Second Audit in Five Years Finds Longer Delays in Providing Financial Relief for Families of Children with Catastrophic Medical Conditions Time taken to process applications has increased since the last audit in 2017

BOSTON – State Auditor Suzanne M. Bump today released an audit of the Catastrophic Illness in Children Relief Fund (CICRF), which found that delays in processing applications for assistance had not improved since the last audit in 2017, and in fact increased by 11 days, with families waiting an average of 300 days to be approved for reimbursement.

Delays in processing applications means that families of children with a catastrophic illness are potentially subject to financial hardship. This audit reviewed the period of July 1, 2017 through June 30, 2019, and is one in an ongoing series of audits aimed at identifying and making recommendations to eliminate barriers to access that the Commonwealth’s residents face when seeking public assistance.

“It is dismaying that the agency’s response to our last audit has been so deficient,” Bump said of the audit. “The families of catastrophically ill children must carry many burdens; wondering if they will ever hear back from an agency created to assist them should not be among their concerns. I hope that this time our audit findings will be taken to heart.”

Although CICRF indicated in self-reported information provided to the OSA six months after the 2017 audit was issued that it was planning to take measures to address this problem, our current audit found that this problem still existed during the audit period and in fact, had worsened. The current audit found that on average, CICRF took an average of 300 days from receiving an application to approving the reimbursement, up from an average of 289 days in the previous audit. During the majority of this time, applications sat idle, waiting to be assigned to staff members for review and processing. Many families applying for financial assistance have incomes near or below the federal poverty level.

The audit also found that CICRF did not pursue federal matching funds for qualified medical services, and reimbursed some applicants without having the required documentation. During the audit period, CICRF reimbursed applicants $24,455 for medical expenses that did not have the required documentation necessary to determine whether they were qualified expenses or that the allowable amount of reimbursement was accurately calculated. In addition, CICRF did not pursue federal matching funds for qualified medical services, and as a result, the Commonwealth lost an opportunity to receive federal matching funds for $49,588 in healthcare costs.

The audit calls on CICRF to develop formal performance standards for employees, including time-based goals for processing and reviewing applications to reduce delays. Additionally, the audit recommends CICRF pursue federal matching funds when available, and develop monitoring controls to ensure its staff has all required documentation before reimbursing medical expenses. Based on its response, CICRF is taking measures to address most of the findings in the audit.

CICRF provides assistance to families for catastrophic medical and health-related expenses that are not covered by insurance, public benefits, or other financial sources. The program is managed by the Department of Public Health. During the audit period, CICRF reimbursed 363 families a total of $3,548,763 for medical and related expenses.

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