FAC Explorer

Finding 498446 (2023-005)

Significant Deficiency Repeat Finding
Requirement
ABE
Questioned Costs
-
Year
2023
Accepted
2024-09-26
Audit: 321142
Organization: State of Missouri (MO)
Auditor: Office of the Mo State Auditor

AI Summary

  • Core Issue: The DSS lacks sufficient controls to ensure compliance with eligibility redetermination for MAGI-based participants, affecting approximately 11,500 cases.
  • Impacted Requirements: 42 CFR Section 435.916 mandates annual redeterminations and timely termination of benefits for ineligible participants, which were not properly executed post-COVID-19.
  • Recommended Follow-Up: DSS must remove manual overrides, initiate overdue redeterminations, and ensure all cases are reviewed for eligibility compliance.

Finding Text

2023-005 Medicaid and CHIP MAGI-Based Participant Eligibility Redeterminations As similarly noted in our 4 previous audits, the DSS does not have sufficient controls to ensure compliance with eligibility redetermination requirements of the Medical Assistance Program (Medicaid) and the Children's Health Insurance Program (CHIP) for certain participants whose eligibility is based on the Modified Adjusted Gross Income (MAGI). The DSS did not correct manual system overrides for approximately 11,500 (1 percent) MAGI-based participants, preventing their cases from being closed when necessary, and did not perform redeterminations for those participants requiring redeterminations once previously-suspended requirements resumed. To ensure MAGI-based participants continue to be eligible for benefits, 42 CFR Section 435.916 requires a redetermination of eligibility once every 12 months, or when circumstances affecting a participant's eligibility change. The regulation requires termination of benefits when a participant no longer meets eligibility requirements. During the period March 19, 2020, to March 31, 2023, the eligibility redetermination and most termination requirements were temporarily suspended in response to the COVID-19 Public Health Emergency (PHE). During that period, all validly enrolled participants on March 19, 2020, were to remain continuously enrolled, except for participants who requested removal, moved out of state, or died. Effective April 1, 2023, the DSS was required to initiate redeterminations within 12 months, and complete redeterminations within 14 months, for all participants. Of the approximately 1.5 million Medicaid and CHIP participants as of June 30, 2023, approximately 1.1 million were MAGI-based participants. The Medicaid Eligibility Determination and Enrollment System (MEDES), implemented in January 2014, tracks eligibility information for MAGI-based participants, including redetermination due dates; and in some cases, performs redeterminations. Non-automatic redeterminations for MAGI-based participants are performed manually by FSD eligibility benefit technicians. Eligibility information is transferred from MEDES into the Medicaid Management Information System (MMIS), the Medicaid claims payment system, nightly. To ensure continuous enrollment during the PHE, the DSS programmed the MEDES to continue coverage effective March 18, 2020, except in the case of a participant's death, out of state move, or voluntary closure. For some exceptions, the MEDES automatically closed the case. For other exceptions, an FSD eligibility benefit technician manually recorded the reason for closure and initiated closure of the participant's case in the MEDES. The COVID-19/Annual Renewals Unwinding User Acceptance Test Plan (unwinding plan), submitted to the DHHS - Centers for Medicare and Medicaid Services (CMS), provided that redeterminations would resume on April 1, 2023, and be completed over a 14-month period. Per the unwinding plan, for the year ended June 30, 2023, redeterminations were to be initiated for all participants with April, May, and June due dates and completed for participants with April due dates. MEDES operations have been problematic since implementation and manual overrides to individual cases to compensate for previous system errors and limitations were not corrected. DSS officials explained there was a period of time when the MEDES was incorrectly closing some eligible cases before a redetermination could be performed. To prevent affected cases