A new state audit says that the Department of Social Services, which oversees Medicaid funding for the elderly, has fallen short of its goals. In addition, the effort by state officials has been given a failing grade by a high-ranking Republican state senator.

The audit focused on Community First Choice, an optional Medicaid program where the elderly and disabled can choose to remain at home in the community instead of in a nursing home or assisted living facility. The program itself has been growing rapidly as it jumped to 3,952 clients in the 2020 fiscal year — more than double the total of 1,683 in the 2016 fiscal year.

State funding has more than tripled to $125 million in 2020, up from $36 million four years earlier.

The latest update was a follow-up audit by the bipartisan Auditors of Public Accounts after an original audit in June 2022.

“The Department of Social Services appears to have partially or fully implemented 31% of our audit recommendations,” the auditors wrote. “This information is solely based upon the department’s responses to our update request and may be verified during our next departmental audit.”

Senate Republican leader Kevin Kelly, who also works as an eldercare lawyer, said the state must do better.

“This is a failing grade, and that’s unacceptable, especially when you consider how our elderly, vulnerable and disabled are the ones who are left behind,” Kelly said. “It must be our priority to provide these individuals with the dignity and lifestyle choices they deserve. This follow-up audit shows that it isn’t. Performance must improve, efficiencies must be implemented, taxpayers’ dollars must be respected, and these recommendations must be implemented. In short, DSS must do better.”

The Medicaid community program is relatively new as it was created under the federal Affordable Care Act that was signed into law by President Barack Obama.

Medicaid pays for personal care assistants who perform many tasks that older people can no longer do, including helping with dressing, bathing, meal preparation, and household chores, among others. The program helps those who qualify for “institutional level of care,” meaning that they would most likely be sent to a nursing home if they did not have the services in their own home.

Among 16 recommendations, the auditors called for “creating a better system to identify clients struggling with self-direction,” integrating the computer systems of the state’s strategy and operations units, crafting a new method to easily identify critical incident reports for the frail clients, tracking applications of new clients with better computer systems, enhancing fraud investigations and ensuring proper collections of payments.

DSS responded in writing in the audit, saying that some implementations had been delayed due to staffing issues and the coronavirus pandemic.

“The department continues to work towards these recommendations,” DSS said. “The long-term goal is to fully integrate [computer] systems through the use of CT METS (CT Medicaid Enterprise Technology System). The community options team continues to make progress in this area through attending design meetings with the CT METs team. … The department has faced competing priorities, including the public health emergency, and staffing changes that have delayed some of these activities, though the department continues to work towards these changes.”

DSS added, “The strategy group is further tracking all incidents of CFC participants through abuse/neglect/exploitation reports to ensure timely standards of response.”

In the 11-page audit report, DSS responded six different times with the exact same opening sentence that “the department continues to work towards these recommendations.”

Sen. Lisa Seminara of Avon, the ranking Senate Republican on the aging and human services committees, said the audit shows that improvements are needed.

“This deeply concerning report shows that our auditors’ recommendations regarding the CFC program have been largely ignored. That’s unacceptable,” Seminara said Tuesday. “This is a program which allows elderly and disabled individuals to hire personal care attendants. Recommendations aimed at improving the program’s efficiency and effectiveness must be heeded. The importance of providing essential services and support to the elderly, vulnerable, and disabled individuals who rely on the CFC program for their well-being and independence cannot be understated. We can — and must — do better in terms of providing vital human services for our neediest residents.”

Sen. Matt Lesser, a Middletown Democrat who co-chairs the human services committee, said the department’s performance will continue to be monitored in the months ahead.

“The audit did not find any fraud or abuse by the Department of Social Services but did reveal that DSS needs to restructure the program,” Lesser said. “I hope the department takes these findings seriously and follows through on the recommendations. The work of the auditors in this newer role of evaluating performance, not finances, will be a focus of the Human Services Committee this session.”

For further information on the program, prospective clients can call 2-1-1 during business hours on weekdays.