Finding Text
2022-002 Eligibility Prior Year Finding Number: 2021-002 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: 2205MN5ADM and 2205MN5MAP, 2022 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: The Minnesota Department of Human Services (DHS) maintains the computer systems, MAXIS and METS, which are 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 80 case files tested: ? Eight MAXIS case files included amounts for various client accounts (assets) that were not properly updated and/or substantiated for the most recent application/certification prior to being automatically renewed during the COVID-19 pandemic. ? Six MAXIS case files did not have the support for the income listed in MAXIS. ? Five MAXIS case files did not meet the application requirements, such as obtaining the required signature, obtaining the Authorized Representative (AREP) form for signatures of representatives of the applicant, or requesting and obtaining the case file information from the previous agency. ? Two METS case files did not have the support for the income listed in METS. ? Two METS case files attested to zero income on the application, but the income was not verified to an external source. ? Two METS case files included social security numbers, but the process was incomplete, and therefore, not verified. Questioned Costs: Not applicable. The Health and Human Services administers the program, but benefits to participants in this program are paid by the State of Minnesota. 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 and METS systems, which supports the eligibility determination 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 METS and the lack of verification or follow-up of eligibility-determining factors increases the risk that a program participant will receive benefits when they are not eligible. Cause: Program personnel entering case file information into MAXIS and METS did not ensure all required information was input or updated in MAXIS and METS correctly or that all required information was obtained and/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 METS and issues are followed up in a timely manner. In addition, consideration should be given to providing further training to program personnel. View of Responsible Official: Acknowledge