Recurring Findings

Health Care: Recurring Most severe Noncompliance
Federal Program Issue First Year Reported
Department's Assertion Page Number
Medical Assistance Program Eligibility. Based on our review of 140 participants across multiple counties, we found five instances for which at least one type of required eligibility information was not obtained or evidenced in the Statewide Automated Welfare System (SAWS). As a result, we could not conclude that the five participants were eligible to receive $1,068 in benefits for fiscal year 2014-15. 2015-16
Partially Corrected. Health Care Services will issue county guidance to reiterate the need for counties to: perform timely renewals and maintain appropriate verification documents in the State Automated Welfare System, to ensure when verification of a social security number fails, and the county knows that further action to resolve the failed verification must be performed. 46
SCHIP (State Children's Insurance Program) Activities Allowed or Unallowed; Allowable Costs/Cost Principles. We tested a sample of 40 cash draws for the Children’s Health Insurance Program (CHIP) amounting to $1,086,034,397. Of the sample items tested, we noted that 10 cash draws included a total of $3,685,271 in Local Education Agency (LEA) expenditures that are not allowed to be funded under CHIP. 2015-16
Uncorrected. Internal controls exist to ensure program expenditures are properly funded from allowable federal funding sources. Business rules were implemented through the fiscal intermediary to draw down funding according to Aid Codes. A coding error associated with Aid Code 7x, One Month Bridge to Healthy Families, resulted in payments claimed under CHIP from title XIX funding. LEA Medi-Cal Billing Option Program expenditures are not allowed to be claimed under CHIP. Health Care Services conducted a root-cause analysis to identify the coding error associated with Aid Code 7x and made the necessary corrections. Health Care Services will work with the fiscal intermediary to ensure LEA claims are paying correctly; program will work with the accounting office to ensure funding for prior claims paid are adjusted accordingly. In addition, Health Care Services will review claiming regularly to protect against errant billing in the future. 37
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