Hundreds of millions of dollars in Medicaid benefits, but auditors say the paperwork meant to protect the system didn’t always keep up. A new government audit is now raising red flags about how Medicaid client eligibility is handled at the Department of Public Health and Social Services.

The Office of Public Accountability released the second part of its Performance Audit on Medicaid Client Eligibility, examining files from fiscal years 2023 and 2024.

Auditors reviewed 30 client files and identified widespread documentation and compliance gaps — including missing or late Medicaid application forms, absent eligibility documentation, delayed or missing change reports and off-island referral forms, and a lack of required “notices of action” informing clients of eligibility decisions.  

In some cases, eligibility decisions were made without proper signatures or timely documentation from eligibility specialists or clients.

The audit found more than $400 million in Medicaid benefits were provided to an average of more than 35,000 clients during the review period. While auditors did not identify questioned costs, they noted some benefits could be tied to prior fiscal years because of documentation deficiencies.

Auditors issued seven recommendations, calling for stricter and more consistent compliance with application, documentation, monitoring, and notification requirements — saying corrective action is needed to protect the integrity of the Medicaid program and restore public confidence.

Public Health disputed several findings but later submitted additional documents. Auditors noted the department’s filing system still needs improvement to ensure records are readily available during inspections.