Itasca CountyLocal Government

CASEFILE REVIEW (2024-005) Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Medical Assistance Program (Medicaid Cluster) Assistance Listing Number: 93.778 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2405MN5ADM, 2405MN5MAP Federal Award Identification Number and Year: 2405MN5ADM, 2405MN5MAP, 2024 Compliance Requirement Affected: Eligibility Award Period: Year Ended December 31, 2024 Type of Finding: Material Weakness in Internal Control Over Compliance Criteria or Specific Requirement: Standard internal control procedures recommend internal reviews over case file eligibility determinations to ascertain case workers are complying with state and federal requirements and correctly determining program eligibility. Condition: There was no formal review documented over internal case files worked by program eligibility specialists. Questioned Costs: None Context: During our testing of eligibility and testing of case file reviews completed during 2024 for Medical Assistance, it was noted that there were no documented case file reviews performed. Cause: The Minnesota Department of Human Services is not requiring a review of case files and lack of staffing. Effect: Errors made in determining eligibility may not be discovered and benefits may be issued to clients who are not eligible. Repeat Finding: Yes, 2023-005. Recommendation: We recommend that the County review case files on a periodic basis throughout the year and document the review. Views of Responsible Officials: There is no disagreement with the audit finding.

ELIGIBILITY (2024-006) Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Temporary Assistance for Needy Families (TANF) Assistance Listing Number: 93.558 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2401MNTANF Federal Award Identification Number and Year: 2401MNTANF, 2024 Compliance Requirement Affected: Eligibility Award Period: Year Ended December 31, 2024 Type of Finding: Material Weakness in Internal Control Over Compliance Criteria or Specific Requirement: Standard internal control procedures recommend internal reviews over case file eligibility determinations to ascertain case workers are complying with state and federal requirements. Condition: There was no formal review documented over internal case files worked by program eligibility specialists. Questioned Costs: None Context: During our testing of case file reviews during 2024, it was noted that there were no documented case file reviews performed for the human services component of Temporary Assistance for Needy Families. Cause: The Minnesota Department of Human Services is not requiring a review of case files and lack of staffing. Effect: Errors made in determining eligibility may not be discovered and benefits may be issued to clients who are not eligible. Repeat Finding: Yes, 2023-006. Recommendation: We recommend that the County review case files on a periodic basis throughout the year and document the review. Views of Responsible Officials: There is no disagreement with the audit finding.

REPORTING (2024-007) Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Medical Assistance Program (Medicaid Cluster) Assistance Listing Number: 93.778 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2405MN5ADM, 2405MN5MAP Federal Award Identification Number and Year: 2405MN5ADM, 2405MN5MAP, 2024 Compliance Requirement Affected: Reporting Award Period: Year Ended December 31, 2024 Type of Finding: Significant Deficiency in Internal Control Over Compliance Criteria or Specific Requirement: Standard internal control procedures recommend that reports should have a review documented by someone other than the preparer. Condition: The County’s annual LCTS collaborative report filed was missing documentation of review by someone other than the preparer. Questioned Costs: None Context: During our testing of the annual LCTS collaborative report, it was noted that the annual report was missing documentation of review by someone other than the preparer. Cause: The Minnesota Department of Human Services is not requiring a review and lack of management oversight. Effect: Reports could be prepared with errors that are not corrected prior to submission. Repeat Finding: Yes, 2023-007. Recommendation: We recommend that the County ensure each report is reviewed by someone other than the preparer. Views of Responsible Officials: There is no disagreement with the audit finding.

