By Christine Sexton, Florida Phoenix
In Summary:
A new Auditor General report accuses the Florida Department of Children and Families of repeatedly delaying responses and providing incomplete records during an audit of the state's Medicaid eligibility determinations after the COVID-19 public health emergency ended. The audit also identified errors, including improper Medicaid terminations, delayed removals of ineligible recipients, and failures to provide required notices to beneficiaries. DCF rejected the findings, arguing it cooperated throughout the audit and that the Auditor General's characterization of the agency's responsiveness was inaccurate.
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The DeSantis administration slowed state auditors' review of how Florida conducted its Medicaid eligibility determinations after the end of the COVID-19 public health emergency, a state Auditor General report found.
Related: Orange County faces a $26.7 million Medicaid bill as property tax cuts loom.
The report cites “Significant Audit Constraints” and recommends Department of Children and Families management “should demonstrate a commitment to accountability, transparency, and compliance with State law by ensuring that access to records and information needed to facilitate a complete and timely audit is promptly provided upon auditor request. “
DCF, whose secretary works at the pleasure of Gov. Ron DeSantis, strongly objected to that finding.
Department of Children and Families Deputy Secretary Kathryn Williams (Photo from DCF)
“The Department respects the responsibility bestowed upon the Auditor General’s Office to promote accountability, transparency, and advance the quality of service provided to Floridians,” DCF Deputy Secretary Kathryn Williams wrote.
She continued:
“[I]t is both misleading and inaccurate for the Auditor General to suggest, through its narrative, that that the department does not support this statutory responsibility.”
The auditor general works at the pleasure of the Legislature and is appointed upon a majority vote by the Legislative Auditing Committee. The auditor general must be confirmed by both chambers the Legislature.
Florida law makes clear that anyone who “willfully fails or refuses to provide access to an employee, officer, or agent of an entity subject to an audit or to furnish or produce any book, record, paper, document, data, or sufficient information necessary to a proper audit or examination,” commits a first degree misdemeanor.
Slow responses
To underscore the finding that DCF management “significantly delayed” access to the records auditors needed to conduct the analysis the report includes a table of requested documents, the dates they were requested, and when DCF responded to the requests for information.
The chart indicates DCF’s responses were often partial or incomplete. It took DCF eight months to respond to a follow up inquiry regarding 135 cases of recipients whose Medicaid coverage was terminated “and additional inquiry regarding unwinding data and continuous eligibility coverage.”
The auditors initially asked for the information on May 23. DCF provided partial responses in August and September but didn’t give auditors all the information requested until more than eight months later, on Jan. 22, 2026, the office said.
“Throughout our audit fieldwork, our requests for Department records and information regarding the Department’s determination of recipient eligibility for Medicaid, including requests related to missing or incomplete documentation, questions regarding the verification of income and residency, missing case comments explaining eligibility decisions, and discrepancies between eligibility system data and supporting records, were met with significant delays and incomplete responses,” the office said.
“[O]ur requests were met with excessive delays and incomplete responses, which necessitated additional follow-up with the Department and frustrated the timely performance of audit procedures.”
According to the report, DCF management attributed the delays to factors ranging from the need for additional time to finalize the agency’s responses, to a busy 2024 hurricane season that required DCF’s response, to having to manage the federal government shutdown last year that resulted in loss of people’s federal food benefits through the Supplemental Nutrition and Assistance Program.
DCF responds
To bolster its position, DCF’s Williams included the agency’ own version of the chart which she presented as a “factual record” of communications throughout the audit period.
The auditor general’s office, however, disagreed. It said DCF’s chart wasn’t an accurate reflection of the auditing process or the auditor general’s conclusions regarding the department’s responsiveness.
DCF also alleged that “at no point did the Auditor General’s office escalate concerns related to any perceived delays or access issues, and as such, the Department was not provided an opportunity to remedy any concerns.”
Again, the auditor general report said that’s not accurate.
“To the contrary, on April 1, 2024, and again on August 27, 2025, Auditor General management notified Department management and appropriate Department personnel in writing that excessive delays in responding to audit requests may lead to a finding regarding significant constraints on audit.”
Other findings
The auditor general report made additional findings about the state’s Medicaid eligibility determinations during the “unwinding” — the term used to describe the process states followed after expiration of the public health emergency.
During the pandemic, states that agreed to accept enhanced federal Medicaid contributions were required to maintain continuous enrollment of Medicaid beneficiaries through the end of the pandemic unless the beneficiary voluntarily disenrolled, became ineligible due to a change in state residency, or died.
The audit reviews Medicaid records from March 2023 through April 2024 in which the state reported to the Centers for Medicare and Medicaid Services that it was reviewing eligibility determinations for 2,988,936 beneficiaries. Following the reviews, the state reported to CMS that 1,848,480 people were no longer eligible.
The Auditor General reviewed the records of beneficiaries whose eligibility was reviewed as well as those who lost benefits.
The audit found the agency:
- Erroneously paid $32,050 for eight people it determined were ineligible but didn’t timely remove from the program.
- Kept one person on the program although “it appeared the the recipient was receiving Medicaid in another state.”
- Improperly terminated eligible people from the program.
- Prematurely ended 12-month continuous eligibility for at least two children.
- Failed to provide Medicaid recipients notice of decisions affecting their eligibility or, when notifying recipients of decisions, didn’t provide them all the information required by federal regulations.
- Did not include in its notice of eligibility review template used by Medicaid beneficiaries notice that the information needed to renew Medicaid eligibility must be provided to the state within 30 days of submission of the renewal form.
Florida’s Medicaid unwinding process was the center of a class action filed in federal court by the Florida Health Justice Project and the National Health Law Program. A judge ruled in January that Florida violated the constitutional rights of poor people it removed from the Medicaid rolls, issuing a scathing 273-page ruling.
The DeSantis administration has appealed the ruling to the 11th U.S. Circuit Court of Appeals, which will consider the case next week.
Key Points:
- The Auditor General found DCF significantly delayed providing records needed to audit Florida's Medicaid eligibility determinations.
- Auditors said some requests took months to fulfill and often required repeated follow-up because responses were incomplete.
- The audit identified several eligibility errors, including improper terminations, delayed removals of ineligible recipients and inadequate notices to beneficiaries.
- DCF disputed the report, saying it cooperated with auditors and objecting to the finding that it impeded the audit.
- The audit comes as Florida continues defending its Medicaid eligibility process in federal court following a judge's ruling that the state violated recipients' constitutional rights during the post-pandemic "unwinding."
