures, and impacts of the work they do. As changes occur to the rules/regulations, system, or process, detailed training should be required of all users on those changes. ? Regularly evaluating selected benefit payments for all programs to verify the recipient?s eligibility, verify the recipient information entered into Ohio Benefits by the CDJFS is accurate and the information is being maintained to support the State?s eligibility decision, and ensure initial eligibility determinations and redeterminations are completed timely. Any problems noted should be promptly corrected to reduce the risk of benefit payments being made to or on behalf of ineligible individuals and additional training provided to the State and/or county employees affected. ? Identifying and coordinating Ohio Benefits program changes to address the system design weaknesses identified above. This should include working collaboratively with DAS to prioritize program changes which could directly impact the eligibility determinations or benefit amounts to ensure they are corrected in a timely manner to prevent and detect further improper payments. In addition, the Department should evaluate these enhancements to assist DAS in determining if the desired outcome was achieved. ? Ensuring interagency agreements are formalized, contain all parties of the agreements, and fully and clearly define the roles, responsibilities, and expectations related to each party, including completion of required risk assessments and evaluations, and any other specific tasks designed to achieve program compliance. ? Implementing a data governance structure designed to ensure data quality and reliability for management, the grantor agencies, and other users of this information. This structure should include data subject experts from each related agency to help ensure quality of data requests before external and internal users rely on the data, issues are addressed with a clear escalation path, and accountability and alignment between the related agencies is established. ? Evaluating current processes for identifying duplicate recipient IDs and deceased individuals and updating Ohio Benefits and MITS in a timely manner. Controls should be implemented to ensure caseworkers are following up on the Social Security Administration, Ohio Department of Health, or other death indicators in a timely manner. This should include developing a process for confirming an individual?s death if the family member, caretaker, or facility is not responding to the caseworkers and ensuring the recipient is disenrolled from the managed care plan and converted to fee for services until date of death is confirmed.

Corrective Action Plan

Corrective Action Plan: ODM has either completed or begun corrective action on all of the following recommendations. CDJFS Caseworker Case Processing Weaknesses AOS cited caseworker reliance as an eligibility process weakness. While Medicaid eligibility systems have been updated to bring efficiencies in the Medicaid renewal and enrollment processes, human intervention is integral to ensure cases are processed accurately and appropriately. The dependence on caseworker knowledge and judgement is ongoing and is not perceived as a weakness, but an expectation for a state supervised county administered program. The federal regulation at 42 CFR ?431.10(c) limits the state?s ability to delegate authority to make eligibility determinations to only a government agency which maintains personnel standards on a merit basis. CMS provided additional information in its response to Q32 in the COVID-19 Public Health Emergency Unwinding Frequently Asked Questions for State Medicaid and CHIP Agencies document dated October 17, 2022, indicating that the merit-based personnel standards apply to all eligibility determination functions that require discretion, whereas contractors may be used to support the administrative functions of the eligibility determination process that do not require discretion. This guidance to states supports ODM?s established process that caseworkers are expected to exercise their own judgement with regard to the eligibility determination. Further, it would not be an effective use of federal or state funds to build an eligibility system in such a way that every possible exception scenario can be addressed by system rules and functionality. There are simply too many permutations of household scenarios and eligibility outcomes to make that a feasible option. As a result, caseworker knowledge, judgement, and discretion are integral to the eligibility determination process. AOS cited caseworker training as an eligibility process weakness. ODM, in collaboration with ODJFS, will continue to conduct a variety of trainings throughout the year as described below. While not yet mandatory, all trainings are offered to all 88 CDJFS agencies and are open to caseworkers and supervisors. In addition, high priority trainings are offered live on various days and times and are made available online to view at any time. At this time, we do not yet have the technology available to assign learning plans to county caseworkers and ensure completion, however ODM continues to consider its options for mandating training for county employees, and the advantages and disadvantages of that approach. ? New Worker Training - In SFY2022, the new worker training program underwent a total overhaul to update materials, improve interactivity, and close information gaps between programs. New worker training sessions are scheduled quarterly in 2023 and are offered to all new workers across the state. A new worker training began on February 27, 2023. ? Regularly Scheduled Webinars - ODM hosts monthly webinars and other targeted trainings throughout the year with all 88 counties. The monthly webinars include policy updates, training material, and general guidance or instruction on recent changes and issues. During SFY2022, ODM