SUSPENSION AND DEBARMENT (2024-008) Federal Agency: U.S. Department of Treasury Federal Program Name: COVID-19 Coronavirus State and Local Fiscal Recovery Funds (SLFRF) Assistance Listing Number: 21.027 Pass-Through Agency: Not applicable, direct Pass-Through Numbers: Not applicable, direct Federal Award Identification Number and Year: Not applicable, direct Compliance Requirement Affected: Suspension and Debarment Award Period: Year Ended December 31, 2024 Type of Finding: Significant Deficiency in Internal Control Over Compliance and Other Matter Criteria or Specific Requirement: According to Uniform Guidance 2 CFR 180.300, the County must check for federally suspended or debarred vendors prior to entering into a covered transaction. Condition: The County did not retain documentation for the date that the verification was completed. Questioned Costs: None Context: For seven of seven transactions tested for suspension and debarment, the County did not retain documentation that the verification was completed. Cause: Lack of oversight by management. Effect: The County could be using a vendor that is suspended or debarred at the time of the transaction. Repeat Finding: No Recommendation: We recommend that the County review their procedures to ensure they are following their policy that requires all suspension and debarment checks to be retained and follow federal guidelines. Views of Responsible Officials: There is no disagreement with the audit finding.

CASEFILE REVIEW (2024-005) Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Medical Assistance Program (Medicaid Cluster) Assistance Listing Number: 93.778 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2405MN5ADM, 2405MN5MAP Federal Award Identification Number and Year: 2405MN5ADM, 2405MN5MAP, 2024 Compliance Requirement Affected: Eligibility Award Period: Year Ended December 31, 2024 Type of Finding: Material Weakness in Internal Control Over Compliance Criteria or Specific Requirement: Standard internal control procedures recommend internal reviews over case file eligibility determinations to ascertain case workers are complying with state and federal requirements and correctly determining program eligibility. Condition: There was no formal review documented over internal case files worked by program eligibility specialists. Questioned Costs: None Context: During our testing of eligibility and testing of case file reviews completed during 2024 for Medical Assistance, it was noted that there were no documented case file reviews performed. Cause: The Minnesota Department of Human Services is not requiring a review of case files and lack of staffing. Effect: Errors made in determining eligibility may not be discovered and benefits may be issued to clients who are not eligible. Repeat Finding: Yes, 2023-005. Recommendation: We recommend that the County review case files on a periodic basis throughout the year and document the review. Views of Responsible Officials: There is no disagreement with the audit finding.

ELIGIBILITY (2024-006) Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Temporary Assistance for Needy Families (TANF) Assistance Listing Number: 93.558 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2401MNTANF Federal Award Identification Number and Year: 2401MNTANF, 2024 Compliance Requirement Affected: Eligibility Award Period: Year Ended December 31, 2024 Type of Finding: Material Weakness in Internal Control Over Compliance Criteria or Specific Requirement: Standard internal control procedures recommend internal reviews over case file eligibility determinations to ascertain case workers are complying with state and federal requirements. Condition: There was no formal review documented over internal case files worked by program eligibility specialists. Questioned Costs: None Context: During our testing of case file reviews during 2024, it was noted that there were no documented case file reviews performed for the human services component of Temporary Assistance for Needy Families. Cause: The Minnesota Department of Human Services is not requiring a review of case files and lack of staffing. Effect: Errors made in determining eligibility may not be discovered and benefits may be issued to clients who are not eligible. Repeat Finding: Yes, 2023-006. Recommendation: We recommend that the County review case files on a periodic basis throughout the year and document the review. Views of Responsible Officials: There is no disagreement with the audit finding.

REPORTING (2024-007) Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Medical Assistance Program (Medicaid Cluster) Assistance Listing Number: 93.778 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2405MN5ADM, 2405MN5MAP Federal Award Identification Number and Year: 2405MN5ADM, 2405MN5MAP, 2024 Compliance Requirement Affected: Reporting Award Period: Year Ended December 31, 2024 Type of Finding: Significant Deficiency in Internal Control Over Compliance Criteria or Specific Requirement: Standard internal control procedures recommend that reports should have a review documented by someone other than the preparer. Condition: The County’s annual LCTS collaborative report filed was missing documentation of review by someone other than the preparer. Questioned Costs: None Context: During our testing of the annual LCTS collaborative report, it was noted that the annual report was missing documentation of review by someone other than the preparer. Cause: The Minnesota Department of Human Services is not requiring a review and lack of management oversight. Effect: Reports could be prepared with errors that are not corrected prior to submission. Repeat Finding: Yes, 2023-007. Recommendation: We recommend that the County ensure each report is reviewed by someone other than the preparer. Views of Responsible Officials: There is no disagreement with the audit finding.

