Overall, we identified a number of problems with the financial controls at the Kansas Soldiers Home and the Kansas Veterans Home. Controls were mostly adequate for the funds that had the largest amounts of revenues and expenditures—the resident fee fund and resident trust fund. However, the financial controls were inadequate for the following areas: credit cards, canteen funds, benefit funds, and employee travel reimbursements. Common problems included a lack of supporting documentation, not obtaining supervisory approval before making purchases and inadequate policies. We also found that KCVA’s central office has not provided adequate oversight and management of the two facilities’ business operations, in part because officials were not aware they had authority over the two facilities.
State Asset Management: Evaluating the Possibility of Cost Savings and Revenue Enhancements through Property Sales.
Our targeted review identified eight surplus properties that could be sold for an estimated $1.5 million to $2.2 million. We found that identifying surplus real property is a subjective, lengthy, and sometimes difficult process. That is because property use must be periodically evaluated, the owner and boundaries of land are not always clear, and lease agreements can make it more difficult to determine whether land or buildings are surplus. Additionally, the Department of Administration has not proactively identified surplus real property as required by law and lacks the authority to independently designate what properties are surplus. Moreover, the process for selling surplus real property includes several disincentives for state agencies. Finally, delays in selling the Atchison Juvenile Correctional Facility highlight problems with the surplus real property disposal process. We also found that the State Surplus Property program is not an efficient way of disposing of surplus personal property. In each of the past two years, the program operated at a net loss of approximately $50,000. Further, the state’s contractor for online auctions is better equipped to maximize agencies’ revenues from selling surplus items and several state agencies prefer to use the state’s contractor instead of the state’s program. Finally, agencies do not want to sell surplus vehicles because they are hard to replace once sold, and agencies have few negative consequences for holding onto surplus personal property.
Kansas Lottery: Funding of Scholarships for Veterans
We looked to see whether the state’s National Guard Educational Assistance Program duplicates available federal benefits for members of the National Guard. We found that there is some limited duplication between the state’s program and federal Post 9-11 GI Bill (GI Bill), but eliminating the state’s program would significantly affect members of the Air National Guard. Specifically, state and GI Bill funding cover two different National Guard populations, although there is some overlap. Further, for veterans who are eligible for both the state and federal programs, it is rare that federal dollars could fully replace state benefits. Finally, eliminating the state’s National Guard Educational Assistance Program would have little impact on members of the Army National Guard, but would significantly affect members of the Air Guard. We also noted that while the National Guard Educational Assistance Program is supposed to be funded through the Lottery’s Veteran game, State General Fund monies have made up a significant portion of the program’s funding. Further, we noticed that language in the National Guard Educational Assistance Act may be outdated.
Kansas Commission on Veterans’ Affairs: A K-GOAL Audit Reviewing Issues Related to Veterans’ Benefits
The Veterans’ Claim Assistance Program (VCAP), created in 2006, has not increased the services provided to veterans. Because neither the Commission on Veterans’ Affairs nor the veteran service organizations have added significant resources or changed how veterans are served, this is not surprising. In addition, we discovered the Commission does not collect reliable management information about the services provided to veterans, through both VCAP and Commission staff. This severely limits the Commission’s ability to make good management decisions. In an effort to reduce Medicaid costs, several states have started initiatives to transition Medicaid-eligible veterans to U.S. Department of Veterans Affairs health care benefits. We estimate Kansas could save between $1 million to $2 million a year in State funds from a similar initiative. The State may need to add or reprioritize resources to achieve these savings, but these resources may decrease over time. To be successful, the State will also need to establish a structure to better coordinate efforts between several State agencies.
State Benefit Programs: Identifying Disincentives for Marriage
Most of the benefit programs we reviewed have income-based eligibility criteria that could discourage marriage in some situations, or have no effect at all. That’s because programs vary in how household income is defined. Some programs don’t distinguish between the income of married and cohabitating couples. Other programs may consider two unmarried people living together to be two separate households. Very few of the frontline program staff we interviewed think program eligibility rules have a significant effect on clients’ decision to marry. Further, the majority of clients we spoke with told us eligibility criteria have little to no effect on their decision to marry. Lastly, literature acknowledges that programs with income-based eligibility rules have built-in disincentives, but there’s little information about whether those disincentives actually cause people to avoid getting married.
