IMPLEMENTATION OF THE STATE

LEGALIZATION IMPACT ASSISTANCE

GRANTS UNDER THE IMMIGRATION

REFORM AND CONTROL ACT OF 1986

FLORIDA
STATE  OF 
RICHARD P. KUSSEROW

INSPECTOR GENERAL

-800 
OAI-07  AUGUST 1989  EXECUTIVE SUMMARY 
PURPOSE 
The purse of ths inspection was to determe how effectively Florida implemente the 
State Legalzation Impact Assistace Grats (SLIAG) progr, to identi potential problems 
early in the process, and to identiy goo practices which al States could shar. 
BACKGROUND 
progr  Imgrtion 
The SLIAG  was established under the  Reform and Contrl Act (IRCA) 
of 1986 to reuce the fmancial burden of providig public assistace, public health assistace, 
and educational servces to eligible legalze alens. In Fiscal Year (F) 1988, $928.5 miion 
progr fuds 
in  were alocated to States, and fuds will contiue to be alocated thugh FY 
1991. . These fuds also cover adstrtive costs for implementing SLIAG at the State and 
local levels. Payments ar mad for public assistace activities generaly available to all 
neey individuals and public health assistace services offered under the States ' public health 
progrs. The paymnts also cover educational servces designed to assist eligible legalized 
alens to att a satisfactory level of performce in school and to achieve English language 
proficiency and citizenship skis necessar to beome perment residents. The Famly 
adisterig  progr. 
Suppon Admistrtion (FSA) is responsible for  the 
Because SLIAG establishes a new progr, FSA realze that prob.1em aras would surace 
early in its implementation. In adtion to the norm diculties encountered in crating new 
reognze 
processes and procedurs, FSA  that SLIAG would have unique problems. Some 
progrs 
of these issues include the diversity of  which SLIAG encompasses, cultual and 
mataing 
language barers assocate with the servce population  confdentiality of 
inormation, and the extrmely shon ti fres for the grt awar proess. 
METHODOLOGY 
In response to the anticipated diculties with implementig SLIAG, the FSA reuested that 
the Offce of Inspector General (OIG) conduct reviews in 10 States to determne the progress 
of States' implementig this progr. The FSA selected nine States and the Distrct of 
progr 
Columbia beause of the varety of  they offere the number of eligible legalized 
aliens in the population, or the amount of the grt awar The nie States ar Arzona, 
Caifornia, Colorado, Flori  Ilinois, Masachusetts, New York, Texas, and Washington. 
strctud  progr 
Intervews based on  discussion guides for each major  ara, as well as 
documentation fuished by FSA and State and local offcias, built the base of information for 
this repon. This report represents the review conducte in the State of Florida and repons on 
progr 
its implementing the SLIAG  as of August 1988.  commtt 
Both FSA and Florida were  to identiyig problem aras and developing 
Imately 
inovative and effective solutions for them.  followig our on-site visits, FSA 
was given an outle of the State concerns identied in ths repon. The FSA and Florida have 
alady intiated action on some of the fidigs and reommendations. 
FINDING:  FSA ha held national conferences and issued informtion to States 
Since  1987,
on imlementing the SUAG program. 
begig 
The FSA held severa national conferences 
in 1987 to share 
inormation with States on SLIAG legislation, the implications for States, the 
application process, and the documentation of costs 
The FSA also provide States with "Question and Answer" issuances and 
demographic data from the Imgration and Natualzation Servce. 
strtue 
FINDING: Florida established a  to identfy organizational and program needs. 
Prgrs 
The Refugee  Admnistrtor for the Deparnt of Health and 
Rehabiltative Servces is the  contat for Florida. The Governor 
single point of 
placement of the single point of contact in the deparent 
ensures high visibilty 
for SLIAG. 
- Florida sureyed its public assistace, public health assistace, and educational 
services programs to assess the overa need in providing expanded assistance 
to eligible legalze alens. 
To assist eligible legalze alens meet educational reuiements for permanent
progr 
resident status, Florida develope a new educational  caled 
Citizenship. " 
FINDING: Florida also took immediate steps to documnt exenditures and .;ontrol 
disbursements . 
Florida began planing modfications to the existig State Automated 
Management Accountig System to captu addtional new data elements for 
SLIAG. Alowable expenditus wi be identied by object cods or other 
mechanisms to prevent reimburment for unalowable expenditus. 
Plans for implementig SLIAG include developing form contracts, 
grts, or
operatig agrements with servce providers such as the counties, a major 
hospital, and the Deparent of Education. Expenditur and disbursement 
contrls wil be an integr pan of the form agrments. The SLIAG services 
ar provided on a cost-reimburable basis. 
ar 
No cash advances or cash balances  anticipated. Contrct 
compliance wil be 
closely monitore accordig to established State stadads. 
Neverteless, there ar some funds contrl vulnerabilties.  FINDING: Florida' s planned modifcation of its aumated accounting system to control 
ha 
SUA.G expenditures and disbursements  not been implemented. 
FINDING: The necessary forml operating agreements between the State, countes, and 
ha 
major providers containing the details for implementng SUAG  not yet been formlized. 
FINDING: The FSA' s definition of public assistance includes some public health activities 
which created adinistrative and service delivery problems for Florida public health agencies. 
FINDING: At the time of the inspectin, Florida ha onl broad, informl guidelines from 
FSA on the allowability of SUAG costs and the documntation requirements which it could 
share with the counties. 
FINDING: The FSA applicatin review process created a nuer of significant problems for 
Florid. Also, the FSA's application review process interfered with the State s ability to plan 
for services.

