The audit identified concerns with the methods the Department of Social Services uses to prevent and detect inappropriate payments to child care providers. For example, auditors found cases where parents or guardians were approved for child care financial assistance, but were not working the required 20 hours per week to qualify for those subsidies, or did not have clear proof of income eligibility or other requirements. In other cases the child care provider was not able to provide adequate records as proof of child attendance. Auditors recommended the department implement additional procedures to ensure license-exempt child care providers comply with state law. Providers who care for four or less unrelated children are exempt from licensing requirements. For 43 percent of "four or less" providers reviewed, the department incorrectly classified some children as related to the provider or could not verify the relationship for some children classified as related to the provider.
Other findings in the report noted issues with program oversight and monitoring. Auditors found that Missouri HealthNet, a division of the Department of Social Services, did not remove inactive user accounts from its Medicaid Management system in a timely manner, increasing the risk that sensitive information could be compromised. Four of 25 active system accounts belonged to individuals who had not been employed by the department or a contractor in more than eight months.
Additionally, the Department of Mental Health failed to retain documentation to support daily rates paid to some group homes for residential services, preventing auditors from determining whether amounts paid to homes were allowable under Medicaid Program guidelines. Without supporting documentation, auditors questioned federal payments of approximately $659,000.
Auditors found that, in administering grants from the federal Department of Homeland Security, the state's Department of Public Safety did not take steps to ensure recipients of federal funds obtained independent audits when required by federal law. Similarly, the department did not adequately monitor whether recipients complied with purchasing requirements.
In previous reviews of federal money, auditors determined the Department of Health and Senior Services had failed to ensure annual reassessments were performed for recipients of certain Medicaid services. The department has implemented various changes in recent years and significantly reduced the backlog of outstanding reassessments. The current audit shows that reassessments were due for approximately 2,700 recipients, a 73 percent reduction from the previous year.
In addition to the review of federal expenditures, auditors examined Missouri's annual statewide financial statements. During an audit of the state's comprehensive annual financial report, released in January, auditors identified incorrect financial data submitted to the Office of Administration by the Office of the State Treasurer. The misstatement included $214 million incorrectly categorized as cash holdings instead of investments, and the state's bank account balances understated by over $753 million. Because the reported balances were corrected before the financial statements were finalized, there were no material misstatements in the final report and no impact on the office's opinion on the state's comprehensive annual financial report.
The complete audit report may be found online here.