SUSPENSION AND DEBARMENT (2024-008) Federal Agency: U.S. Department of Treasury Federal Program Name: COVID-19 Coronavirus State and Local Fiscal Recovery Funds (SLFRF) Assistance Listing Number: 21.027 Pass-Through Agency: Not applicable, direct Pass-Through Numbers: Not applicable, direct Federal Award Identification Number and Year: Not applicable, direct Compliance Requirement Affected: Suspension and Debarment Award Period: Year Ended December 31, 2024 Type of Finding: Significant Deficiency in Internal Control Over Compliance and Other Matter Criteria or Specific Requirement: According to Uniform Guidance 2 CFR 180.300, the County must check for federally suspended or debarred vendors prior to entering into a covered transaction. Condition: The County did not retain documentation for the date that the verification was completed. Questioned Costs: None Context: For seven of seven transactions tested for suspension and debarment, the County did not retain documentation that the verification was completed. Cause: Lack of oversight by management. Effect: The County could be using a vendor that is suspended or debarred at the time of the transaction. Repeat Finding: No Recommendation: We recommend that the County review their procedures to ensure they are following their policy that requires all suspension and debarment checks to be retained and follow federal guidelines. Views of Responsible Officials: There is no disagreement with the audit finding.

Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Medical Assistance Program (Medicaid Cluster) Assistance Listing Number: 93.778 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2305MN5ADM, 2305MN5MAP Federal Award Identification Number and Year: 2305MN5ADM, 2305MN5MAP, 2023 Compliance Requirement Affected: Eligibility Award Period: Year Ended December 31, 2023 Type of Finding: Material Weakness in Internal Control Over Compliance Criteria or Specific Requirement: Standard internal control procedures recommend internal reviews over case file eligibility determinations to ascertain case workers are complying with state and federal requirements and correctly determining program eligibility. Condition: There was no formal review documented over internal case files worked by program eligibility specialists. Questioned Costs: None Context: During our testing of eligibility and testing of case file reviews completed during 2023 for Medical Assistance, it was noted that there were no documented case file reviews performed. Cause: The Minnesota Department of Human Services is not requiring a review and lack of management oversight. Effect: Errors made in determining eligibility may not be discovered and benefits may be issued to clients who are not eligible. Repeat Finding: Yes, 2022-007. Recommendation: We recommend that the County review case files on a periodic basis throughout the year and document the review. Views of Responsible Officials: There is no disagreement with the audit finding.

Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Temporary Assistance for Needy Families (TANF) Assistance Listing Number: 93.558 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2301MNTANF Federal Award Identification Number and Year: 2301MNTANF, 2023 Compliance Requirement Affected: Eligibility Award Period: Year Ended December 31, 2023 Type of Finding: Material Weakness in Internal Control Over Compliance Criteria or Specific Requirement: Standard internal control procedures recommend internal reviews over case file eligibility determinations to ascertain case workers are complying with state and federal requirements. Condition: There was no formal review documented over internal case files worked by program eligibility specialists. Questioned Costs: None Context: During our testing of case file reviews during 2023, it was noted that there were no documented case file reviews performed for the human services component of Temporary Assistance for Needy Families. Cause: The Minnesota Department of Human Services is not requiring a review of case files and lack of management oversight. Effect: Errors made in determining eligibility may not be discovered and benefits may be issued to clients who are not eligible. Repeat Finding: Yes, 2022-008. Recommendation: We recommend that the County review case files on a periodic basis throughout the year. Views of Responsible Officials: There is no disagreement with the audit finding.

Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Medical Assistance Program (Medicaid Cluster) Assistance Listing Number: 93.778 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2305MN5ADM, 2305MN5MAP Federal Award Identification Number and Year: 2305MN5ADM, 2305MN5MAP, 2023 Compliance Requirement Affected: Reporting Award Period: Year Ended December 31, 2023 Type of Finding: Significant Deficiency in Internal Control Over Compliance Criteria or Specific Requirement: Standard internal control procedures recommend that reports should have a review documented by someone other than the preparer. Condition: The County’s annual LCTS collaborative report filed was missing documentation of review by someone other than the preparer. Questioned Costs: None Context: During our testing of the annual LCTS collaborative report, it was noted that the annual report was missing documentation of review by someone other than the preparer. Cause: The Minnesota Department of Human Services is not requiring a review and lack of management oversight. Effect: Reports could be prepared with errors that are not corrected prior to submission. Repeat Finding: No Recommendation: We recommend that the County ensured each report is reviewed by someone other than the preparer. Views of Responsible Officials: There is no disagreement with the audit finding.

CONTROLS OVER REPORTING (2022 – 006) Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Medical Assistance Program (Medicaid Cluster) Assistance Listing Number: 93.778 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2205MN5ADM, 2205MN5MAP Federal Award Identification Number and Year: 2205MN5ADM, 2205MN5MAP, 2022 Compliance Requirement Affected: Reporting Award Period: Year Ended December 31, 2022 Type of Finding: Material Weakness in Internal Control over Compliance Criteria or Specific Requirement: Standard internal control procedures recommend that reports should have a review documented by someone other than the preparer. Condition: The quarterly CTC reports filed were missing documentation of review by someone other than the preparer. Questioned Costs: None Context: During our testing of the four CTC quarterly reports, it was noted that two quarterly reports were missing documentation of review by someone other than the preparer. Cause: The Minnesota Department of Human Services is not requiring a reviewer and lack of management oversight. Effect: Reports could be prepared with errors that are not corrected prior to report submission. Repeat Finding: Yes, Finding 2021-006 Recommendation: We recommend that the County ensures each report is reviewed by someone other than the preparer. Views of responsible officials: There is no disagreement with the audit finding.

CASEFILE REVIEW (2022 – 007) Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Medical Assistance Program (Medicaid Cluster) Assistance Listing Number: 93.778 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2205MN5ADM, 2205MN5MAP Federal Award Identification Number and Year: 2205MN5ADM, 2205MN5MAP, 2022 Compliance Requirement Affected: Eligibility Award Period: Year Ended December 31, 2022 Type of Finding: Material Weakness in Internal Control over Compliance, Other Matters Criteria or Specific Requirement: Standard internal control procedures recommend internal reviews over case file eligibility determinations to ascertain case workers are complying with state and federal requirements and correctly determining program eligibility. Condition: There was no formal review documented over internal case files worked by program eligibility specialists. Questioned Costs: None Context: During our testing of eligibility and testing of case file reviews completed during 2022 for Medical Assistance, it was noted that there were no documented case file reviews performed. Cause: The Minnesota Department of Human Services is not requiring a review and lack of management oversight. Effect: Errors made in determining eligibility may not be discovered and benefits may be issued to clients who are not eligible. Repeat Finding: No Recommendation: We recommend that the County review case files on a periodic basis throughout the year and document the review. Views of responsible officials: There is no disagreement with the audit finding.

ELIGIBILITY (2022 – 008) Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Temporary Assistance for Needy Families (TANF) Assistance Listing Number: 93.558 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2201MNTANF Federal Award Identification Number and Year: 2201MNTANF, 2022 Compliance Requirement Affected: Eligibility Award Period: Year Ended December 31, 2022 Type of Finding: Material Weakness in Internal Control over Compliance, Other Matters Criteria or Specific Requirement: Standard internal control procedures recommend internal reviews over case file eligibility determinations to ascertain case workers are complying with state and federal requirements. Condition: There was no formal review documented over internal case files worked by program eligibility specialists. There was also missing documentation of the County’s screening of eligibility. Questioned Costs: None Context: During our testing of case file reviews during 2022, it was noted that there were no documented case file reviews performed for the public health or human services component of Temporary Assistance for Needy Families. It was also noted that during our testing of case files that 3 of 13 public health cases and 0 of 60 human services case files tested did not have documentation on file showing the case file worker’s screening of eligibility. Cause: The Minnesota Department of Human Services is not requiring a review of case files and lack of management oversight. Effect: Errors made in determining eligibility may not be discovered and benefits may be issued to clients who are not eligible. Repeat Finding: No Recommendation: We recommend that the County review case files on a periodic basis throughout the year. Views of responsible officials: There is no disagreement with the audit finding.

