The Office of Inspector General (OIG) within the U.S.
Department of Health and Human Services (HHS) is charged with determining, on
an annual basis, the use of federal funds across all HHS agencies and areas.
These include the Centers for Medicare and Medicaid Services (CMS); Public
Health (e.g., Centers for Disease Control and Prevention [CDC], Indian Health
Services [HIS], Substance Abuse and Mental Health Administration [SAMHSA], Food
and Drug Administration [FDA], etc.); and Human Services (i.e., Administration
for Children and Families [ACF] and Administration for Community Living
[ACL]). Total expenditures across all HHS agencies in 2016 totaled $1.1
trillion, with 89.5 percent (or $986 billion) attributed to CMS and 4.8 percent
(or $53.1 billion) for ACF, which was the second highest amount.
The OIG has identified several fund sources or programs
within ACF to address in 2017. The following are areas identified within ACF:
State’s accuracy of reporting Temporary
Assistance for Needy Families (TANF) spending information. The
requirements changed in Federal Fiscal Year (FY) 2015 requiring each quarterly
report to reflect expenditures cumulative through the quarter for the fiscal
year, resulting in a fourth quarter report that reflects actual expenditures
made with the grant year award funds for the year. States will no longer
report expenditures through the current reporting period.
Head Start – review of single audit findings
and recommendations. The OIG will review the Office of Head Start’s audit
resolution process for findings and recommendations as part of the Single State
Audit reports for grantees for FY 2013 through 2015. The focus will be on
repeat findings and what action the Office of Head Start has taken to resolve.
Unaccompanied Children (UC) program grantee
reviews. The UC program is administered by the Office of
Refugee Resettlement (ORR). Before 2012, about 8,000 children were served
through the program; in 2014, more than 57,500 children were in the
program. The grant totaled $911 million in 2014 and was awarded to a wide
array of grantees. The audit will focus on whether the grantee (1) used
the funding appropriately, (2) adequately monitored the activities of the
subcontractors and (3) met safety standards applicable for the children under
the care of UC program.
Post-placement activities for UC. The
program provides temporary shelter, care and related services to UC in
custody. ORR places children with sponsors who may not be fully vetted or
appropriate for providing care. The OIG recommended that sponsors be
required to ensure the physical, mental and financial well-being of UC, as well
as ensuring that children remain safe after placements. The audit will
review progress made by ORR in meeting the recommendations.
States’ implementation of guardian ad litem
(GAL) requirements. Each state’s Child Abuse Prevention and Treatment
Act (CAPTA) requires as a condition to receive funding, that each child
involved in abuse and neglect judicial proceedings is appointed an advocate, or
GAL. The role of the GAL is to ensure the best interests of the child are
represented in court. The OIG plans to assess selected states’ compliance
and whether states ensure that GALs receive appropriate training.
States’ protocol for the use and monitoring
of psychotropic medications for children in foster care. The Social
Security Act (SSA) in section 422 (b) (15) (A) was amended to require each state
to develop a plan for ongoing oversight and coordination of health services for
foster children, including the oversight of prescription medication. In a
number of states, the OIG will pull a sample of children in foster care who
received Medicaid and were prescribed psychotropic medication to confirm
application of states requirements.
Monitoring the health and safety of children
through the Compliant Resolution and Licensing process. Under Title IV-E of
the SSA, states must establish compliant procedures for handling allegations of
abuse and noncompliance of health and safety requirements for foster care
children. OIG will review whether reports or complaints against foster
homes are investigated and resolved, and what processes states utilize to ensure
that proper oversight of licensing occurs.
States’ Child Care and Development Fund
(CCDF) payment rates and access to child care services. CCDF is the
primary federal fund source for subsidizing child care expenses for low income
families. States must set payment standards for childcare providers and ACF
provides oversight. The OIG will assess whether payment rates of states ensure
proper access to families and how states’ processes determine payment rates and
if the rate is sufficient to ensure access to childcare services.
The comprehensive OIG Work Plan for 2017 can be found here.