| Medical Assistance Program |
Eligibility. Out of 140 beneficiaries reviewed, there were 26
beneficiaries with the following eligibility exceptions:
One instance in which a completed initial application not
on file to establish eligibility.
21 instances in which redeterminations had not been
performed within a year and another instance in which the
redetermination was performed within a year, however,
the benefits were not terminated timely once the
beneficiary was determined to be ineligible.
One instance in which a social security number had not
been verified with the Social Security Administration and
another instance in which the social security number was
noted as verified, however, but the verification code used
to support the verification was missing from the file and
documented as being deleted.
One instance of an individual that was not disabled who was
receiving benefits under a disabled aid code and another instance
of an individual receiving benefits who did not pass a resource
test. |
2014-15 |
| Remains Uncorrected. Health Care Services resumed conducting
quality control reviews that focus on timeliness and accuracy of
renewals in March 2017. Health Care Services permanently
incorporated this review process as part of its oversight and
monitoring activities. A formal process for monitoring Medi-Cal
Eligibility Data System alerts is under development with a
projected implementation date of June 2019. |
31 |
| Block Grants for Prevention and Treatment of Substance Abuse |
Cash Management. The Substance Use Disorder Program, Policy
and Fiscal Division of Health Care Services distributes funds
awarded to subrecipients on a quarterly basis in accordance with
an allocation schedule. The cash management process does not
provide for appropriate monitoring to ensure that subrecipients are
minimizing the time elapsing between the receipt and
disbursements of federal funds. |
2015-16 |
| Remains Uncorrected. Health Care Services has consulted with
the Substance Abuse and Mental Health Services Administration
(SAMHSA) on the proposed Quality Federal Financial
Management Report (QFFMR) process to address the finding.
SAMHSA has approved the proposed QFFMR process and agreed
to an implementation date of January 2019. Health Care Services
has developed budget and quarterly reporting forms for counties
to report expenditures for reimbursement.
Health Care Services conducted two webinars in July and
September 2018 for stakeholders and presented forms and
processes that must be followed for reimbursement. Health Care
Services has also published an Information Notice that outlines
the process and deadline. Substance Abuse Block Grant (SABG)
funds will no longer be advances as of January 2019, and counties
must submit a QFFMR for reimbursement starting March 2019. |
29 |
| Medical Assistance Program |
Subrecipient Monitoring. Health Care Services did not evaluate
each subrecipient’s risk of noncompliance with federal statutes,
regulations, and the terms and conditions of the subaward.
|
2015-16 |
| Remains Uncorrected. Health Care Services assesses every
agreement to determine whether the other entity is a contractor or
subrecipient, and documents and tracks the outcome of the
determination. Health Care Services is continuing work on
formalizing policies and procedures for ongoing risk assessment
and monitoring arising from an entity’s subrecipient status.
|
50 |
| Medical Assistance Program |
Subrecipient Monitoring. Twelve of the 56 subrecipients of
Short-Doyle funding were tested and five had not submitted their
cost reports timely. Two of the five subrecipients had not
submitted their cost reports for fiscal year 2014-15 and 2015-16,
and the other three subrecipients had not submitted their cost
report for fiscal year 2015-16. Although the Mental Health
Division of Health Care Services did take the required action of
notifying the five subrecipients in writing within 30 days of
noncompliance, they have not taken any additional actions
necessary to ensure contract and performance compliance. |
2015-16 |
| Partially Corrected. In response to prior year finding 2017-018,
this year Health Care Services updated its assessment of the
counties’ Short-Doyle funding contracts and determined they
better fit the definition of contractors as opposed to subrecipients
under the Uniform Guidance. Therefore, Health Care Services is
no longer reporting these as subrecipient expenditures in the
Schedule of Expenditures of Federal Awards. As a result, this
condition is being reported this year (see finding 2018-004) in the
activities allowed or unallowed category. Health Care Services
finalized its policy regarding sanctions, fines, and penalties. On
June 5, 2018, Health Care Services posted to its website
Information Notice 18-024, which communicates the Mental
Health Services Division’s sanctions, fines, and penalties policy
to mental health plans. Health Care Services plans to implement
this policy when counties are late in submitting cost reports by
December 2019. Health Care Services is currently drafting a
process to impose financial sanctions upon a mental health plan
when it does not submit its annual cost report timely. |
23 |
| SCHIP (State Children's Insurance Program) |
Subrecipient Monitoring. Health Care Services did not evaluate
each subrecipient’s risk of noncompliance with federal statutes,
regulations, and the terms and conditions of the subaward.
|
2015-16 |
| Remains Uncorrected. Health Care Services assesses every
agreement to determine whether the other entity is a contractor or
subrecipient, and documents and tracks the outcome of the
determination. Health Care Services is continuing work on
formalizing policies and procedures for ongoing risk assessment
and monitoring arising from an entity’s subrecipient status.
|
50 |
| SCHIP (State Children's Insurance Program) |
Subrecipient Monitoring. Twelve of the 56 subrecipients of
Short-Doyle funding were tested and five had not submitted their
cost reports timely. Two of the five subrecipients had not
submitted their cost reports for fiscal year 2014-15 and 2015-16,
and the other three subrecipients had not submitted their cost
report for fiscal year 2015-16. Although the Mental Health
Division of Health Care Services did take the required action of
notifying the five subrecipients in writing within 30 days of
noncompliance, they have not taken any additional actions
necessary to ensure contract and performance compliance. |
2015-16 |
| Partially Corrected. In response to prior year finding 2017-018,
this year Health Care Services updated its assessment of the
counties’ Short-Doyle funding contracts and determined they
better fit the definition of contractors as opposed to subrecipients
under the Uniform Guidance. Therefore, Health Care Services is
no longer reporting these as subrecipient expenditures in the
Schedule of Expenditures of Federal Awards. As a result, this
condition is being reported this year (see finding 2018-004) in the
activities allowed or unallowed category. Health Care Services
finalized its policy regarding sanctions, fines, and penalties. On
June 5, 2018, Health Care Services posted to its website
Information Notice 18-024, which communicates the Mental
Health Services Division’s sanctions, fines, and penalties policy
to mental health plans. Health Care Services plans to implement
this policy when counties are late in submitting cost reports by
December 2019. Health Care Services is currently drafting a
process to impose financial sanctions upon a mental health plan
when it does not submit its annual cost report timely. |
23 |
