Finding 59685 (2022-002)

Eligibility Material Weakness, Internal Control Over Compliance, Eligibility and Special Tests ALN 93.778: Medicaid Cluster Federal Agency: U.S. Department of the Health and Human Services Criteria Or Specific Requirement: The Medicaid program provides medical assistance to individuals whose incomes and resources are insufficient to meet the costs of necessary medical services. Beneficiary eligibility is generally based on financial and non-financial criteria. Mesa is responsible for determining eligibility and establishing controls over the determination of eligible individuals. Condition: Review of eligibility determinations was not documented for all periods during 2022. Cause: Internal controls over the eligibility determinations are the responsibility of management. Mesa County did not follow its formal process in place for reviews of eligibility determinations. Effect: Without sufficient documentation and monitoring controls, Mesa may not timely detect an error in eligibility determinations. Identification As A Repeat Finding: Not Applicable Recommendation: We recommend that Mesa follow the current documented internal control process over review of eligibility determinations. Views Of Responsible Officials And Planned Corrective Action: Mesa agrees with the finding and has put together a correction action plan for the finding. See corrective action plan included in this report.