BOSTON, Mass. (WWLP)– A second audit of the Catastrophic Illness in Children Relief Fund (CICRF) finds the agency is still behind in reimbursing families who have applied for assistance.

According to a report from the Massachusetts Office of the State Auditor (OSA), an audit of the period of July 1, 2017 through June 30, 2019 discovered that delays in processing applications for assistance had not improved since the last audit in 2017, and had increased by 11 days, with families waiting an average of 300 days to be approved for reimbursement.

Many families applying for CICRF financial assistance have incomes near or below the federal poverty level and delays in reimbursement can cause extreme financial hardship. The fund offers help 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. The audit is part of an ongoing series of audits aimed at identifying and making recommendations to eliminate barriers to access that state residents face when seeking public assistance.

After the first audit CICRF reported that it was planning to work to alleviate the problems. But the current audit found that the process time had actually increased 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.

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. In addition, CICRF did not pursue federal matching funds for qualified medical services, resulting in the state losing 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. 

During the audit period, CICRF reimbursed 363 families a total of $3,548,763 for medical and related expenses. The audit can be viewed HERE.