2017 Human Services, Department of

Report Highlights

The report identifies 21 deficiencies within the context of the objectives of the audit. These deficiencies include 10 recommendations made in the prior audit that were not implemented.

Program Operations: Operations surrounding early childhood services licensing, foster care licensing, and child protective services were reviewed. Some deficiencies are highlighted below.

Early Child Care Licensing

• Some child care providers were licensed or remained licensed after incidents of child abuse or neglect had occurred.
• Child care providers operating under memorandum of understanding agreements (MOU) were not properly monitored.  These MOUs are issued for circumstances that rise above the severity of a correction order.
• Necessary background checks were not completed for all child care providers, household members, staff, and emergency designees.
• Child care providers were at times licensed without receiving proper evidence of licensing requirements.

Family Foster Care Licensing

• Annual background check requirements did not include searches of the sex offender registry, North Dakota courts or Minnesota courts records.
• Family foster care providers operating under memorandum of understanding agreements (MOU) were not properly monitored. These MOUs are issued in instances of non-compliance with licensing requirements.

Child Protective Services

• Timeliness of face-to-face contact with suspected victims was not always ensured for their immediate safety and determination of whether child abuse or neglect occurred.
• Several individuals having made confirmed child abuse or neglect actions within the last 10 years were not properly listed in the Child Abuse and Neglect Index. This Index is used for background check searches for individuals applying for employment in positions to work with children.
• Circumstances for when members of the child’s household, teachers, or babysitters are responsible for a child’s welfare have not been defined. Lack of defined circumstances resulted in inconsistent decisions to determine whether child abuse or neglect occurred and identify individuals on the Child Abuse and Neglect Index.

Internal Control: We evaluated and tested high risk areas including: early childhood services licensing, foster care licensing, child protective services, expenditures (including correcting entries and purchase card transactions), compliance with legislative intent, drug rebate analysis and management system (DRAMS), and the child welfare case management system (FRAME) including the child abuse and neglect index.  We identified deficiencies in internal control explained in the operations section of this report as well as the following areas.

• Procedures do not ensure benefit payments are not made to or for the benefit of deceased or incarcerated individuals.
• Procedures surrounding the implementation of DRAMS in November 2015 were not properly designed. The following conditions were identified:
• • Completeness of claims data electronically loaded into DRAMS was not verified.
  • Adjustments to DRAMS data were not reviewed or approved.
  • Interest was not properly calculated on overdue drug rebate balances.
  • Access privileges were granted beyond the demonstrated need to add, view, or modify data.
  • Incorrect receivables balances were calculated on the DRAMS reports.

Legislative Intent: We evaluated and tested high risk areas including: appropriation laws, proper use of special funds and compliance with state procurement requirements.

• We concluded there was compliance with legislative intent except within areas explained in the operations section of this report.

Financial:  Revenues and expenditures decreased approximately $24.7 million and $4.1 million, respectively, between state fiscal years 2016 and 2017.

• Revenue from the federal government decreased approximately $14 million mainly due to a 5% reduction in federal reimbursement for medical assistance expansion which was subsequently paid with state general funds. Medical assistance coverage was expanded January 1, 2014 pursuant to the Affordable Care Act.
• Revenue from local governments decreased approximately $5.8 million due to the financial responsibility for certain county social service program costs assumed by the Department of Human Services. [Senate Bill 2206 of the 2015 Session Laws]

IT contractual services expenditures decreased $6.8 million subsequent to the payment for services to implement the Medicaid management information system (MMIS) in October 2015 and the eligibility system (SPACES) in February 2016.

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