from being closed, DSS personnel manually overrode system controls. However, once these system limitations were corrected in June 2017, the DSS did not remove the previously established manual overrides, which prevented the system from taking automatic actions such as identifying cases needing redetermination and closing cases. Additional overrides have also been made subsequent to the June 2017 corrections. In the response to recommendations in the prior 4 audits, and in the unwinding plan, DSS officials indicated they developed a report and process to identify MEDES participants with overdue redeterminations due to system problems; and effective April 1, 2023, they planned to begin removing the manual overrides and performing redeterminations for these participants. However, as of June 30, 2023, the DSS had not developed a usable report, reviewed these participants to ensure they remained eligible and did not meet one of the exceptions requiring termination during the PHE, or initiated or completed redeterminations for all participants with April due dates. As a result, cases for participants with manual overrides that did not meet eligibility requirements prior to, during, or after the PHE ended, may not have been closed. After our inquiries, the DSS developed a usable report in August 2023, identifying approximately 11,500 individuals with active overrides, or 1 percent of the MAGI-based participant population. The DSS Corrective Action Plan (CAP) and Summary Schedule of Prior Audit Findings for prior audit finding number 2022-002 state the DSS has processes in place to terminate eligibility for individuals who are deceased, voluntarily request closure, or report they have moved out of state. However, these processes have not been applied to all participant cases with manual system overrides needing closure. Although our random sample of 60 (of over 1 million) MAGI-based participants that were continuously enrolled during the year ended June 30, 2023, did not identify any participants with previously-established overrides, the condition remained that participants with manual overrides applied to their case had not been identified or reviewed to ascertain whether they continue to meet eligibility requirements. The failure to implement adequate internal controls to ensure ineligible participant cases are closed and redeterminations are performed as required can result in Medicaid and CHIP payments being made on behalf of ineligible individuals, which would be unallowable costs of the federal programs. Regulation 45 CFR Section 75.303(a) requires the non-federal entity to "[e]stablish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award." Recommendation The DSS through the MHD and the FSD review and correct cases for participants with manual overrides in the MEDES, ensure redeterminations are completed for these participants as required, and close the cases of any ineligible participants. In addition, the DSS should ensure system controls are functioning as designed for these participants. Auditee's Response We disagree with the auditor's finding. Our Corrective Action Plan includes an explanation and specific reasons for our disagreement. Auditor's Comment The DSS Corrective Action Plan (CAP) states the DSS disagrees there is a significant deficiency in internal controls because no participants with manual overrides were identified in the audit sample. Once the DSS finally identified these participants in August 2023 (despite recommendations in the prior 4 audits), the DSS confirmed there were approximately 11,500 participants with active overrides, or 1 percent of the MAGI-based participant population. The significant internal control weaknesses associated with these participants, which have existed for many years, remain regardless of whether any of these participants were selected in the audit sample. The CAP states the DSS had processes in place to terminate eligibility for individuals who were deceased, voluntarily requested closure, or reported they moved out of state. However, as noted in the finding, these processes were not applied to all participant cases with manual system overrides, and instead of proactively reviewing cases as recommended, the DSS merely reacted when information was provided to them. Until the manual overrides are corrected and/or applicable participants reviewed, there will be continued circumvention of established internal controls and risk of improper payments on these cases. Therefore, this finding is valid.

