Catastrophic Illness in Children Relief Fund

This is a Massachusetts State Auditor performance audit of the Catastrophic Illness in Children Relief Fund, covering July 1, 2012 through June 30, 2015.

“I am pleased to provide this performance audit of the Catastrophic Illness in Children Relief Fund.”

The Auditor reviewed whether the fund helped families that applied, paid only eligible people for eligible medical costs, and tried to get federal matching money when allowed.

“The objective of this audit was to determine whether CICRF met the needs of families that applied for financial assistance, whether it disbursed funds only to eligible applicants and only for qualified medical expenses, and whether it sought federal matching funds (also called federal financial participation) in accordance with state regulations for all eligible medical expenses.”

The fund is meant to reduce crushing medical costs for Massachusetts families with children who have catastrophic illnesses, so delays or weak controls can directly affect families under financial stress.

“CICRF’s mission is to provide financial assistance to families with non-covered medical expenses related to their children’s catastrophic illnesses.”

If you are a Massachusetts resident with a child facing very high uncovered medical costs, this program may reimburse some costs, but the audit says the process was often slow and needed better oversight.

“CICRF reimburses families for medical expenses that health insurers do not cover or for which they have denied payment.”

The Auditor recommended that the fund create a proper sliding fee scale, reduce delays, seek federal matching funds, collect required documentation, file annual reports, and update policies if it changes how eligibility periods work.

“CICRF should perform a staffing and workflow analysis to establish strategies to mitigate the delays it is experiencing and should work toward creating attainable, time-based goals for processing applications to reduce the time that applications remain unassigned and idle.”

The audit found problems involving millions of dollars in reimbursements, long average wait times, and missed federal money, meaning the issues were not just paperwork concerns.

“In total, CICRF reimbursed families $2,241,029 without using a sliding fee scale during the audit period.”

CICRF is the Catastrophic Illness in Children Relief Fund. DPH is the Department of Public Health. A sliding fee scale means payment amounts should account for a family’s ability to pay, including income, family size, assets, and medical expenses. Federal matching funds are federal Medicaid-related reimbursements the state may be able to claim for eligible medical costs.

“Establish the amount of reimbursement for the medical expenses of each child using a sliding fee scale based on a family's ability to pay for medical expenses, which takes into account family size, family income and assets and family medical expenses.”