INACCURATE LISTING OF EMPLOYEES FOR RANDOM MOMENT STUDIES (2022 – 009) Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Medical Assistance Program (Medicaid Cluster) & Temporary Assistance for Needy Families (TANF) Assistance Listing Number: 93.778 & 93.558 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2205MN5ADM, 2205MN5MAP, 2201MNTANF Federal Award Identification Number and Year: 2205MN5ADM, 2205MN5MAP, 2201MNTANF, 2022 Compliance Requirement Affected: Activities Allowed or Unallowed/Allowable Cost/Cost Principles Award Period: Year Ended December 31, 2022 Type of Finding: Significant Deficiency in Internal Control over Compliance, Other Matters Criteria or Specific Requirement: The County maintains a list of all employees subject to random moment studies, which the State uses as a basis for determining salary reimbursement under federal programs. Condition: The County did not properly report employees working on the Medical Assistance and Temporary Assistance for Needy Families programs to the state of Minnesota during a time study conducted by the Minnesota Department of Human Services. Questioned Costs: None Context: During our testing of eligibility and testing of the second and fourth quarter random moment study listing completed during 2022 for the Medical Assistance and Temporary Assistance for Needy Families programs, it was noted that one individual was included on the second quarter Income Maintenance listing that should not have been included. Cause: The Minnesota Department of Human Services is not requiring a review of and lack of management oversight. Effect: The County could receive an incorrect federal funding allocation on incorrect employee information provided to the state for reimbursement. Repeat Finding: No Recommendation: We recommend that the County review the listing of employees working on certain programs on a periodic basis throughout the year and document the review. Views of responsible officials: There is no disagreement with the audit finding.

CONTROLS OVER REPORTING (2022 – 006) Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Medical Assistance Program (Medicaid Cluster) Assistance Listing Number: 93.778 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2205MN5ADM, 2205MN5MAP Federal Award Identification Number and Year: 2205MN5ADM, 2205MN5MAP, 2022 Compliance Requirement Affected: Reporting Award Period: Year Ended December 31, 2022 Type of Finding: Material Weakness in Internal Control over Compliance Criteria or Specific Requirement: Standard internal control procedures recommend that reports should have a review documented by someone other than the preparer. Condition: The quarterly CTC reports filed were missing documentation of review by someone other than the preparer. Questioned Costs: None Context: During our testing of the four CTC quarterly reports, it was noted that two quarterly reports were missing documentation of review by someone other than the preparer. Cause: The Minnesota Department of Human Services is not requiring a reviewer and lack of management oversight. Effect: Reports could be prepared with errors that are not corrected prior to report submission. Repeat Finding: Yes, Finding 2021-006 Recommendation: We recommend that the County ensures each report is reviewed by someone other than the preparer. Views of responsible officials: There is no disagreement with the audit finding.

CASEFILE REVIEW (2022 – 007) Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Medical Assistance Program (Medicaid Cluster) Assistance Listing Number: 93.778 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2205MN5ADM, 2205MN5MAP Federal Award Identification Number and Year: 2205MN5ADM, 2205MN5MAP, 2022 Compliance Requirement Affected: Eligibility Award Period: Year Ended December 31, 2022 Type of Finding: Material Weakness in Internal Control over Compliance, Other Matters Criteria or Specific Requirement: Standard internal control procedures recommend internal reviews over case file eligibility determinations to ascertain case workers are complying with state and federal requirements and correctly determining program eligibility. Condition: There was no formal review documented over internal case files worked by program eligibility specialists. Questioned Costs: None Context: During our testing of eligibility and testing of case file reviews completed during 2022 for Medical Assistance, it was noted that there were no documented case file reviews performed. Cause: The Minnesota Department of Human Services is not requiring a review and lack of management oversight. Effect: Errors made in determining eligibility may not be discovered and benefits may be issued to clients who are not eligible. Repeat Finding: No Recommendation: We recommend that the County review case files on a periodic basis throughout the year and document the review. Views of responsible officials: There is no disagreement with the audit finding.