Categories

Allowable Costs / Cost Principles Eligibility Significant Deficiency Matching / Level of Effort / Earmarking

Other Findings in this Audit

  • 498405 2023-012
    Material Weakness
  • 498406 2023-013
    Material Weakness
  • 498407 2023-018
    Significant Deficiency
  • 498408 2023-011
    Significant Deficiency
  • 498409 2023-011
    Significant Deficiency
  • 498410 2023-011
    Significant Deficiency
  • 498411 2023-010
    Material Weakness
  • 498412 2023-008
    Significant Deficiency Repeat
  • 498413 2023-008
    Significant Deficiency Repeat
  • 498414 2023-016
    Significant Deficiency
  • 498415 2023-011
    Significant Deficiency
  • 498416 2023-016
    Significant Deficiency
  • 498417 2023-011
    Significant Deficiency
  • 498418 2023-016
    Significant Deficiency
  • 498419 2023-017
    Significant Deficiency Repeat
  • 498420 2023-008
    Significant Deficiency Repeat
  • 498421 2023-008
    Significant Deficiency Repeat
  • 498422 2023-009
    Significant Deficiency
  • 498423 2023-008
    Significant Deficiency Repeat
  • 498424 2023-001
    Material Weakness Repeat
  • 498425 2023-002
    Material Weakness
  • 498426 2023-003
    Material Weakness
  • 498427 2023-004
    Material Weakness
  • 498428 2023-005
    Significant Deficiency Repeat
  • 498429 2023-006
    Significant Deficiency
  • 498430 2023-007
    - Repeat
  • 498431 2023-015
    - Repeat
  • 498432 2023-015
    - Repeat
  • 498433 2023-001
    Material Weakness Repeat
  • 498434 2023-002
    Material Weakness
  • 498435 2023-003
    Material Weakness
  • 498436 2023-004
    Material Weakness
  • 498437 2023-005
    Significant Deficiency Repeat
  • 498438 2023-006
    Significant Deficiency
  • 498439 2023-007
    - Repeat
  • 498440 2023-008
    Significant Deficiency Repeat
  • 498441 2023-014
    Significant Deficiency
  • 498442 2023-001
    Material Weakness Repeat
  • 498443 2023-002
    Material Weakness
  • 498444 2023-003
    Material Weakness
  • 498445 2023-004
    Material Weakness
  • 498447 2023-006
    Significant Deficiency
  • 498448 2023-007
    - Repeat
  • 498449 2023-008
    Significant Deficiency Repeat
  • 498450 2023-014
    Significant Deficiency
  • 1074847 2023-012
    Material Weakness
  • 1074848 2023-013
    Material Weakness
  • 1074849 2023-018
    Significant Deficiency
  • 1074850 2023-011
    Significant Deficiency
  • 1074851 2023-011
    Significant Deficiency
  • 1074852 2023-011
    Significant Deficiency
  • 1074853 2023-010
    Material Weakness
  • 1074854 2023-008
    Significant Deficiency Repeat
  • 1074855 2023-008
    Significant Deficiency Repeat
  • 1074856 2023-016
    Significant Deficiency
  • 1074857 2023-011
    Significant Deficiency
  • 1074858 2023-016
    Significant Deficiency
  • 1074859 2023-011
    Significant Deficiency
  • 1074860 2023-016
    Significant Deficiency
  • 1074861 2023-017
    Significant Deficiency Repeat
  • 1074862 2023-008
    Significant Deficiency Repeat
  • 1074863 2023-008
    Significant Deficiency Repeat
  • 1074864 2023-009
    Significant Deficiency
  • 1074865 2023-008
    Significant Deficiency Repeat
  • 1074866 2023-001
    Material Weakness Repeat
  • 1074867 2023-002
    Material Weakness
  • 1074868 2023-003
    Material Weakness
  • 1074869 2023-004
    Material Weakness
  • 1074870 2023-005
    Significant Deficiency Repeat
  • 1074871 2023-006
    Significant Deficiency
  • 1074872 2023-007
    - Repeat
  • 1074873 2023-015
    - Repeat
  • 1074874 2023-015
    - Repeat
  • 1074875 2023-001
    Material Weakness Repeat
  • 1074876 2023-002
    Material Weakness
  • 1074877 2023-003
    Material Weakness
  • 1074878 2023-004
    Material Weakness
  • 1074879 2023-005
    Significant Deficiency Repeat
  • 1074880 2023-006
    Significant Deficiency
  • 1074881 2023-007
    - Repeat
  • 1074882 2023-008
    Significant Deficiency Repeat
  • 1074883 2023-014
    Significant Deficiency
  • 1074884 2023-001
    Material Weakness Repeat
  • 1074885 2023-002
    Material Weakness
  • 1074886 2023-003
    Material Weakness
  • 1074887 2023-004