Delay in FSA issuing the implementing reguation resulted in the State 
inabilty to properly plan for SLIAG. 
Numerous policy misinterpretations and disagrments resulted beause FSA 
did not provide defintive wrtten instrctions to assist Florida in understading 
SLIAG application reuirements. 
The tie frames were too short for submittg the initial SLIAG application 
FSA review and comment, and revisions of the application. 
progr 
The implementation of SLIAG-funded  was delayed because of a 
notig  grt 
signifcant delay in  Florida of the  award. 
progrs 
No formal appeals process exists if  or costs ar denied in the fIrst level 
review. 
As mentioned earlier, FSA and Florida have aleady intiated action on some of the 
reommendations made in this repon. Steps have ben taen by FSA to provide States with 
progr 
more specific, formal guidelines for identing and documentig actual  and 
adistrative costs. However, adtional actions ar necessar in other aras on the pan of 
FSA and Florida 
RECOMMENDATION: Florida should complete its planned modifcation of the automated 
system to control SUAG exenditures and disbursements. 
RECOMMENDATION: Florida should develop SUAG operating agreements with the 
counties and providers as soon as possible. 
RECOMMENDATION: The FSA should reconsider its position to 
classif certain public 
health services as public assistance and mae appropriate adjustments to thi position.  RECOMMENDATION: The FSA shoul issue written guidelines for determining and 
documnting SUAG costs. In tun, Florid should ensure disseminating informtionfor 
determining and documntng SUAG program and adnistrative costs to the counties. 
ma 
RECOMMENDATION: The FSA should  its application and grant process more 
orderly. Specifcally, FSA should 
provide defitive wrtten instrctions on the SLIAG application requirments 
and establish a dialogue with Florida on SLIAG policy, compliance, and 
minie 
reponig issues to  the confsion that occured in the initial application 
process; 
tie  alott 
ensur that sufficient  is  to the application process including 
Florida' s initial application, FSA' s review and formal comment, Florida' 
consideration of FSA comments and negotition of disputes, and its submission 
of the revised application for FSA approval; 
progr 
develop an appeals process to use if  or costs associated with providing 
servces ar denied in the intial application process; and 
revise the  proess for approved applications so that the notice of 
grt award 
grt  begig 
award reaches Florida prior to the  of the fiscal year. 
COMMENTS 
drt 
The FSA and the State of Florida both commented on the  repon. The commnts 
respetively. 
include as Appendices B and C, 
agr 
The FSA and the State generaly  with our fmdigs and recommendations. Both 
reponed havig taen a number of steps to improve implementig SLIAG. Where 
moed 
appropriate, we have  the repon based on their comments.  .............................................  ..
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TABLE OF CONTENTS 
EXECUTIVE SUMMARY 
INTRODUCTION. 
FLORIDA' S ORGANIZATIONAL STRUCTURE. . . . . . . . 
FINDINGS AND RECOMMENDATIONS 
Public Assistace. . . . 

Public Health Assistace. . 

