Finding Text
2023-006 Eligibility
Prior Year Finding Number: N/A
Year of Finding Origination: 2023
Type of Finding: Internal Control Over Compliance and Compliance
Severity of Deficiency: Significant Deficiency and Other Matter
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.
Title 42 U.S. Code of Federal Regulations §§ 435.911 and 435.945 require the state Medicaid agency to determine and verify eligibility of enrollees in Medicaid. The Minnesota Department of Human Services provides the Minnesota Health Care Programs Eligibility Policy Manual. The manual contains the Minnesota Department of Human Services eligibility policies for the Minnesota Health Care Programs, including the eligibility requirements of Medical Assistance. Specific eligibility requirements are included for participants’ assets. Minnesota Statutes § 256B.05 requires county agencies to administer Medical Assistance.
Condition: The Minnesota Department of Human Services maintains the computer system, MAXIS, which is used by Carlton County to support the eligibility determination process. In the case files reviewed for eligibility, not all documentation to support participant eligibility was available, updated, or input correctly into MAXIS. In the sample of 40 case files tested, three case files had assets listed in MAXIS that did not match the documentation in the case file.
Questioned Costs: Not applicable. The County administers the program, but the State of Minnesota pays benefits to participants in this program.
Context: The State of Minnesota and the County split the eligibility determination process. Pursuant to Minnesota statutes, Carlton County performs the “intake function” needed for this program, while the state maintains the MAXIS system, which supports the eligibility determination process. Participants receive benefit payments from the state.
The sample size was based on the guidance from Chapter 11 of the AICPA Audit Guide, Government Auditing Standards and Single Audits.
Effect: The lack of updated information in MAXIS to document verification of key 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 Carlton County implement additional procedures to provide reasonable assurance that all necessary documentation to support eligibility determinations exists and is properly input or updated in MAXIS. In addition, Carlton County should consider providing further training to program personnel.
View of Responsible Official: Concur