    Material Weakness
  • 1074888 2023-005
    Significant Deficiency Repeat
  • 1074889 2023-006
    Significant Deficiency
  • 1074890 2023-007
    - Repeat
  • 1074891 2023-008
    Significant Deficiency Repeat
  • 1074892 2023-014
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $11.82B
10.551 Supplemental Nutrition Assistance Program $1.47B
20.205 Highway Planning and Construction $1.14B
84.425 American Rescue Plan -Elementary and Secondary School Emergency Relief (arp Esser) $604.00M
93.767 Children's Health Insurance Program $352.79M
10.555 National School Lunch Program $329.29M
84.010 Title I Grants to Local Educational Agencies $278.60M
84.027 Special Education_grants to States $236.87M
17.225 Unemployment Insurance $233.54M
93.558 Temporary Assistance for Needy Families $207.84M
84.425 Elementary and Secondary School Emergency Relief (esser) Fund $194.42M
21.027 Coronavirus State and Local Fiscal Recovery Funds $173.78M
93.568 Low-Income Home Energy Assistance $111.49M
10.542 Pandemic Ebt Food Benefits $111.32M
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $102.95M
10.553 School Breakfast Program $95.99M
93.658 Foster Care_title IV-E $87.86M
93.575 Child Care and Development Block Grant $79.05M
93.268 Immunization Cooperative Agreements $78.42M
10.558 Child and Adult Care Food Program $76.39M
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $76.20M
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $76.02M
84.126 Rehabilitation Services_vocational Rehabilitation Grants to States $72.14M
93.659 Adoption Assistance $70.44M
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $64.14M
12.401 National Guard Military Operations and Maintenance (o&m) Projects $58.18M
64.015 Veterans State Nursing Home Care $55.24M
93.667 Social Services Block Grant $51.58M
96.001 Social Security_disability Insurance $48.74M
16.575 Crime Victim Assistance $48.25M
84.367 Improving Teacher Quality State Grants $37.53M
93.959 Block Grants for Prevention and Treatment of Substance Abuse $33.01M
14.228 Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii $32.59M
93.563 Child Support Enforcement $31.36M
20.106 Airport Improvement Program $30.63M
15.611 Wildlife Restoration and Basic Hunter Education $28.66M
84.048 Career and Technical Education -- Basic Grants to States $27.81M
97.039 Hazard Mitigation Grant $26.28M
66.458 Capitalization Grants for Clean Water State Revolving Funds $24.37M
93.788 Opioid Str $21.41M
93.777 State Survey and Certification of Health Care Providers and Suppliers (title Xviii) Medicare $21.34M
10.569 Emergency Food Assistance Program (food Commodities) $21.12M
93.569 Community Services Block Grant $19.64M
84.424 Student Support and Academic Enrichment Program $18.89M
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $17.83M
93.090 Guardianship Assistance $16.55M
93.958 Block Grants for Community Mental Health Services $16.23M
84.425 American Rescue Plan -Emergency Assistance to Non-Public Schools (arp Eans) Program $13.88M
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $13.72M
17.207 Employment Service/wagner-Peyser Funded Activities $13.69M
20.509 Formula Grants for Rural Areas and Tribal Transit Program $13.62M
17.278 Wia Dislocated Worker Formula Grants $13.29M
84.032 Federal Family Education Loans $13.28M
10.559 Summer Food Service Program for Children $13.21M
84.287 Twenty-First Century Community Learning Centers $13.07M
14.267 Continuum of Care Program $13.02M
20.218 National Motor Carrier Safety $12.84M
20.933 National Infrastructure Investments $12.81M
93.994 Maternal and Child Health Services Block Grant to the States $12.66M
84.425 Coronavirus Response and Relief Supplemental Appropriations Act, 2021- Emergency Assistance to Non-Public Schools (crrsa Eans) Program $12.59M
66.468 Capitalization Grants for Drinking Water State Revolving Funds $12.18M
66.605 Performance Partnership Grants $11.67M
17.258 Wia Adult Program $11.23M
84.425 Governor's Emergency Education Relief (geer) Fund $10.76M
81.042 Weatherization Assistance for Low-Income Persons $10.72M
11.031 Broadband Infrastructure Program $10.40M
93.069 Public Health Emergency Preparedness $10.28M
84.002 Adult Education - Basic Grants to States $9.89M
17.259 Wia Youth Activities $9.56M
21.023 Emergency Rental Assistance Program $9.51M
