Maryland Did Not Comply With Federal Waiver and State Requirements at 20 Adult Day Care Facilities Audited
Learn how the AI-generated research projects were createdOverall Conclusion
The Maryland Department of Health did not fully comply with Federal waiver and State requirements in overseeing adult day care facilities; 253 noncompliance instances were identified across health and safety and administrative areas, with inspections insufficient to detect violations; the OIG recommends corrective actions and oversight improvements.
Source Document
Audit Scope
The audit examined Maryland’s Home and Community-Based Services (HCBS) 1915(c) waiver program and the operation and oversight of adult day care facilities that serve adults enrolled in the program. Of the 141 adult day care providers in Maryland as of November 16, 2023, a nonstatistical sample of 20 providers was selected for unannounced site visits conducted between January 9 and June 27, 2024, across 14 counties (Allegany, Anne Arundel, Baltimore, Baltimore City, Caroline, Dorchester, Frederick, Harford, Howard, Kent, Montgomery, Prince George’s, Washington, and Wicomico). In 2023, Maryland claimed $106.7 million for services at these 141 facilities, with the 20 reviewed providers reimbursed $20,732,903. The audit focused on provider compliance with health and safety requirements and state administrative requirements, and on the Maryland State agency’s oversight and monitoring of these providers; it did not assess the overall internal controls of the State agency or the Medicaid program beyond those areas relevant to the objective.
Key Findings Summary
Maryland did not fully comply with Federal waiver and State requirements in overseeing providers that serve adults receiving adult day care services; of 20 facilities visited, 18 did not comply with health and safety requirements and all 20 failed to meet at least one administrative requirement; total 253 noncompliance instances.
AI-Assisted
AI Scope Summary
To assess whether Maryland's oversight of adult day care facilities under the 1915(c) HCBS waiver ensures participant health and safety and complies with federal and state requirements, and to identify gaps in monitoring and enforcement.
AI-Generated Insight
This audit highlights significant gaps in the oversight of Medicaid home- and community-based services waivers at the provider level, with widespread health and safety and administrative noncompliance across 20 facilities. The evidence suggests that Maryland’s inspection regime did not consistently identify hazards or administrative deficiencies, potentially endangering vulnerable adults. The MDH responded with a robust corrective action plan including on-site follow-ups, enhanced sampling, centralized tracking, and new compliance checklists, but implementation timelines will determine the ultimate impact on program integrity and participant safety.