Education

Crosscuttg Issues

OIG RESPONSE TO COMMENTS 
APPENDICES 
APPENDIX A: Goo Prctices 
APPENDIX B: Famy Suppon Admnistration s Comments 
EN:DIX C: Florida's Comments  INTRODUCTION

--'i ' 
PURPOSE 
The Famy Suppon Admnistrtion (FSA) reuested that the Offce of Inspector General 
(OIG) conduct an insption in nine States and the Distrct of Columbia to determe how 
Grts 
effectively the States implemente the State Legalzation Impact Assistace  (SLIAG) 
progr  Imgrtion 
awarded under the  Reform and Control Act (lCA) of 1986. The 
insption include reviewig mehansms in place to identify these funds and determning 
whether present or projected policies and predures adere to FSA  FSA also 
gudelies. The 
identig 
was interested in  potential problems early in the process and any goo practices 
which all States could shar. Ths repon presents the results of the inspection penag to the 
State of Florida. 
BACKGROUND 
Under IRCA, eligible legalize alens may apply for permanent residency within a I-year 
period afr they ar fIrst eligible (Le., by the 31 st month afr they receive tempora resident 
status). 
Ths new population will incrase the demand for State public assistace and public he 
assistace servces signcantly. It wil also incras the demand for State educational 
servces as these new residents obta English language and civic skis neeed to become 
S. citizens. 
To help States defry may of the costs of providig public assistace, 
public health 
assistace, and educational seces to eligible legalze alens, IRCA authorize $1 bilon 
(F 
each year from Fiscal fear  1988 thugh 1991 for SLIG grts, less an amount 
identied as the "Federa offset." With few exceptions, eligible legalize aliens are ineligible 
progrs 
for federay funded public assistace  such as Aid to Fames with Dependent 
Childrn (AFC), foo staps, and Medcaid. The "Fedra offset" is the estiate cost to 
the Federa Government of providig these servces or benefits to those few legalize aliens 
who ar eligible for them. In FY 1988, the law alocated $928.5 millon to States. 
To reeive SLIAG fuds, States must apply to the FSA Division of State Legalization 
Assistace, which is respnsible for apprvig applications and adnistering the progr. 
The application must be approved in tota for a State to reeive any SLIG funds. The FSA 
also provides States with tehnical assistace on policy issues and on the method use to 
estimate costs and veriy actual costs. 
The basic reuirment for States to clai reimburement is that costs must be alowable, 
reasonable, and alocable. State public assistace and public health assistace progrs must 
progr 
be the same ones avaiable to the genera public. States cannot crate new  in these  aras speifcaly for eligible legalize alens. However, States may create new or additional 
progrs 
education  for eligible legalize alens. States may also claim reimbursement for 
adstrative 
progr adstrtive and SLIAG  costs. 
lite 
Reimburement for public assIstace and public health assistace is  only to the amunt 
maum 
of State and local funds expende for SLIAG-relate costs. The  SLIAG 
reimburment for educational servces is an average of $500 per year per eligible legalize 
alen. Determg progr adistrtive costs is ma in accordce with the fmal 
reguation at 45 CP 402.22. 
progr 
adnisterig 
The FSA is responsible for  the  Because SLIAG was a new program, 
real 
FSA  that problems would surace early in its implementation. In adtion to the 
norm diculties encountered in cratig new processes and proedures, FSA reognizd 
that SLIAG would have unque problems. Some of these issues include the diversity of 
progrs 
which SLIAG encompasses, cultu and language barers assoiated with the 
matang  tie
servce population  confdentiity of inormtion, and tle extrmely shon 
fres 
for the  process. 
grt award 
METHODOLOGY 
The FSA selected nine States and the Distrct of Columbia for the inspection beause of the 
varety of program offere the number of eligible legalize alens in the population, or the 
amount of the  Arona, Calornia, Colorado, Florida, llinois, 
grt. The nie States are 
Massachusetts, New York, Texas, and Washington. This repon reviews Florida' 
progr 
implementation of the SLIAG  as of August 1988. 
strctu 
Pror to conducting the inspetion, the OIG develope  discussion guides for each 
progr 
major  activity at the State and local levels. In conducting ths review, intervews 
progr 
were held with  and/or financia offcias at the State capita in Talahassee, two 
metrpolita counties (Dad and  county. (St. Lucie). 
Broward), and a  . ,
FLORIDA' S ORGANIZATIONAL STRUCTURE