provided training updates on over 30 policy or procedural topics. Targeted trainings are scheduled to continue throughout 2023. Recordings for presentations are made available to access online at any time. ODM and ODJFS also host Operational System Release Webinars to review implemented system enhancements and fixes. ? On-Demand Inquiry Assistance - Technical Assistance and System support are provided via email for counties to submit questions and receive ODM guidance on both policy and procedures, as well as how to process within the Ohio Benefits system. During the return to routine eligibility operations period, county ?Ambassadors? have access to a Return to Routine Operations Team channel with real-time Q&A support, as well as training materials and desk aids. ? Future Training Plan - Moving forward, training will be a critical success factor for closing the knowledge gap(s) identified during various audits. ODM County Technical Assistance (TA) will identify the training topics, develop curriculum and training delivery methods for the identified training areas. To ensure successful and timely delivery, ODM TA will develop a 24-36 month training schedule of development, review, and delivery milestones to monitor progress. Calendar year 2023 training will focus on returning to routine case processing outside of the PHE, including revisiting conditions of eligibility, electronic verification processing, and proper discontinuance processes. ODM conducted six live sessions in February 2023, addressing returning to routine eligibility operations and will conduct a variety of trainings in April and May on eligibility basics, considering how many case workers have not determined eligibility outside of the public health emergency continuous eligibility restrictions. Recordings of these sessions are available on the County Resources page and will be converted to the Ohio Benefits Program website. The ODM Medicaid Eligibility Quality Control (MEQC) Unit continually monitors Medicaid case processing accuracy. The MEQC Unit reviews CDJFS eligibility determinations, verifies accuracy of recipient information in Ohio Benefits, verifies information is being maintained to support the eligibility decision, and evaluates timeliness of applications. All MEQC error and technical deficiency findings are shared with the CDJFS agencies for review, appeal, and correction if warranted. The federally mandated MEQC Pilot review is currently underway and is expected to be completed in March 2023, at which time regular case evaluations will begin. ODM promptly notifies the CDJFS agencies of errors, and the root cause analysis and corrective action plans are requested. The communication between MEQC and our ODM partners, ensures potential vulnerabilities in the eligibility determination process are being addressed promptly. In addition to the offered trainings and MEQC monitoring efforts, ODM has made significant improvements to the ex parte renewal process during SFY22, to increase the number of Medicaid renewals that occur in the system without county caseworker intervention. These ex parte updates are expected to greatly assist the CDJFS agencies and decrease the burden of processing cases, while also improving accuracy. The MEQC unit has been reviewing a sample of ex parte cases each month to ensure system modifications were effective. System improvements, CDJFS training, and monitoring will be ongoing as the Medicaid program continues to change over time. System Weaknesses Ohio Benefits generates alerts to notify CDJFS caseworkers of actions to be taken on a Medicaid or CHIP case. These alerts may include potential dates of death, notifications that individuals have moved to another state, and information about changes in income. Alerts are an important feature of the Ohio Benefits system. ODM has worked with ODJFS and DAS to reduce the volume of alerts generated in an attempt to improve the usability of the information for CDJFS caseworkers. ODJFS monitors IEVS alert completion. ODM has implemented automation using bots to help work and clear certain alerts. In 2021, multiple small releases, or `sprints? were implemented as part of the plan to reduce the volume of alerts being generated. Alert reduction efforts reduced overall ~29 million backlog alerts and drove a ~22 million annual reduction in new arrival of alerts. ODM, ODJFS and DAS remain committed to improving the alert functionality. The table below shows the impact in each of the sprints during SFY22 and the beginning of SFY23. Sprint Deployment Interface Projected Backlog Reduction Actual Backlog Reduction Projected Arrival Reduction-Monthly Actual Arrival Reduction Per Month Cumulative yearly Arrival Reduction 3 7.8.21 UCB SDX/SSI 936K 936K 399K 451K 4.7M 4 7.8.21 110K 115K 1.3M R3.8 8.14.21 Healthchek, Verification, LTC, DODD, DRC Incarceration, SVES Prisoner, AVS, Buy-IN 300K 736K 66K 63K 792K 5 9.17.22 SSP Document Upload, Companion EDBC 8.3M 9M 90K 100K 1.2M 6 4.15.23 IRS TBD TBD 33K TBD TBD ODM has plans for additional improvements in 2023 to reduce the volume of alerts generated. A sprint is scheduled in April 2023, after monitoring the impact of the initial five sprints. ODM continues to work with DAS and ODJFS on correcting defects and implementing enhancements to the existing alerts. In release R4.3 (August 2022), eight defects impacting alerts were corrected and in release R4.3.1 (September 2022), two alert enhancements were implemented, along with one additional defect fix. This weakness will continue to be remediated through future system modifications. ODM will continue to work collaboratively with DAS to update Ohio Benefits to bring efficiencies in effort to improve Medicaid eligibility determination outcomes. Several releases are scheduled into 2023 to improve system functionality. ODM will continue to evaluate enhancements to assist DAS in determining if the desired outcome was achieved.