84.181 Special Education-Grants for Infants and Families $8.92M
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $8.83M
15.605 Sport Fish Restoration Program $8.59M
10.565 Commodity Supplemental Food Program $8.06M
20.600 State and Community Highway Safety $7.84M
93.434 Every Student Succeeds Act/preschool Development Grants $7.63M
93.940 Hiv Prevention Activities_health Department Based $7.60M
97.067 Homeland Security Grant Program $7.36M
97.042 Emergency Management Performance Grants $7.33M
20.616 National Priority Safety Programs $7.24M
84.369 Grants for State Assessments and Related Activities $7.17M
93.498 Provider Relief Fund $6.88M
10.560 State Administrative Expenses for Child Nutrition $6.61M
93.243 Substance Abuse and Mental Health Services_projects of Regional and National Significance $6.37M
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $6.15M
97.045 Cooperating Technical Partners $5.99M
93.136 Injury Prevention and Control Research and State and Community Based Programs $5.80M
84.173 Special Education_preschool Grants $5.74M
93.645 Stephanie Tubbs Jones Child Welfare Services Program $5.61M
93.556 Promoting Safe and Stable Families $5.23M
16.576 Crime Victim Compensation $5.14M
20.607 Alcohol Open Container Requirements $5.06M
84.365 English Language Acquisition State Grants $4.85M
93.155 Rural Health Research Centers $4.53M
93.052 National Family Caregiver Support, Title Iii, Part E $4.18M
93.053 Nutrition Services Incentive Program $4.17M
84.371 Striving Readers $4.14M
16.034 Coronavirus Emergency Supplemental Funding Program $4.09M
93.991 Preventive Health and Health Services Block Grant $4.05M
10.676 Forest Legacy Program $4.01M
95.001 High Intensity Drug Trafficking Areas Program $3.98M
93.791 Money Follows the Person Rebalancing Demonstration $3.81M
16.738 Edward Byrne Memorial Justice Assistance Grant Program $3.80M
93.889 National Bioterrorism Hospital Preparedness Program $3.67M
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $3.57M
10.578 Wic Grants to States (wgs) $3.26M
45.310 Grants to States $3.25M
10.582 Fresh Fruit and Vegetable Program $3.25M
84.358 Rural Education $3.24M
93.870 Maternal, Infant and Early Childhood Home Visiting Grant $3.23M
14.231 Emergency Solutions Grant Program $3.19M
16.588 Violence Against Women Formula Grants $3.15M
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $3.05M
97.047 Pre-Disaster Mitigation $3.02M
93.982 Mental Health Disaster Assistance and Emergency Mental Health $2.79M
97.012 Boating Safety Financial Assistance $2.72M
10.665 Schools and Roads - Grants to States $2.68M
15.252 Abandoned Mine Land Reclamation (amlr) Program $2.58M
90.404 2018 Hava Election Security Grants $2.22M
15.438 National Forest Acquired Lands $2.16M
94.003 State Commissions $2.07M
93.671 Family Violence Prevention and Services/domestic Violence Shelter and Supportive Services $2.05M
15.916 Outdoor Recreation_acquisition, Development and Planning $2.04M
93.426 Improving the Health of Americans Through Prevention and Management of Diabetes and Heart Disease and Stroke $2.02M
10.664 Cooperative Forestry Assistance $1.97M
66.802 Superfund State, Political Subdivision, and Indian Tribe Site-Specific Cooperative Agreements $1.93M
93.747 Elder Abuse Prevention Interventions Program $1.92M
64.005 Grants to States for Construction of State Home Facilities $1.92M
93.103 Food and Drug Administration_research $1.88M
93.977 Preventive Health Services_sexually Transmitted Diseases Control Grants $1.85M
17.235 Senior Community Service Employment Program $1.85M
93.775 State Medicaid Fraud Control Units $1.76M
17.801 Jobs for Veterans State Grants $1.72M
84.425 American Rescue Plan – Elementary and Secondary School Emergency Relief –homeless Children and Youth $1.70M
84.323 Special Education - State Personnel Development $1.64M
93.630 Developmental Disabilities Basic Support and Advocacy Grants $1.63M
10.475 Cooperative Agreements with States for Intrastate Meat and Poultry Inspection $1.62M
93.599 Chafee Education and Training Vouchers Program (etv) $1.59M
39.003 Donation of Federal Surplus Personal Property $1.59M
17.504 Consultation Agreements $1.55M
94.008 Commission Investment Fund $1.55M
10.568 Emergency Food Assistance Program (administrative Costs) $1.50M
12.112 Payments to States in Lieu of Real Estate Taxes $1.50M