Health-Care Related Services: Reviewing Opportunities for Better Coordinating the State's Health-Care Related Programs
By changing Medicaid billing practices, the State could save money spent on inpatient care for Department of Correction’s inmates. Although State agencies could also better coordinate a number of other health-care related programs, service gap issues such as lack of affordable health insurance for low-income single adults can only be addressed through State-level policy decisions. Of more importance is the upcoming federal health care reform, which will greatly affect how health-care related services are provided in Kansas. Its primary goals are to reduce the number of uninsured, slow increases in health care costs, and increase access to health care services and providers. Implementing those reforms will require significant coordination among State agencies. Some State agencies that traditionally have provided health care services will have added responsibilities, while other State agencies—such as the Kansas Insurance Department—will start having a role. At this point, it is too early to know whether State agencies are on track to implement the various provisions of federal health care reform.
Commission on Veterans’ Affairs: Reviewing How Well It Is Spending Its Money and Serving Veterans
The Kansas Commission on Veterans’ Affairs appears to be taking reasonable steps to identify veterans through its field offices and their outreach efforts and, although other State agencies have varied methods for identifying veterans, they seem to be referring veterans on to federal officials to determine their eligibility for federal benefits. The Commission and other veteran service organizations take steps to coordinate certain activities, but coordination is being deterred by long-standing rivalries between the leadership of the veteran entities. In recent years, there have been two significant vacancies in the Commission’s veteran service representative positions; other positions the Commission has referred to as “vacant” primarily included positions whose job responsibilities had been transferred to a State-funded grant program. The Soldiers’ Home had 12 more direct-care staff positions filled in July 2008 than it did in July 2007, and its corrective action plan apparently has brought it back into good standing with both the State and federal inspectors. However, Home officials cited huge challenges in attracting and keeping qualified nursing staff because of location and competition factors. Finally, we concluded that the Commission’s goal of holding its monthly meetings outside Topeka to attract more veterans hadn’t been successful, and didn’t justify the additional costs incurred. Those meetings cost almost four times as much as Topeka-based meetings.
Health-Care Related Programs in Kansas: Determining What Funding Kansas Receives and Who Administers It
Our inventory focused on three types of government-funded health-care related programs in Kansas--State administered, federally administered, and research--and on programs that were clearly medical in nature or related to substance abuse and mental health. Health-care related programs administered by seven State agencies accounted for about $2.5 billion of the nearly $6 billion in spending we identified for 2006, including $1.6 billion on health care programs and $.8 billion on long-term care. Federally administered health-care related programs accounted for $3.3 billion in spending, nearly all of which was for Medicare. Health-care related research spending totaled about $131 million, with most of that being spent by the University of Kansas.
Compliance and Control Audit: Commission on Veterans' Affairs
NHUMAN RIGHTS COMMISSION, ATTORNEY GENERAL'S OFFICE, KANSAS BUREAU OF INVESTIGATION, BICENTENNIAL COMMISSION OF THE U.S. CONSTITUTION, BOARD OF INDIGENTS' DEFENSE SERVICES, COMMISSION ON VETERANS' AFFAIRS
Oversight of the Soldiers Home is exercised primarily by the Veterans Commission. Actions are needed to help ensure that current residents’ needs are met and that the quality of care they receive is consistent with State standards. Projected increases in veteran residents can be accommodated in the existing facilities, but capital improvements will be needed.
Examining Selected Areas of the Veterans Commissions Operations
This limited scope performance audit addressed specific questions relating to veterans service representatives job qualificaitons and training, the requirements for Power of attorney in obtaining veterans benefits of Commsiions services, preferential treatment of some veterans who belong to improving the efficiency of the Commissions operations.