Categories

Questioned Costs Allowable Costs / Cost Principles Subrecipient Monitoring Eligibility

Other Findings in this Audit

  • 48557 2022-001
    Material Weakness Repeat
  • 48558 2022-011
    -
  • 48559 2022-013
    Material Weakness Repeat
  • 48560 2022-017
    Material Weakness Repeat
  • 48561 2022-001
    Material Weakness Repeat
  • 48562 2022-011
    -
  • 48563 2022-013
    Material Weakness Repeat
  • 48564 2022-017
    Material Weakness Repeat
  • 48565 2022-003
    Material Weakness
  • 48602 2022-004
    Material Weakness
  • 48603 2022-002
    Material Weakness
  • 48604 2022-012
    Material Weakness Repeat
  • 48605 2022-009
    Significant Deficiency Repeat
  • 48606 2022-012
    Material Weakness Repeat
  • 48607 2022-009
    Significant Deficiency Repeat
  • 48608 2022-010
    Material Weakness Repeat
  • 48609 2022-014
    Material Weakness
  • 48610 2022-015
    Material Weakness Repeat
  • 48611 2022-014
    Material Weakness
  • 48612 2022-015
    Material Weakness Repeat
  • 48613 2022-014
    Material Weakness
  • 48614 2022-015
    Material Weakness Repeat
  • 48615 2022-007
    Material Weakness Repeat
  • 48616 2022-006
    Material Weakness
  • 48617 2022-007
    Material Weakness Repeat
  • 48618 2022-008
    Material Weakness
  • 48619 2022-006
    Material Weakness
  • 48620 2022-007
    Material Weakness Repeat
  • 48621 2022-008
    Material Weakness
  • 48622 2022-006
    Material Weakness
  • 48623 2022-007
    Material Weakness Repeat
  • 48624 2022-008
    Material Weakness
  • 48625 2022-006
    Material Weakness
  • 48626 2022-007
    Material Weakness Repeat
  • 48627 2022-008
    Material Weakness
  • 48628 2022-006
    Material Weakness
  • 48629 2022-007
    Material Weakness Repeat
  • 48630 2022-008
    Material Weakness
  • 48631 2022-001
    Material Weakness Repeat
  • 48632 2022-013
    Material Weakness Repeat
  • 48633 2022-015
    Material Weakness Repeat
  • 48634 2022-016
    Material Weakness
  • 48635 2022-017
    Material Weakness Repeat
  • 48636 2022-015
    Material Weakness Repeat
  • 48637 2022-004
    Material Weakness Repeat
  • 48638 2022-005
    Material Weakness Repeat
  • 48639 2022-005
    Material Weakness Repeat
  • 48640 2022-014
    Material Weakness
  • 48762 2022-015
    Material Weakness Repeat
  • 48763 2022-015
    Material Weakness Repeat
  • 48764 2022-015
    Material Weakness Repeat
  • 48765 2022-020
    Material Weakness Repeat
  • 48766 2022-022
    Material Weakness Repeat
  • 48767 2022-001
    Material Weakness Repeat
  • 48769 2022-019
    Material Weakness Repeat
  • 48770 2022-001
    Material Weakness Repeat
  • 48771 2022-018
    Material Weakness Repeat
  • 48772 2022-019
    Material Weakness Repeat
  • 48773 2022-001
    Material Weakness Repeat
  • 48774 2022-018
    Material Weakness Repeat
  • 48775 2022-019
    Material Weakness Repeat
  • 48776 2022-001
    Material Weakness Repeat
  • 48777 2022-018
    Material Weakness Repeat
  • 48778 2022-019
    Material Weakness Repeat
  • 48779 2022-001
    Material Weakness Repeat
  • 48780 2022-018
    Material Weakness Repeat
  • 48781 2022-019
    Material Weakness Repeat
  • 48782 2022-001
    Material Weakness Repeat
  • 48783 2022-018
    Material Weakness Repeat
  • 48784 2022-019
    Material Weakness Repeat
  • 48785 2022-001
    Material Weakness Repeat
  • 48786 2022-018
    Material Weakness Repeat
  • 48787 2022-019
    Material Weakness Repeat
  • 48788 2022-020
    Material Weakness Repeat
  • 48789 2022-021
    Material Weakness
  • 49761 2022-022
    Material Weakness Repeat
  • 49762 2022-020
    Material Weakness
  • 49763 2022-021
    Material Weakness
  • 49764 2022-022
    Material Weakness
  • 50040 2022-020
    Material Weakness
  • 50041 2022-022
    Material Weakness
  • 50042 2022-023
    Material Weakness Repeat
  • 50043 2022-024
    Material Weakness Repeat
  • 50044 2022-023
    Material Weakness Repeat
  • 50045 2022-024
    Material Weakness Repeat
  • 624999 2022-001
    Material Weakness Repeat
  • 625000 2022-011
    -
  • 625001 2022-013
    Material Weakness Repeat
  • 625002 2022-017
    Material Weakness Repeat
  • 625003 2022-001
    Material Weakness Repeat
  • 625004 2022-011
    -
  • 625005 2022-013
    Material Weakness Repeat
  • 625006 2022-017
    Material Weakness Repeat
  • 625007 2022-003
    Material Weakness
  • 625044 2022-004
    Material Weakness
  • 625045 2022-002
    Material Weakness
  • 625046 2022-012
    Material Weakness Repeat
  • 625047 2022-009
    Significant Deficiency Repeat
  • 625048 2022-012
    Material Weakness Repeat
  • 625049 2022-009
    Significant Deficiency Repeat
  • 625050 2022-010
    Material Weakness Repeat
  • 625051 2022-014
    Material Weakness
  • 625052 2022-015
    Material Weakness Repeat
  • 625053 2022-014
    Material Weakness
  • 625054 2022-015
    Material Weakness Repeat
  • 625055 2022-014
    Material Weakness
  • 625056 2022-015
    Material Weakness Repeat
  • 625057 2022-007
    Material Weakness Repeat
  • 625058 2022-006
    Material Weakness
  • 625059 2022-007