20.200 Highway Research and Development Program $1.49M
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $1.45M
66.460 Nonpoint Source Implementation Grants $1.45M
93.435 Innovative State and Local Public Health Strategies to Prevent and Manage Diabetes and Heart Disease and Stroke- $1.37M
93.387 National and State Tobacco Control Program (b) $1.33M
84.196 Education for Homeless Children and Youth $1.28M
10.934 Feral Swine Eradication and Control Pilot Program (c, Z) $1.28M
93.669 Child Abuse and Neglect State Grants $1.26M
93.070 Environmental Public Health and Emergency Response $1.25M
20.224 Federal Lands Access Program $1.20M
20.526 Buses and Bus Facilities Formula, Competitive, and Low Or No Emissions Programs $1.18M
10.649 Pandemic Ebt Administrative Costs $1.15M
66.805 Leaking Underground Storage Tank Trust Fund Corrective Action Program $1.15M
16.554 National Criminal History Improvement Program (nchip) $1.14M
15.634 State Wildlife Grants $1.12M
64.101 Burial Expenses Allowance for Veterans $1.11M
93.324 State Health Insurance Assistance Program $1.11M
93.665 Emergency Grants to Address Mental and Substance Use Disorders During Covid-19 $1.10M
84.013 Title I State Agency Program for Neglected and Delinquent Children and Youth $1.09M
66.817 State and Tribal Response Program Grants $1.08M
17.002 Labor Force Statistics $1.06M
81.041 State Energy Program $1.05M
10.025 Plant and Animal Disease, Pest Control, and Animal Care $1.00M
93.439 State Physical Activity and Nutrition (span $981,491
16.741 Dna Backlog Reduction Program $958,565
94.006 Americorps $953,578
93.235 Affordable Care Act (aca) Abstinence Education Program $949,765
16.833 National Sexual Assault Kit Initiative $895,812
64.024 Va Homeless Providers Grant and Per Diem Program $868,464
93.150 Projects for Assistance in Transition From Homelessness (path) $865,195
93.092 Affordable Care Act (aca) Personal Responsibility Education Program $851,519
93.110 Maternal and Child Health Federal Consolidated Programs $836,253
16.593 Residential Substance Abuse Treatment for State Prisoners $833,210
16.540 Juvenile Justice and Delinquency Prevention_allocation to States $772,896
93.310 Trans-Nih Research Support $770,924
12.113 State Memorandum of Agreement Program for the Reimbursement of Technical Services $742,335
93.071 Medicare Enrollment Assistance Program $734,995
93.590 Community-Based Child Abuse Prevention Grants $725,380
16.813 Nics Act Record Improvement Program $709,474
16.017 Sexual Assault Services Formula Program $689,507
16.710 Public Safety Partnership and Community Policing Grants $675,713
17.245 Trade Adjustment Assistance $665,850
64.203 State Cemetery Grants $664,356
66.454 Water Quality Management Planning $652,968
16.585 Drug Court Discretionary Grant Program $651,346
84.011 Migrant Education_state Grant Program $643,096
93.241 State Rural Hospital Flexibility Program $629,077
93.436 Well-Integrated Screening and Evaluation for Women Across the Nation (wisewoman) $625,051
93.165 Grants to States for Loan Repayment $580,407
97.008 Non-Profit Security Program $567,029
64.115 Veterans Information and Assistance $559,065
10.902 Soil and Water Conservation $550,070
20.513 Enhanced Mobility of Seniors and Individuals with Disabilities $547,739
17.600 Mine Health and Safety Grants $540,990
20.219 Recreational Trails Program $536,242
20.700 Pipeline Safety Program State Base Grant $534,525
93.564 Child Support Enforcement Research $533,217
93.301 Small Rural Hospital Improvement Grant Program $528,688
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $527,804
10.093 Voluntary Public Access and Habitat Incentive Program $526,758
93.464 Acl Assistive Technology $517,153
93.043 Special Programs for the Aging_title Iii, Part D_disease Prevention and Health Promotion Services $510,050
15.608 Fish and Wildlife Management Assistance $507,467
93.336 Behavioral Risk Factor Surveillance System $506,013
93.686 Ending the Hiv Epidemic: A Plan for America — Ryan White Hiv/aids Program Parts A and B (b) $494,639
15.978 Upper Mississippi River System Long Term Resource Monitoring Program $489,083
30.001 Employment Discrimination_title Vii of the Civil Rights Act of 1964 $489,079
93.586 State Court Improvement Program $486,440