adster 
Each State designate a single point of contat to  and coordate the SLIAG 
progr. The Governor designated the Deparnt of Health and Rehabiltative Servces as 
adstering  progr 
the agency responsible for  the SLIAG  in Florida The SLIAG single 
point of contact is the Admistrtor of Refugee Progrs. The State supervises and the 
adister 
counties  the SLIG progr in Florida. 
The Deparent of Health and Rehabiltative Servces has 11 servce delivery distrcts 
thughout Florida. Distrct Admistrtors, who have the same standing as an Assistat 
Secta, ar appointed by the Secta and ditly responsible to the Deputy Secrta for 
Admtrtors  deparenta 
Oprations. The Distrct  have dit-lie authority over al 
progr 
operatig in their distrcts. 
The delivery of educational serces for both school-age childrn and adults is handled by the 
Florida Deparnt of Education. Its head is the Commssioner of Education who is an 
The designated point of contat in the education deparent responsible for 
elected offcial. 
seurng and submittg reuir information relative to SLIAG is the Burau of 
Compensatory Education at the State capita in Talahasse. Adult education inormtion and 
concerns ar provided to the Bureau of Compensatory Education by the Burau of Adult and 
wi adister 
Community Education. The two buraus  and deliver SLIAG-related 
educational servces to eligible legalze alens of school age (kderganen though 12th 
adults. 
grad) and 
The inspection revealed that the counties exercise signcant autonomy and contrl over 
progrs 
and other matters withn their resptive jurdictions. Robust competition exists 
progr 
between the counties for avaiable Fedra and State  funds alocated by the State.  FINDINGS AND RECOMMENDATIONS