    Material Weakness Repeat
  • 625060 2022-008
    Material Weakness
  • 625061 2022-006
    Material Weakness
  • 625062 2022-007
    Material Weakness Repeat
  • 625063 2022-008
    Material Weakness
  • 625064 2022-006
    Material Weakness
  • 625065 2022-007
    Material Weakness Repeat
  • 625066 2022-008
    Material Weakness
  • 625067 2022-006
    Material Weakness
  • 625068 2022-007
    Material Weakness Repeat
  • 625069 2022-008
    Material Weakness
  • 625070 2022-006
    Material Weakness
  • 625071 2022-007
    Material Weakness Repeat
  • 625072 2022-008
    Material Weakness
  • 625073 2022-001
    Material Weakness Repeat
  • 625074 2022-013
    Material Weakness Repeat
  • 625075 2022-015
    Material Weakness Repeat
  • 625076 2022-016
    Material Weakness
  • 625077 2022-017
    Material Weakness Repeat
  • 625078 2022-015
    Material Weakness Repeat
  • 625079 2022-004
    Material Weakness Repeat
  • 625080 2022-005
    Material Weakness Repeat
  • 625081 2022-005
    Material Weakness Repeat
  • 625082 2022-014
    Material Weakness
  • 625204 2022-015
    Material Weakness Repeat
  • 625205 2022-015
    Material Weakness Repeat
  • 625206 2022-015
    Material Weakness Repeat
  • 625207 2022-020
    Material Weakness Repeat
  • 625208 2022-022
    Material Weakness Repeat
  • 625209 2022-001
    Material Weakness Repeat
  • 625210 2022-018
    Material Weakness Repeat
  • 625211 2022-019
    Material Weakness Repeat
  • 625212 2022-001
    Material Weakness Repeat
  • 625213 2022-018
    Material Weakness Repeat
  • 625214 2022-019
    Material Weakness Repeat
  • 625215 2022-001
    Material Weakness Repeat
  • 625216 2022-018
    Material Weakness Repeat
  • 625217 2022-019
    Material Weakness Repeat
  • 625218 2022-001
    Material Weakness Repeat
  • 625219 2022-018
    Material Weakness Repeat
  • 625220 2022-019
    Material Weakness Repeat
  • 625221 2022-001
    Material Weakness Repeat
  • 625222 2022-018
    Material Weakness Repeat
  • 625223 2022-019
    Material Weakness Repeat
  • 625224 2022-001
    Material Weakness Repeat
  • 625225 2022-018
    Material Weakness Repeat
  • 625226 2022-019
    Material Weakness Repeat
  • 625227 2022-001
    Material Weakness Repeat
  • 625228 2022-018
    Material Weakness Repeat
  • 625229 2022-019
    Material Weakness Repeat
  • 625230 2022-020
    Material Weakness Repeat
  • 625231 2022-021
    Material Weakness
  • 626203 2022-022
    Material Weakness Repeat
  • 626204 2022-020
    Material Weakness
  • 626205 2022-021
    Material Weakness
  • 626206 2022-022
    Material Weakness
  • 626482 2022-020
    Material Weakness
  • 626483 2022-022
    Material Weakness
  • 626484 2022-023
    Material Weakness Repeat
  • 626485 2022-024
    Material Weakness Repeat
  • 626486 2022-023
    Material Weakness Repeat
  • 626487 2022-024
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
10.551 Supplemental Nutrition Assistance Program $4.50B
93.778 Medical Assistance Program $1.56B
21.027 Coronavirus State and Local Fiscal Recovery Funds $1.49B
20.205 Highway Planning and Construction $1.35B
17.225 Unemployment Insurance $1.31B
21.019 Coronavirus Relief Fund $649.23M
84.010 Title I Grants to Local Educational Agencies $599.83M
10.542 Covid 19-- Pandemic Related Ebt $459.87M
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $294.56M
93.658 Foster Care Title IV-E $279.26M
21.023 Emergency Rental Assistance Program (era) $272.79M
93.575 Child Care and Development Block Grant $257.12M
93.659 Adoption Assistance $184.34M
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $138.33M
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $136.81M
93.563 Child Support Enforcement $133.24M
93.667 Social Services Block Grant $125.38M
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $124.35M
93.568 Low-Income Home Energy Assistance $122.44M
84.126 Rehabilitation Services Vocational Rehabilitation Grants to States $119.27M
93.788 Opioid Str $113.25M
93.268 Immunization Cooperative Agreements $92.72M
66.458 Capitalization Grants for Clean Water State Revolving Funds $89.45M
96.001 Social Security Disability Insurance $81.54M
84.367 Supporting Effective Instruction State Grants (formerly Improving Teacher Quality State Grants) $70.12M
16.575 Crime Victim Assistance $47.74M
17.259 Wioa Youth Activities $46.23M
84.048 Career and Technical Education -- Basic Grants to States $45.78M
84.287 Twenty-First Century Community Learning Centers $43.53M
20.509 Formula Grants for Rural Areas and Tribal Transit Program $43.21M
12.401 National Guard Military Operations and Maintenance (o&m) Projects $39.93M
84.424 Student Support and Academic Enrichment Program $38.49M
17.258 Wioa Adult Program $36.12M
17.278 Wioa Dislocated Worker Formula Grants $31.31M
93.767 Children's Health Insurance Program $31.04M
14.228 Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii $29.12M
10.555 National School Lunch Program $28.86M
66.468 Capitalization Grants for Drinking Water State Revolving Funds $27.75M
17.207 Employment Service/wagner-Peyser Funded Activities $24.55M
