St. Louis CountyLocal Government

ELIGIBILITY DOCUMENTATION OVER INCOME AND ASSETS (2020-002) 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: Year-Ended December 31, 2020 Type of Finding: Significant Deficiency in Internal Control over Compliance and Other Matters Criteria: According to Uniform Guidance 2 CFR Part 200, Appendix XI Compliance Supplement for CFDA 93.778 and 42 CFR section 431.10, the federal eligibility compliance requirements for Non-MAGI and MAGI Medical Assistance include verification of specific assets and income of applicants. In order for benefit amounts to be calculated correctly, it?s necessary for the asset and income information to be entered into the state eligibility system, MAXIS, accurately. Condition and Context: During our testing of Medical Assistance, it was noted that one of the sixty case files for Medical Assistance did not have documentation to support the income amount that was entered into the state system, MAXIS, and one of the sixty case files for Medical Assistance did not have documentation to support the asset amount. The sample size was based on guidance from chapter 11 of the AICPA Audit Guide, Government Auditing Standards and Single Audits and was a statistically valid sample. Questioned Costs: Not applicable. The County administers the program, but benefits to participants in this program are paid by the State of Minnesota. Possible Effect: If asset and income values are not properly entered into the state MAXIS system, benefit amounts may be incorrect or paid to ineligible clients. Cause: Human error and lack of verification, amounts missing did not affect eligibility by oversight and were not updated in MAXIS due to the small nature of the change from the previous amount entered by County staff. Recommendation: We recommend the County implement procedures to provide reasonable assurance that all necessary documentation to support eligibility determinations is retained and is properly input or updated in MAXIS and issues followed up on in a timely manner. Repeat Finding: Yes ? Finding 2019-001 View of Responsible Officials: There is no disagreement with the audit finding.

RANDOM MOMENT TIME STUDIES (2020-003) Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Medical Assistance Program (Medicaid Cluster) and Foster Care Title IV-E CFDA Number: 93.778 and 93.658 Pass-Through Agency: Minnesota Department of Human Services Pass-Through Numbers: 2005MN5ADM, 2005MN5MAP, 2001MNFOST Compliance Requirement Affected: Activities Allowed or Unallowed and Allowable Costs/Cost Principles Award Period: Year-Ended December 31, 2020 Type of Finding: Significant Deficiency in Internal Control over Compliance and Other Matters Criteria: The County should remove all employees that no longer have time allocated to the income maintenance & social service programs on the random moment time studies. Condition and Context: During our testing of the applicable Random Moment Studies (RMS), it was noted that 3 of the 287 SSTS members during Quarter 1, 2 of the 288 SSTS members during Quarter 4, and 1 of the 22 LCTS members during Quarter 1 were terminated and not removed from the applicable RMS listings timely. Questioned Costs: None. Possible Effect: The County could receive incorrect federal funding allocation based on incorrect employee information provided to the state for reimbursement. Cause: Lack of oversight by management. Recommendation: We recommend that employees be removed from the RMS listings as soon as they are terminated or are no longer required to be tracked. Repeat Finding: Not applicable. View 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 Compliance Criteria: According to Uniform Guidance 2 CFR Part 200, Appendix XI Compliance Supplement for CFDA 93.778 and 42 CFR section 431.10, the federal eligibility compliance requirements for Medical Assistance include verification of income of applicants. In order for benefit amounts to be calculated correctly, it?s necessary for the income information to be retained and entered into the state eligibility system, MAXIS, accurately. Condition and Context: During our testing of Medical Assistance, it was noted that one of the sixty case files for Medical Assistance did not have documentation to support the income amount that was entered into the state system, MAXIS. The sample size was based on guidance from chapter 11 of the AICPA Audit Guide, Government Auditing Standards and Single Audits and was a statistically valid sample. Questioned Costs: Not applicable. The County administers the program, but benefits to participants in this program are paid by the State of Minnesota. Possible Effect: The improper input or updating of income information in MAXIS 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: Lack of oversight by management. Recommendation: We recommend the County implement procedures to provide reasonable assurance that all necessary documentation to support eligibility determinations is retained and is properly input or updated in MAXIS and issues followed up on in a timely manner. Repeat Finding: 2018-002 View 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 Compliance Criteria: According to Uniform Guidance 2 CFR Part 200, Appendix XI Compliance Supplement for CFDA 93.778 and 42 CFR section 431.10, the federal eligibility compliance requirements for Medical Assistance include verification of citizenship of applicants. In order to determine eligibility correctly, it?s necessary for the citizenship information to be retained and entered into the state eligibility system, MAXIS, accurately. Condition and Context: During our testing of Medical Assistance, it was noted that one of the sixty case files for Medical Assistance did not have documentation of citizenship on file. The sample size was based on guidance from chapter 11 of the AICPA Audit Guide, Government Auditing Standards and Single Audits and was a statistically valid sample. Questioned Costs: Not applicable. The County administers the program, but benefits to participants in this program are paid by the State of Minnesota. Possible Effect: The lack of verification or follow-up of eligibility determining factors, such as citizenship, increases the risk that a program participant will receive benefits when they are not eligible. Cause: Lack of oversight by management. Recommendation: We recommend the County implement procedures to provide reasonable assurance that all necessary documentation to support eligibility determinations is retained and is properly input or updated in MAXIS and issues followed up on in a timely manner. Repeat Finding: Not applicable. View of Responsible Officials: There is no disagreement with the audit finding.

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