10.579 Child Nutrition Discretionary Grants Limited Availability $475,092
93.639 Aca-Transforming Clinical Practice Initiative: Support and Alignment Networks (sans) $470,076
93.367 Flexible Funding Model - Infrastructure Development and Maintenance for State Manufactured Food Regulatory Programs $469,637
84.224 Assistive Technology $465,073
93.981 Improving Student Health and Academic Achievement Through Nutrition, Physical Activity and the Management of Chronic Conditions in Schools $460,809
17.285 Apprenticeship USA Grants $442,342
93.197 Childhood Lead Poisoning Prevention Projects_state and Local Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children $438,889
66.034 Surveys, Studies, Research, Investigations, Demonstrations, and Special Purpose Activities Relating to the Clean Air Act $433,960
10.170 Specialty Crop Block Grant Program - Farm Bill $432,919
12.U01 Excess Property Program $426,619
20.528 Rail Fixed Guideway Public Transportation System State Safety Oversight Formula Grant Program $420,866
93.643 Children's Justice Grants to States $420,603
93.240 State Capacity Building $417,268
15.810 National Cooperative Geologic Mapping Program $412,926
93.478 Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees (b) $412,184
84.177 Rehabilitation Services_independent Living Services for Older Individuals Who Are Blind $408,089
15.904 Historic Preservation Fund Grants-in-Aid $400,100
10.069 Conservation Reserve Program $378,712
20.505 Metropolitan Transportation Planning and State and Non-Metropolitan Planning and Research $378,252
66.804 Underground Storage Tank (ust) Prevention, Detection, and Compliance Program $364,507
20.703 Interagency Hazardous Materials Public Sector Training and Planning Grants $362,558
66.442 Assistance for Small and Disadvantaged Communities Drinking Water Grant Program (sdwa 1459a) (a) $348,981
93.042 Special Programs for the Aging_title Vii, Chapter 2_long Term Care Ombudsman Services for Older Individuals $346,682
93.369 Acl Independent Living State Grants $345,993
84.187 Supported Employment Services for Individuals with the Most Significant Disabilities $345,336
97.023 Community Assistance Program State Support Services Element (cap-Ssse) $342,072
16.742 Paul Coverdell Forensic Sciences Improvement Grant Program $336,445
66.040 State Clean Diesel Grant Program $322,906
17.277 Workforce Investment Act (wia) National Emergency Grants $320,031
93.967 Cdc's Collaboration with Academia to Strengthen Public Health $318,176
17.005 Compensation and Working Conditions $314,529
93.945 Assistance Programs for Chronic Disease Prevention and Control $310,046
97.032 Crisis Counseling $296,371
16.750 Support for Adam Walsh Act Implementation Grant Program $295,619
84.325 Special Education - Personnel Development to Improve Services and Results for Children with Disabilities $294,931
93.366 State Actions to Improve Oral Health Outcomes and Partner Actions to Improve Oral Health Outcomes $288,276
16.582 Crime Victim Assistance/discretionary Grants $260,746
93.251 Early Hearing Detection and Intervention $260,537
10.479 Food Safety Cooperative Agreements $251,942
93.270 Adult Viral Hepatitis Prevention and Control $250,669
16.839 Stop School Violence $250,648
84.423 Supporting Effective Educator Development Program $249,996
10.525 Farm and Ranch Stress Assistance Network Competitive Grants Program (b) $244,245
84.326 Special Education_technical Assistance and Dissemination to Improve Services and Results for Children with Disabilities $242,347
11.035 Broadband Equity, Access, and Deployment Program $233,875
17.271 Work Opportunity Tax Credit Program (wotc) $231,894
10.535 Snap Fraud Framework Implementation Grant $230,373
64.053 Payments to States for Programs to Promote the Hiring and Retention of Nurses at State Veterans Homes $223,662
93.913 Grants to States for Operation of Offices of Rural Health $220,120
11.032 State Digital Equity Planning Grants $218,838
93.234 Traumatic Brain Injury State Demonstration Grant Program $212,207
10.572 Wic Farmers' Market Nutrition Program (fmnp) $205,928
93.130 Cooperative Agreements to States/territories for the Coordination and Development of Primary Care Offices $205,615
10.576 Senior Farmers Market Nutrition Program $186,847
93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs $183,759