93.959 Block Grants for Prevention and Treatment of Substance Abuse $23.08M
93.994 Maternal and Child Health Services Block Grant to the States $22.37M
14.231 Emergency Solutions Grant Program $19.70M
93.069 Public Health Emergency Preparedness $17.21M
81.042 Weatherization Assistance for Low-Income Persons $17.18M
17.245 Trade Adjustment Assistance $15.63M
84.173 Special Education Preschool Grants $15.37M
84.002 Adult Education - Basic Grants to States $14.68M
84.181 Special Education-Grants for Infants and Families $14.09M
93.917 Hiv Care Formula Grants $13.81M
15.611 Wildlife Restoration and Basic Hunter Education $13.30M
20.513 Enhanced Mobility of Seniors and Individuals with Disabilities $13.27M
93.558 Temporary Assistance for Needy Families $13.24M
93.556 Marylee Allen Promoting Safe and Stable Families Program $12.77M
93.569 Community Services Block Grant $11.56M
14.239 Home Investment Partnerships Program $11.43M
93.775 State Medicaid Fraud Control Units $11.18M
14.235 Supportive Housing Program $10.78M
84.365 English Language Acquisition State Grants $10.55M
84.371 Comprehensive Literacy Development $10.44M
64.005 Grants to State for Construction of State Home Facilities $10.12M
20.933 National Infrastructure Investments $9.78M
10.558 Child and Adult Care Food Program $9.68M
10.649 Pandemic Ebt Administrative Costs $9.60M
93.958 Block Grants for Community Mental Health Services $9.59M
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $9.38M
45.310 Grants to States $9.36M
97.067 Homeland Security Grant Program $9.18M
15.252 Abandoned Mine Land Reclamation (amlr) $9.15M
93.045 Special Programs for the Aging, Title Iii, Part C, Nutrition Services $9.12M
20.218 Motor Carrier Safety Assistance $8.91M
93.217 Family Planning Services $8.80M
93.773 Medicare Hospital Insurance $8.49M
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $8.35M
94.006 Americorps $8.28M
93.940 Hiv Prevention Activities Health Department Based $7.94M
93.982 Mental Health Disaster Assistance and Emergency Mental Health $7.72M
10.560 State Administrative Expenses for Child Nutrition $7.71M
20.616 National Priority Safety Programs $7.61M
20.600 State and Community Highway Safety $7.20M
93.991 Preventive Health and Health Services Block Grant $7.13M
93.155 Rural Health Research Centers $6.79M
84.377 School Improvement Grants $6.76M
17.801 Jobs for Veterans State Grants $6.73M
93.566 Refugee and Entrant Assistance State/replacement Designee Administered Programs $6.64M
16.034 Coronavirus Emergency Supplemental Funding Program $6.60M
66.801 Hazardous Waste Management State Program Support $6.50M
14.275 Housing Trust Fund $6.49M
93.053 Nutrition Services Incentive Program $6.43M
10.025 Plant and Animal Disease, Pest Control, and Animal Care $6.19M
20.505 Metropolitan Transportation Planning and State and Non-Metropolitan Planning and Research $6.16M
84.369 Grants for State Assessments and Related Activities $6.10M
15.916 Outdoor Recreation Acquisition, Development and Planning $5.98M
10.475 Cooperative Agreements with States for Intrastate Meat and Poultry Inspection $5.47M
66.419 Water Pollution Control State, Interstate, and Tribal Program Support $5.35M
16.588 Violence Against Women Formula Grants $5.34M
93.243 Substance Abuse and Mental Health Services Projects of Regional and National Significance $5.33M
16.738 Edward Byrne Memorial Justice Assistance Grant Program $5.17M
66.460 Nonpoint Source Implementation Grants $5.14M
66.001 Air Pollution Control Program Support $5.01M
16.576 Crime Victim Compensation $4.99M
66.469 Great Lakes Program $4.57M
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $4.42M
66.432 State Public Water System Supervision $4.41M
23.003 Appalachian Development Highway System $4.08M
97.047 Bric: Building Resilient Infrastructure and Communities $4.01M
93.369 Acl Independent Living State Grants $3.92M
90.404 2018 Hava Election Security Grants $3.91M
10.582 Fresh Fruit and Vegetable Program $3.70M
97.012 Boating Safety Financial Assistance $3.50M
15.605 Sport Fish Restoration $3.48M
20.615 E-911 Grant Program $3.40M
93.044 Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers $3.32M
17.235 Senior Community Service Employment Program $3.21M
84.282 Charter Schools $3.20M
93.599 Chafee Education and Training Vouchers Program (etv) $3.18M
84.334 Gaining Early Awareness and Readiness for Undergraduate Programs $3.06M
59.037 Small Business Development Centers $3.01M
84.425 Education Stabilization Fund $2.90M
93.630 Developmental Disabilities Basic Support and Advocacy Grants $2.83M
17.277 Wioa National Dislocated Worker Grants / Wia National Emergency Grants $2.82M
84.196 Education for Homeless Children and Youth $2.82M
93.665 Emergency Grants to Address Mental and Substance Use Disorders During Covid-19 $2.60M
10.664 Cooperative Forestry Assistance $2.56M
10.163 Market Protection and Promotion $2.53M
84.358 Rural Education $2.53M
93.426 Improving the Health of Americans Through Prevention and Management of Diabetes and Heart Disease and Stroke $2.51M
10.565 Commodity Supplemental Food Program $2.46M
