Missouri state agencies failed to correct several longstanding problems involving the management of federal funds, according to a new audit from State Auditor Scott Fitzpatrick.
The review examined about $20.5 billion in federal spending during fiscal year 2025 and identified 16 findings, including nine that had been reported in previous audits. Fitzpatrick said repeated failures to address those issues increase the risk of fraud, waste and improper payments and could jeopardize future federal funding.
Among the findings was a problem involving duplicate enrollment in Missouri’s Medicaid eligibility systems.
“We found almost 10,000 people that were enrolled in the Medicaid program twice, which when you take that across 10,000 people, I mean, that can be between 50 and $60 million a year of additional expenditures the state has made unnecessarily,” Fitzpatrick told Missourinet.
The audit also found a backlog of about 85,000 Medicaid and Children’s Health Insurance Program eligibility redeterminations as of Dec. 31, 2025, along with delays in processing some applications.
Fitzpatrick said Missouri spends tens of billions of dollars annually on Medicaid, making accurate eligibility reviews critical.
“Hey, we want to make sure that we’re going to be spending federally literally hundreds of billions of dollars every year and at the state level 10s of billions of dollars on Medicaid. We want to make sure that money is being spent on people who are actually eligible for the program and need the care,” he said.
The audit also raised concerns about the Department of Health and Senior Services’ oversight of the Child and Adult Care Food Program. Auditors found 12% of meal reimbursement claims tested were unsupported or contained errors, a problem that has appeared in multiple audits.
Fitzpatrick said some providers found to have significant overpayments in one program were allowed to continue participating in another.
“There’s an adult care and a child version of this program, and they would go review one of those programs, find somebody who was overpaid by 100% in one month, and then they would just terminate them from that program, but wouldn’t terminate them from the other program. They were allowed to continue working in the other program,” he told Missourinet.
Other findings involved oversight of federal disaster assistance grants, monitoring of organizations that receive federal funds and delays in required federal transparency reporting.
Fitzpatrick said agencies need to act on audit recommendations to strengthen accountability and better safeguard taxpayer dollars.
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