Both FSA and Florida wer commtt to identiyig problems and developing innovative and 
effective solutions for them. Imedately followig our on-site visits, FSA was given an 
outle of the State concerns identied in ths report The FSA and Florida have alady 
intiated action on some of the fidigs and reommendations. 
FINDING:  FSA ha held national conferences and issued informtion to States 
Since  1987,
on imlementng the SUAG program. 
begig 
The FSA held severa national conferences  in 1987 to shar 
inormtion with States on SLIAG legislation, the implications for States, the 
application process, and the documentation of costs. 
The FSA also provide States with "Question and Answer" issuances and 
Imgrtion  Natuzation 
demographic data from the  and  Servce (IS). 
strtue 
FINDING: Florida established a  to identfy organizational and program needs. 
Prgrs 
The Refugee  Admistrator for the Deparnt of Health and 
Rehabiltative Servces is the  The Governor 
single point of contact in Florida. 
placement of the single point of contat in the deparent ensures high visibilty 
for SLIAG. 
Florida sureyed its public assistace, public health assistace, and educational 
servces progrs to assess the overa need in providig expande assistace 
to eligible legalze alens. 
To assist eligible legalize aliens meet educational reuiments for perment
progr 
resident status, Florida develope a new educational  caled 
Citizenship. " 
St. Lucie County and a local rado station ar workig jointly to broadcast 
avaiable servces (including those under SLIAG) in Crole to reach a large 
Haitian population. 
Broward County adistrators conducte a ZI cod analysis to determne 
where concentrtions of eligible legalze alens reside in the county. Thus, 
local servce delivery centers likely to be affected most  be quickly 
nee  fruently can 
identified, and aras where providers ar  can be tageted This tol  carng  progr 
useful for the county in  out its  assessment and planning 
progr. 
functions for expanding existing 
In Dad County, Jackson Memorial Hospitallses an on-lie computer to 
identiy patients meetig Fedra guidelies 
on povert. These data ar kept on 
adister 
me to aid hospita offcials to  servce delivery programs including 
SLIAG. Jackson Memori Hospita has also developed new SLIAG patient 
reuir 
registration proedures indicating the  documentation for eligible 
legalze alens. 
FINDING: Florida also took immdite steps to document  control 
exenditues and 
disbursement . 
Florida began planning modcations to the existig State Automated 
Maagement Accounting System to captu addtional new data elements for 
SLIAG. Alowable expenditus wi be identied by object cods or other 
mechansms to prvent reimburment for unallowable expenditus. 
Plans for implementing SLIAG include developing form contracts, 
grts, or
operatig agrements with servce providers such as the counties, a major 
hospita, and the Depanent of Education. Expenditu and disbursement 
contrls wi be an integr pan of the form agrments. The SLIAG services 
ar provided on a cost-reimburable basis. 
No cash advances or cash balances ar anticipate. Contrct compliance will be 
closely monitore accordig to established State stadads. 
State and county officials indicate that existig internal controls, fmancial 
stada, 
management  and reportg reuiments applicable to progrms 
servg the refugee population wi be use for SLIAG wherever possible. No 
new or substatially augmented systems ar planned. Ordiar modfications 
wi be made to cwrnt processes as reuird to accommodte SLIAG 
implementation and monitorig. 
Neverteless, there are some funds contrl vulnerabilties. Findings and reommendations 
concerng these vunerabilties follow under major topic aras. Findings and 
reommendations which afect mor than one assistace progr ar discusse in the 
Crosscuttng Issues setion of this repon.  PUBLIC ASSISTANCE 
Assistance or Serve Activities 
progrs  wi 
Major public assistace  provide by Florda that  incur SLIAG-related costs 
as follows: Medcaid; AFC; childrn s medcal servces; foster substitute car; primar 
dit 
foo 
health car; community car for the elderly;  emergency assistace for  clothing, 
shelter, and fiancial aid; home health car to low-income or indigent persons; housing; 
trsprttion 
menta health; alcohol and drg abuse tratment;  for the elderly, low-income 
and handicappe clients; and domestic intervention. 
progr 
State offcials indicate that new  for eligible legalze alens ar not anticipated. 
Existig systems and proesses wi be use wherever possible. However, it was disclosed 
that needs assessments were being conducte thoughout the State to determe the impact on 
progrs  legaliz 
existing  which were reuired to more effectively serve the eligible  alien 
progr 
population. .At the time of the site viits, no new  had ben speifcaly established 
beause of the avaiabilty of SLIAG funds. 
Stats 
Documentaton of Eligible Legalized Alien 
Documentation of eligible legalizd aliens for SLIAG public assistace wi be accomplished 
at the intae stage of processing. For example, Dad County has amended its Basic Intae 
Form to include a section for ths population. Identity documents, e.g., those issued by the 
INS (Le., 1-688, Tempora Resident Car or 1-688A, Employment Authorization Card, etc. 
wi be scrtiize and checked agaist a State-prepar list of acceptable identification. The 
ditors 
single point of contact is now workig with distrct  to clar and establish the list 
These identity documents wi also be photocopied and mataed in the client me for futue 
reference.. Qualty assurce wi include me reviews and contacts with eligible legalzed 
veri 
alen famy members to  identity. 
Program Costs 
FINDING: Florida' s planned modifcation of its automated accounting system to control 
ha 
SUAG exenditues and disbursements  not been implemented. 
The State reognize the nee for modying its accounting system to determne and 
document SLIAG costs. However, at the time of the review, the State had not implemented 
Prgr 
methodologies to do ths.  costs wi be monitor by the mechanisms the State 
employs in documentig SLIAG funds from drwdown to claimed expenditu. Florida fiscal 
offcials advise that the State Automated Management Accounting System will be modfied 
adg  cod 
by  new  data elements for SLIAG. Allowable expenditus wil be defmed 
object codes or other mehanisms. Once these contrls have been established, the State wil 
make a stada accountig joural entr to move the fuds frm the State account to the 
grte 
account. This results in a disburement entr to the State s records and a reeipt in the 
grte  grt 
s reords. The  then advises the State on using the  funds by 
grtee agency  cla 
Oai contag 
submittng  for reimbursement  unalowable items wi be reuced.. 
accordigly by the automated system prior to payment authorization. 
The State automated system also reords monthy and year-todate expenditus agaist 
budget alocations for salares, expenses, and operatig capita outlay. Expenditu rates are 
reorded monthly. These monthly rates project annual expenditues based on curnt spendig 
levels and keep maagers awar of potential surlus or deficit situations. 
The Deparent of Health and Rehabiltative Servces uses a stadad contract management 
system for al contrted servces. It is expeted that contracts for some servces wil involve 
bas 
community- organzations. 
Any irgularties involvig noncompliance with contrts that reuire planned corrctive 
change wil be incorprate in a corrective action plan. Ths plan wi be develope 
cooperatively by the subcontrctor and distrct contrt maager. Financial, maagerial, and
adistrtive 
functions of subcontrtors wi ordary be reviewed at least annually. 
Al contrcts wi be 
cost-reimburable. These ar usualy paid withn 21 days. No cash 
balances ar planed, nor ar cash advances anticipate. However, if a cash advance is 
neeed, the contractor must justify the request. The State wi requir contrctors to account 
for interest on cash balances. Such sums ar deucted frm the face of the contrctor 
ounty is a contrctor of the State, e.g., for SLIAG servces, a cap on the 
invoices. Where a 