17.002 Labor Force Statistics $2.32M
93.110 Maternal and Child Health Federal Consolidated Programs $2.29M
93.590 Community-Based Child Abuse Prevention Grants $2.22M
93.235 Title V State Sexual Risk Avoidance Education (title V State Srae) Program $2.20M
16.922 Equitable Sharing Program $2.18M
14.401 Fair Housing Assistance Program State and Local $2.15M
66.805 Leaking Underground Storage Tank Trust Fund Corrective Action Program $2.12M
93.150 Projects for Assistance in Transition From Homelessness (path) $2.10M
93.495 Community Health Workers for Public Health Response and Resilient $2.06M
93.669 Child Abuse and Neglect State Grants $2.06M
93.103 Food and Drug Administration Research $2.05M
59.U07 State Small Business Credit Initiative $1.98M
93.387 National and State Tobacco Control Program $1.96M
11.419 Coastal Zone Management Administration Awards $1.90M
93.104 Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances (sed) $1.87M
17.504 Consultation Agreements $1.79M
93.324 State Health Insurance Assistance Program $1.76M
10.576 Senior Farmers Market Nutrition Program $1.73M
15.634 State Wildlife Grants $1.73M
84.011 Migrant Education State Grant Program $1.71M
16.540 Juvenile Justice and Delinquency Prevention $1.65M
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $1.65M
93.092 Affordable Care Act (aca) Personal Responsibility Education Program $1.60M
20.934 Nationally Significant Freight and Highway Projects $1.56M
66.454 Water Quality Management Planning $1.52M
17.285 Apprenticeship USA Grants $1.50M
15.250 Regulation of Surface Coal Mining and Surface Effects of Underground Coal Mining $1.45M
66.700 Consolidated Pesticide Enforcement Cooperative Agreements $1.45M
17.720 Disability Employment Policy Development $1.36M
84.177 Rehabilitation Services Independent Living Services for Older Individuals Who Are Blind $1.35M
93.747 Elder Abuse Prevention Interventions Program $1.34M
20.700 Pipeline Safety Program State Base Grant $1.32M
20.219 Recreational Trails Program $1.29M
93.645 Stephanie Tubbs Jones Child Welfare Services Program $1.27M
20.200 Highway Research and Development Program $1.25M
84.184 School Safety National Activities (formerly, Safe and Drug-Free Schools and Communities-National Programs) $1.25M
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $1.24M
12.600 Community Investment $1.23M
20.608 Minimum Penalties for Repeat Offenders for Driving While Intoxicated $1.23M
81.041 State Energy Program $1.21M
93.889 National Bioterrorism Hospital Preparedness Program $1.19M
93.634 Support for Ombudsman and Beneficiary Counseling Programs for States Participating in Financial Alignment Model Demonstrations for Dually Eligible Individuals $1.12M
16.710 Public Safety Partnership and Community Policing Grants $1.11M
93.810 Paul Coverdell National Acute Stroke Program National Center for Chronic Disease Prevention and Health Promotion $1.10M
84.323 Special Education - State Personnel Development $1.08M
93.071 Medicare Enrollment Assistance Program $1.05M
93.796 State Survey Certification of Health Care Providers and Suppliers (title Xix) Medicaid $1.05M
93.052 National Family Caregiver Support, Title Iii, Part E $1.05M
84.426 Randolph-Sheppard-Financial Relief and Restoration Payments $1.03M
16.554 National Criminal History Improvement Program (nchip) $1.03M
17.271 Work Opportunity Tax Credit Program (wotc) $1.00M
16.754 Harold Rogers Prescription Drug Monitoring Program $997,353
66.034 Surveys, Studies, Research, Investigations, Demonstrations, and Special Purpose Activities Relating to the Clean Air Act $988,562
12.U01 1033 Excess Military Property Program $978,288
84.013 Title I State Agency Program for Neglected and Delinquent Children and Youth $961,852
23.002 Appalachian Area Development $957,581
30.U05 Employment Discrimination Title Vii of the Civil Rights Act of 1964 $940,381
66.817 State and Tribal Response Program Grants $921,677
14.900 Lead-Based Paint Hazard Control in Privately-Owned Housing $892,285
16.838 Comprehensive Opioid, Stimulant, and Substance Abuse Program $886,426
11.420 Coastal Zone Management Estuarine Research Reserves $877,350
15.662 Great Lakes Restoration $861,611
20.703 Interagency Hazardous Materials Public Sector Training and Planning Grants $810,038
11.611 Manufacturing Extension Partnership $792,932
93.048 Special Programs for the Aging, Title Iv, and Title Ii, Discretionary Projects $792,851
81.104 Environmental Remediation and Waste Processing and Disposal $786,420
66.040 Diesel Emissions Reduction Act (dera) State Grants $769,472
66.804 Underground Storage Tank (ust) Prevention, Detection, and Compliance Program $768,035
84.187 Supported Employment Services for Individuals with the Most Significant Disabilities $730,912
17.270 Reentry Employment Opportunities $727,142
12.002 Procurement Technical Assistance for Business Firms $717,715
93.043 Special Programs for the Aging, Title Iii, Part D, Disease Prevention and Health Promotion Services $713,939
66.802 Superfund State, Political Subdivision, and Indian Tribe Site-Specific Cooperative Agreements $713,147