ELIGIBILITY (2022 – 008) Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Temporary Assistance for Needy Families (TANF) Assistance Listing Number: 93.558 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2201MNTANF Federal Award Identification Number and Year: 2201MNTANF, 2022 Compliance Requirement Affected: Eligibility Award Period: Year Ended December 31, 2022 Type of Finding: Material Weakness in Internal Control over Compliance, Other Matters Criteria or Specific Requirement: Standard internal control procedures recommend internal reviews over case file eligibility determinations to ascertain case workers are complying with state and federal requirements. Condition: There was no formal review documented over internal case files worked by program eligibility specialists. There was also missing documentation of the County’s screening of eligibility. Questioned Costs: None Context: During our testing of case file reviews during 2022, it was noted that there were no documented case file reviews performed for the public health or human services component of Temporary Assistance for Needy Families. It was also noted that during our testing of case files that 3 of 13 public health cases and 0 of 60 human services case files tested did not have documentation on file showing the case file worker’s screening of eligibility. Cause: The Minnesota Department of Human Services is not requiring a review of case files and lack of management oversight. Effect: Errors made in determining eligibility may not be discovered and benefits may be issued to clients who are not eligible. Repeat Finding: No Recommendation: We recommend that the County review case files on a periodic basis throughout the year. Views of responsible officials: There is no disagreement with the audit finding.

INACCURATE LISTING OF EMPLOYEES FOR RANDOM MOMENT STUDIES (2022 – 009) Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Medical Assistance Program (Medicaid Cluster) & Temporary Assistance for Needy Families (TANF) Assistance Listing Number: 93.778 & 93.558 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Pass-Through Numbers: 2205MN5ADM, 2205MN5MAP, 2201MNTANF Federal Award Identification Number and Year: 2205MN5ADM, 2205MN5MAP, 2201MNTANF, 2022 Compliance Requirement Affected: Activities Allowed or Unallowed/Allowable Cost/Cost Principles Award Period: Year Ended December 31, 2022 Type of Finding: Significant Deficiency in Internal Control over Compliance, Other Matters Criteria or Specific Requirement: The County maintains a list of all employees subject to random moment studies, which the State uses as a basis for determining salary reimbursement under federal programs. Condition: The County did not properly report employees working on the Medical Assistance and Temporary Assistance for Needy Families programs to the state of Minnesota during a time study conducted by the Minnesota Department of Human Services. Questioned Costs: None Context: During our testing of eligibility and testing of the second and fourth quarter random moment study listing completed during 2022 for the Medical Assistance and Temporary Assistance for Needy Families programs, it was noted that one individual was included on the second quarter Income Maintenance listing that should not have been included. Cause: The Minnesota Department of Human Services is not requiring a review of and lack of management oversight. Effect: The County could receive an incorrect federal funding allocation on incorrect employee information provided to the state for reimbursement. Repeat Finding: No Recommendation: We recommend that the County review the listing of employees working on certain programs on a periodic basis throughout the year and document the review. Views of responsible officials: There is no disagreement with the audit finding.

CONTROLS OVER REPORTING (2021 ? 006) Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Medical Assistance Program (Medicaid Cluster) Assistance Listing Number: 93.778 Pass-Through Agency: Minnesota Department of Human Services and the Aitkin-Itasca-Koochiching Community Health Board Federal Award Identification Number and Pass-Through Number(s): 2105MN5ADM, 2105MN5MAP Award Period: Year Ended December 31, 2021 Type of Finding: Material Weakness in Internal Control over Compliance Criteria or Specific Requirement: Standard internal control procedures recommend that reports should have a review documented by someone other than the preparer. Condition: The quarterly CTC reports filed were missing documentation of review by someone other than the preparer. Questioned costs: None Context: During our statistically valid sample testing of reporting and testing of 4 quarterly report, it was noted that two quarterly reports were missing documentation of review by someone other than the preparer. Cause: The Minnesota Department of Human Services is not requiring a reviewer and lack of management oversight. Effect: Reports could be prepared with errors that are not corrected prior to report submission. Repeat Finding: Not applicable. Recommendation: We recommend that the County ensures each report is reviewed by someone other than the preparer. Views of responsible officials: There is no disagreement with the audit finding.

Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Medical Assistance Program (Medicaid Cluster) CFDA Number: 93.778 Pass-Through Agency: Minnesota Department of Human Services Pass-Through Numbers: 2005MN5ADM, 2005MN5MAP Compliance Requirement Affected: Eligibility Award Period: January 1, 2020 through December 31, 2020 Type of Finding: Significant Deficiency in Internal Control over Compliance and Other Matter Criteria All individuals receiving Medical Assistance must meet specific asset guidelines to be eligible. Condition and Context During our statistically valid sample testing of eligibility and inquiry and testing of 60 casefiles, it was noted that two individuals had information in the County's case management system (OnBase) updated with current asset information, but the eligibility software (MAXIS) did not contain the updated information. The sample sizes were based on guidance from chapter 11 of the AICPA audit guide, Government Auditing Standards and Single Audits. Cause Lack of management oversight. Effect Errors made in determining eligibility may not be discovered and benefits may be issued to clients who are not eligible. Questioned Costs Not able to be determined. Repeat Finding Yes, Finding 2019-006. Recommendation We recommend the County review asset verification for each eligible case file. Views of Responsible Officials There is no disagreement with the audit finding.

Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Medical Assistance Program (Medicaid Cluster) CFDA Number: 93.778 Pass-Through Agency: Minnesota Department of Human Services Pass-Through Numbers: 2005MN5ADM, 2005MN5MAP Compliance Requirement Affected: Eligibility Award Period: January 1, 2020 through December 31, 2020 Type of Finding Material Weakness in Internal Control over Compliance and Other Matter Criteria Standard internal control procedures recommend internal reviews over case file eligibility determinations to ascertain case workers are complying with state and federal requirements and correctly determining program eligibility. Condition and Context During our statistically valid sample testing of eligibility and inquiry and testing of case file reviews completed during 2020 for Medical Assistance, it was noted that there were no documented case file reviews performed. The sample sizes were based on guidance from chapter 11 of the AICPA audit guide, Government Auditing Standards and Single Audits. Cause Lack of management oversight. Effect Errors made in determining eligibility may not be discovered and benefits may be issued to clients who are not eligible. Questioned Costs Not able to be determined. Repeat Finding Prior year finding identified as Finding 2019-007. Recommendation We recommend the County review case files on a periodic basis throughout the year and document the review. Views of Responsible Officials There is no disagreement with the audit finding.

Federal Agency: U.S. Department of Treasury Federal Program Title: COVID-19 Coronavirus Relief Fund CFDA Number: 21.019 Pass-Through Agency: Minnesota Department of Revenue Pass-Through Numbers: SLT0016 Compliance Requirement Affected: Reporting Award Period: March 1, 2020 through December 1, 2020 Type of Finding: Significant Deficiency in Internal Control over Compliance and Other Matter Criteria Local Governments receiving Coronavirus Relief Funds (CRF) have guidance from the State of Minnesota that states spending reports must be filed by the 7th business day of the following month. Condition and Context During our statistically valid sample testing of reporting, it was noted that 1 of 4 monthly reports tested were submitted past the due date established by the FAQs for Local Governments receiving Coronavirus Relief Funds (CRF) from the State of Minnesota. The sample sizes were based on guidance from chapter 11 of the AICPA audit guide, Government Auditing Standards and Single Audits. Cause Lack of management oversight due to it being a new grant. Effect The County could risk loss of funding for later submission of required reporting. Questioned Costs None Repeat Finding: Not Applicable. Recommendation We recommend the County implement procedures to ensure any future reports are submitted timely. Views of Responsible Officials There is no disagreement with the audit finding.

Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Medical Assistance Program (Medicaid Cluster) CFDA Number: 93.778 Pass-Through Agency: Minnesota Department of Human Services Pass-Through Numbers: 1905MN5ADM, 1905MN5MAP Compliance Requirement Affected: Eligibility Award Period: Year-Ended December 31, 2019 Type of Finding: Significant Deficiency in Internal Control over Compliance and Other Matter Criteria: All individuals receiving Medical Assistance must meet specific asset guidelines to be eligible. Condition and Context: During our statistically valid sample testing of eligibility and inquiry and testing of 60 casefiles, it was noted that three individuals had information in the County?s case management system (OnBase) updated with current asset information, but the eligibility software (MAXIS) did not contain the updated information. The sample sizes were based on guidance from chapter 11 of the AICPA audit guide, Government Auditing Standards and Single Audits. Questioned Costs: Not able to be determined. Cause: Lack of management oversight. Possible Effect: Errors made in determining eligibility may not be discovered and benefits may be issued to clients who are not eligible. Repeat Finding: Prior year finding identified as Finding 2018-008. Recommendation: We recommend the County review asset verification for each eligible case file. Views of Responsible Officials: There is no disagreement with the audit finding.

Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Medical Assistance Program (Medicaid Cluster) and Title IV-E Foster Care CFDA Number: 93.778 and 93.658 Pass-Through Agency: Minnesota Department of Human Services Pass-Through Numbers: 1905MN5ADM, 1905MN5MAP, 1901MNFOST Compliance Requirement Affected: Eligibility Award Period: Year-Ended December 31, 2019 Type of Finding: Material Weakness in Internal Control over Compliance and Other Matter Criteria: Standard internal control procedures recommend internal reviews over case file eligibility determinations to ascertain case workers are complying with state and federal requirements and correctly determining program eligibility. Condition and Context: During our statistically valid sample testing of eligibility and inquiry, and testing of case files reviews completed during 2019 for Medical Assistance, it was noted that there we no case file reviews performed. In our testing of Title IV-E Foster Care, it was noted that the case file reviews were not documented. The sample sizes were based on guidance from chapter 11 of the AICPA audit guide, Government Auditing Standards and Single Audits. Questioned Costs: Not able to be determined. Cause: Lack of management oversight. Possible Effect: Errors made in determining eligibility may not be discovered and benefits may be issued to clients who are not eligible. Repeat Finding: Prior year finding identified as Finding 2018-006. Recommendation: We recommend the County review case files on a periodic basis throughout the year and document the review. Views of Responsible Officials: There is no disagreement with the audit finding.

Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Medical Assistance Program (Medicaid Cluster) and Title IV-E Foster Care CFDA Number: 93.778 and 93.658 Pass-Through Agency: Minnesota Department of Human Services Pass-Through Numbers: 1905MN5ADM, 1905MN5MAP, 1901MNFOST Compliance Requirement Affected: Special Provisions and Reporting Award Period: Year-Ended December 31, 2019 Type of Finding: Significant Deficiency in Internal Control over Compliance and Other Matter Criteria: It is best practice to have someone other than the preparer review and document their review of the Local Collaborative Time Study reports submitted by other entities for accuracy. In addition, all reports submitted should be reviewed by someone other than the preparer and that review should be documented. Condition and Context: It was noted during testing of 2 of 4 quarters there was no documentation of the accuracy of the Local Collaborative Time Study reports. In addition, we noted that the review of CTC quarterly reports, annual spending reports, annual collaborative reports, and CTC annual reports is not documented. The sample sizes were based on guidance from chapter 11 of the AICPA audit guide, Government Auditing Standards and Single Audits and were statistically valid. Questioned Costs: Not able to be determined. Cause: Lack of management oversight. Possible Effect: Errors made in determining accuracy could lead to entities submitting erroneous amounts on their quarterly reports. Repeat Finding: Not Applicable. Recommendation: We recommend the County implement procedures documenting accuracy of submitted local collaborative time study reports. Views of Responsible Officials: There is no disagreement with the audit finding.

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