16.812 Second Chance Act Reentry Initiative $182,652
10.182 Local Food Purchase Assistance $181,533
15.250 Regulation of Surface Coal Mining and Surface Effects of Underground Coal Mining $178,670
93.876 Antimicrobial Resistance Surveillance in Retail Food Specimens $175,104
66.419 Water Pollution Control State, Interstate, and Tribal Program Support $172,415
20.614 National Highway Traffic Safety Administration (nhtsa) Discretionary Safety Grants $167,795
66.444 Lead Testing in School and Child Care Program Drinking Water (sdwa 1464(d)) (a) $161,473
10.556 Special Milk Program for Children $159,172
93.314 Early Hearing Detection and Intervention Information System (ehdi-Is) Surveillance Program $156,131
93.236 Grants to States to Support Oral Health Workforce Activities $151,417
66.485 Support for the Gulf Hypoxia Action Plan $141,051
16.922 Equitable Sharing Program $137,652
93.597 Grants to States for Access and Visitation Programs $134,081
84.902 National Assessment of Educational Progress $128,221
66.818 Brownfields Assessment and Cleanup Cooperative Agreements $128,104
93.079 Cooperative Agreements to Promote Adolescent Health Through School-Based Hiv/std Prevention and School-Based Surveillance $125,185
66.433 State Underground Water Source Protection $122,959
14.268 Rural Housing Stability Assistance Program $116,555
59.061 State Trade and Export Promotion Pilot Grant Program $116,260
66.032 State Indoor Radon Grants $110,145
17.273 Temporary Labor Certification for Foreign Workers $107,226
15.615 Cooperative Endangered Species Conservation Fund $106,287
93.041 Special Programs for the Aging_title Vii, Chapter 3_programs for Prevention of Elder Abuse, Neglect, and Exploitation $100,983
97.041 National Dam Safety Program $100,823
94.013 Volunteers in Service to America $96,841
17.270 Reintegration of Ex-Offenders $90,650
15.808 U.s. Geological Survey_ Research and Data Collection $89,338
10.163 Market Protection and Promotion $82,350
20.232 Commercial Driver's License Program Improvement Grant $80,363
16.609 Project Safe Neighborhoods $79,447
20.215 Highway Training and Education $73,910
15.814 National Geological and Geophysical Data Preservation Program $71,712
21.016 Equitable Sharing $70,000
97.082 Earthquake Consortium $69,769
93.345 Leading Edge Acceleration Projects (leap) in Health Information Technology $69,301
16.606 State Criminal Alien Assistance Program $65,896
14.241 Housing Opportunities for Persons with Aids $59,487
10.435 State Mediation Grants $59,457
81.136 Long-Term Surveillance and Maintenance $59,418
15.684 White-Nose Syndrome National Response Implementation $58,818
10.153 Market News $46,897
20.240 Fuel Tax Evasion-Intergovernmental Enforcement Effort $45,743
10.187 The Emergency Food Assistance Program (tefap) Commodity Credit Corporation Eligible Recipient Funds $43,227
20.720 State Damage Prevention Program Grants $38,320
12.620 Troops to Teachers Grant Program $37,786
66.961 Superfund State and Indian Tribe Combined Cooperative Agreements (site-Specfic and Core) (b) $35,861
10.605 Quality Samples Program $32,986
10.125 Hazardous Waste Management (b) $32,238
20.500 Federal Transit_capital Investment Grants $31,639
97.088 Disaster Assistance Projects $29,259
84.144 Migrant Education_coordination Program $25,122
10.028 Wildlife Services $25,000
11.307 Economic Adjustment Assistance $24,153
16.U01 FBI Joint Terrorism Task Force $23,325
10.541 Child Nutrition-Technology Innovation Grant $22,196
10.680 Forest Health Protection $21,571
20.507 Federal Transit_formula Grants $15,297
20.721 Phmsa Pipeline Safety Program One Call Grant $7,795
10.171 Organic Certification Cost Share Programs $7,664
66.608 Environmental Information Exchange Network Grant Program and Related Assistance $5,416
20.301 Railroad Safety $5,300
15.980 National Ground-Water Monitoring Network $4,822
84.426 Randolph-Sheppard – Financial Relief and Restoration Payments $4,524
89.003 National Historical Publications and Records Grants $2,750
93.499 Low Income Household Water Assistance Program $2,309
81.138 State Heating Oil and Propane Program $2,004
15.073 Earth Mapping Resources Initiative $561
66.461 Regional Wetland Program Development Grants $36
97.050 Presidential Declared Disaster Assistance to Individuals and Households - Other Needs $-639,140