59.061 State Trade Expansion $707,114
93.439 State Physical Activity and Nutrition (span) $701,566
93.977 Sexually Transmitted Diseases (std) Prevention and Control Grants $675,077
16.593 Residential Substance Abuse Treatment for State Prisoners $674,719
16.742 Paul Coverdell Forensic Sciences Improvement Grant Program $667,838
20.528 Rail Fixed Guideway Public Transportation System State Safety Oversight Formula Grant Program $647,994
93.643 Children's Justice Grants to States $643,834
16.812 Second Chance Act Reentry Initiative $635,556
16.741 Dna Backlog Reduction Program $628,008
16.017 Sexual Assault Services Formula Program $602,343
93.070 Environmental Public Health and Emergency Response $596,655
97.008 Non-Profit Security Program $587,323
66.444 Lead Testing in School and Child Care Program Drinking Water (sdwa 1464(d)) $583,738
93.478 Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees $580,752
93.197 Childhood Lead Poisoning Prevention Projects, State and Local Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children $569,316
93.686 Ending the Hiv Epidemic: A Plan for America Ryan White Hiv/aids Program Parts A and B $557,580
93.564 Child Support Enforcement Research $553,003
16.582 Crime Victim Assistance/discretionary Grants $549,805
10.170 Specialty Crop Block Grant Program - Farm Bill $542,752
93.670 Child Abuse and Neglect Discretionary Activities $536,175
93.603 Adoption and Legal Guardianship Incentive Payments $523,793
15.438 National Forest Acquired Lands $520,836
93.301 Small Rural Hospital Improvement Grant Program $520,614
12.113 State Memorandum of Agreement Program for the Reimbursement of Technical Services $518,079
10.093 Voluntary Public Access and Habitat Incentive Program $504,842
93.671 Family Violence Prevention and Services/domestic Violence Shelter and Supportive Services $495,613
16.U03 Domestic Cannabis Eradication/suppression Program $488,095
66.605 Performance Partnership Grants $483,003
10.902 Soil and Water Conservation $463,172
93.774 Medicare Supplementary Medical Insurance $446,716
10.680 Forest Health Protection $438,943
93.367 Flexible Funding Model-Infrasturcture Development and Maintenance for State Manufactured Food Regulatory Program $434,536
93.165 Grants to States for Loan Repayment $428,304
10.912 Environmental Quality Incentives Program $418,543
94.003 State Commissions $413,653
93.597 Grants to States for Access and Visitation Programs $412,340
93.042 Special Programs for the Aging, Title Vii, Chapter 2, Long Term Care Ombudsman Services for Older Individuals $411,162
20.224 Federal Lands Access Program $409,283
66.032 State Indoor Radon Grants $406,465
16.609 Project Safe Neighborhoods $393,742
20.237 Motor Carrier Safety Assistance High Priority Activities Grants and Cooperative Agreements $389,764
93.240 State Capacity Building $387,275
66.433 State Underground Water Source Protection $385,829
16.585 Drug Court Discretionary Grant Program $368,152
93.336 Behavioral Risk Factor Surveillance System $366,906
10.579 Child Nutrition Discretionary Grants Limited Availability $364,197
93.U09 Mammography Quality Standard Act Inspection $360,155
84.326 Special Education Technical Assistance and Dissemination to Improve Services and Results for Children with Disabilities $356,674
10.572 Wic Farmers' Market Nutrition Program (fmnp) $354,130
45.025 Promotion of the Arts Partnership Agreements $344,700
97.091 Homeland Security Biowatch Program $341,362
11.307 Economic Adjustment Assistance $337,139
93.791 Money Follows the Person Rebalancing Demonstration $336,973
97.042 Emergency Management Performance Grants $334,823
97.041 National Dam Safety Program $332,511
84.372 Statewide Longitudinal Data Systems $316,346
10.676 Forest Legacy Program $313,160
97.039 Hazard Mitigation Grant $305,995
16.839 Stop School Violence $293,520
93.600 Head Start $282,104
17.804 Local Veterans' Employment Representative Program $276,921
93.270 Viral Hepatitis Prevention and Control $274,092
14.267 Continuum of Care Program $262,639
17.600 Mine Health and Safety Grants $260,854
97.029 Flood Mitigation Assistance $258,989
97.044 Assistance to Firefighters Grant $250,076
93.251 Early Hearing Detection and Intervention $249,516
93.761 Evidence-Based Falls Prevention Programs Financed Solely by Prevention and Public Health Funds (pphf) $248,116
66.472 Beach Monitoring and Notification Program Implementation Grants $240,229
10.559 Summer Food Service Program for Children $236,373
84.325 Special Education- Personnel Development to Improve Services and Results for Children with Disabilities $223,608
10.556 Special Milk Program for Children $216,913
17.273 Temporary Labor Certification for Foreign Workers $212,678
93.130 Cooperative Agreements to States/territories for the Coordination and Development of Primary Care Offices $205,600
93.241 State Rural Hospital Flexibility Program $203,874
10.304 Homeland Security Agricultural $196,016
93.913 Grants to States for Operation of State Offices of Rural Health $191,755
16.831 Children of Incarcerated Parents $183,107
