Finding Text
2023-004 Eligibility – MAXIS
Prior Year Finding Number: 2022-002
Repeat Finding Since: 2011
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 Medical Assistance Program
Award Number and Year: 2305MN5ADM; 2023
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 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.
Condition: DHS maintains the computer system, MAXIS, which is used by the Health and Human Services to support the eligibility determination process. While periodic supervisory case reviews are performed to monitor compliance with grant requirements for eligibility, not all documentation was available, updated, or input correctly to support participant eligibility. The following exceptions were noted in the sample of 40 case files tested:
• Four case files included amounts for client accounts (assets) that were not properly updated and/or supported for the most recent application/certification prior to being automatically renewed during the COVID-19 pandemic.
• Four case files did not include support for the income listed in MAXIS.
• One case file did not meet the application requirements such as requesting and obtaining the case file information from the previous agency.
• One case file did not meet the necessary application requirements for residency as no application or case file information could be provided.
Questioned Costs: Not applicable. The Health and Human Services administers the program, but the State of Minnesota pays benefits to program participants.
Context: The State of Minnesota and the Health and Human Services split the eligibility determination process. The Health and Human Services performs the “intake function” (meeting with the social services client to determine income and categorical eligibility), while the state maintains the MAXIS system, which supports the eligibility determination process and actually pays the benefits to participants.
The sample size was based on the guidance from Chapter 11 of the AICPA Audit Guide, Government Auditing Standards and Single Audits.
Effect: The improper input or updating of information into MAXIS and the lack of verification or follow-up of eligibility-determining factors increases the risk that program participants will receive benefits when they are not eligible.
Cause: Program personnel entering case file information into MAXIS did not ensure all required information was input or updated correctly, supported, or retained.
Recommendation: We recommend Southwest Health and Human Services implement additional procedures to provide reasonable assurance that all necessary documentation to support eligibility determinations exists and is properly input or updated in MAXIS and issues are followed up in a timely manner. In addition, Southwest Health and Human Services should consider providing further training for program personnel.
View of Responsible Official: Acknowledge