93.041 Special Programs for the Aging, Title Vii, Chapter 3, Programs for Prevention of Elder Abuse, Neglect, and Exploitation $181,460
12.620 Troops to Teachers Grant Program $180,466
17.005 Compensation and Working Conditions $179,442
10.568 Emergency Food Assistance Program (administrative Costs) $178,019
93.448 Food Safety and Security Monitoring Project $171,449
10.171 Organic Certification Cost Share Program $167,908
39.003 Donation of Federal Surplus Personal Property $158,152
97.045 Cooperating Technical Partners $142,994
20.614 National Highway Traffic Safety Administration (nhtsa) Discretionary Safety Grants and Cooperative Agreements $141,947
10.GSA_MIGRATION Egg Safety $141,358
16.321 Antiterrorism Emergency Reserve $140,011
16.548 Title V Delinquency Prevention Program $139,875
64.U08 Va-Dvs Pharmacy Option 1 $137,056
93.079 Cooperative Agreements to Promote Adolescent Health Through School-Based Hiv/std Prevention and School-Based Surveillance $136,346
16.550 State Justice Statistics Program for Statistical Analysis Centers $125,425
93.127 Emergency Medical Services for Children $122,879
16.606 State Criminal Alien Assistance Program $118,475
94.008 Commission Investment Fund $117,654
93.236 Grants to States to Support Oral Health Workforce Activities $116,726
84.938 Disaster Recovery Assistance for Education $114,784
81.136 Long-Term Surveillance and Maintenance $113,009
93.043 Special Program for the Aginging Title Iii, Part D, Disease Prevention and Health Promotion Services $110,006
66.608 Environmental Information Exchange Network Grant Program and Related Assistance $104,534
66.436 Surveys, Studies, Investigations, Demonstrations, and Training Grants and Cooperative Agreements - Section 104(b)(3) of the Clean Water Act $104,014
16.320 Services for Trafficking Victims $103,946
15.608 Fish and Wildlife Management Assistance $97,421
16.823 Emergency Planning for Juvenile Justice Facilities $96,664
15.808 U.s. Geological Survey Research and Data Collection $95,042
15.615 Cooperative Endangered Species Conservation Fund $92,297
21.016 Equitable Sharing $90,920
93.870 Maternal, Infant and Early Childhood Home Visiting Grant $88,575
66.204 Multipurpose Grants to States and Tribes $87,752
15.810 National Cooperative Geologic Mapping $87,691
15.433 Flood Control Act Lands $87,535
66.461 Regional Wetland Program Development Grants $78,394
16.827 Justice Reinvestment Initiative $74,373
10.691 Good Neighbor Authority $67,169
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $61,195
84.144 Migrant Education Coordination Program $59,949
97.023 Community Assistance Program State Support Services Element (cap-Ssse) $59,584
48.U06 State Justice Institute Ohio Dispute Resolution Pilot Program $58,903
94.021 Volunteer Generation Fund $58,841
16.816 John R. Justice Prosecutors and Defenders Incentive Act $54,546
93.586 State Court Improvement Program $52,050
20.106 Airport Improvement Program $45,500
15.684 White-Nose Syndrome National Response Implementation $44,989
93.752 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations Financed in Part by Prevention and Public Health Funds $44,764
93.136 Injury Prevention and Control Research and State and Community Based Programs $43,989
93.648 Child Welfare Research Training Or Demonstration $43,221
93.421 Strengthening Public Health Systems and Services Through National Partnerships to Improve and Protect the Nations Health $41,583
14.241 Housing Opportunities for Persons with Aids $40,990
20.301 Railroad Safety $40,653
10.479 Food Safety Cooperative Agreement $35,291
15.980 National Ground-Water Monitoring Network $31,985
93.472 Title IV-E Prevention Program $31,005
16.U04 Domestic Cannabis Eradication/suppression Program $29,185
97.050 Presidential Declared Disaster Assistance to Individuals and Households - Other Needs $28,385
10.683 National Fish and Wildlife Foundation $28,251
93.497 Family Violence Prevention and Services/ Sexual Assault/ Rape Crisis Services and Supports $25,689
15.658 Natural Resource Damage Assessment and Restoration $25,393
97.043 State Fire Training Systems Grants $20,000
10.525 Farm and Ranch Stress Assistance Network Competitive Grants Program $19,192
93.322 Csels Partnership: Strengthening Public Health Laboratories $17,569
81.089 Fossil Energy Research and Development $16,316
11.407 Interjurisdictional Fisheries Act of 1986 $16,021
16.750 Support for Adam Walsh Act Implementation Grant Program $15,000
10.553 School Breakfast Program $13,090
12.U02 Fusrap Oversight: Diamond Magnesium Site and Luckey Beryllium Site $11,671
20.232 Commercial Driver's License Program Implementation Grant $9,414
15.650 Research Grants (generic) $7,945
84.027 Special Education Grants to States $5,992
66.809 Superfund State and Indian Tribe Core Program Cooperative Agreements $5,099
93.777 State Survey and Certification of Health Care Providers and Suppliers (title Xviii) Medicare $3,329
64.015 Veterans State Nursing Home Care $2,489
84.305 Education Research, Development and Dissemination $1,276
64.014 Veterans State Domiciliary Care $1,204
15.437 Minerals Leasing Act $180