amount of funds a county can access is established in the contrct. The State wil re-examne 
and re-negotiate a higher limit where appropriate and issue a contract amendment, if
warted 
RECOMMENDATION: Florida should complete its planned modifcation of the automated 
disbursement. 
system to control SUAG exenditues and 
Administratve Costs

adistrtive 
State fiscal offcials said that actual  costs ar monitored by crating cost pools 
using a coded data element called an "Other Cost Accumulator" in the State automated 
system. The State Cost Alocation Plan is followed in calculating costs as a percent of a 
claim. 
At the county level, local offcials advised that the actual adnistrtive costs for each 
progr 
(includig SLIAG) is bas on a percent of annual funding. This percent is 
indit 
predcated upon estiate sta nee and the county federaly approved  cost rate for 
genera and adnistrtive costs. State claimig of progr adnistrtive costs is addressed 
in the final regulation at 45 CF 402.22. 
One county, however, did not have an indict cost rate approved by the cognizat Federal 
agency. Other county offcials were unclear about alowabilty of SLIAG costs. They 
indicate that they had only reeived broad guidelines from the State.  Bales 
Drawdown of Funds and Cash 
The State drws down Fedra funds only on an as-nee basis and no soner than 3 days 
expenditu. "Nee" is based on history of cost estimates. The State 
prior to the actuaJ 
automate system produces grt award estiates for each quaner. Weekly averages 
bas 
calculate  on known pattrns, e.g., payrll. Drws versus expenditus ar monitore 
monthy and expenditus versus eargs ar reviewed quanerly. 
The county must submit its application for fuds to the State single point of contact. This 
rreueest is iinclmude in theb State su applicratiomn to FSA feor SLInAG futnds . A notice is issued by 
the State to the county when the county application is approved. The county then provides the 
SLIAG-relate servces to eligible legalze alens and submits invoices to the State for
FINDING: The necessary forml operating agreements between the State, counes, and 
ha 
major providers containing the details for implementng SUAG  not yet been formlized. 
ty 
Ths  of argement is ustuaill y contrlled by a formal interagency agrment, contrct, 
other device. At the  of the insption, a major aspet of SLIAG 
grt, or 
implementation, i.e., the fonn and content of the controllg instrments, had not yet ben 
determed. 
RECOMMENDATION: Florida should develop SUAG operating agreements with the 
counties and providers as soon as possible. 
PUBLIC HEALTH ASSISTANCE 
Assistam:e or Serve Activities 
progrs  wi 
Major public health  that  incur SLIAG-relate costs include imunizations, 
famy planning, menta health, prenataperiata car, chid health, counselig and testig for
AIS, examnation and tratment of sexualy trsmitted dieass, trating 
dit  and follow-up of 
tuberculosis,  inpatient and outpatient hospita servces, 
rehabiltation and acute care, 
pharcy 
laboratory and 
servces, X-rays, and psychiatrc consultation. Delivery of these 
servces is accomplished thugh the Deparent of Health and Rehabiltative Servces 
community health facilties in the counties, major health car providers, private physicians, 
and laboratores under contract. 
progr 
In one county, offcials have tentatively identied one new  for indigent patients. If 
adopte it wi reimbur physicians for servces provide to these patients. Servces are 
contrte  phary 
out on a cas-by-cas basis and can include laboratory and  servces, 
X-rays, and psychiatrc consultation.  Documentaton of Eligible Legalized Alien Stats 
legal 
progrs 
Eligible  alen documentation for cost reimburment in public health 
reui 
under SLIG is not  if cost estiates ar derived frm a population ratio formula. 
progrs 
However, some public health  have ben identified by FSA as "public assistace 
reui 
and therefor  such documentation. 
FINDING: The FSA's definition of public assistance includes some public health activities 
which created adinistrative and service delivery problems for Florida public health agencies. 
Severa program adistere by the Deparent of Health and Rehabiltative Servces 
progr 
considere public assistace  for SLIAG reimburment purses. The distinction is
impot 
beause identiyig a servce as public assistace reuis documenting costs 
progr 
inCUled for individual eligible legalze alens served If a  or servce is considere 
public health, the population ratio method for establishing costs can be used Applying this 
method costs are determed by the percentage of eligible legalze alens in a servce 
population to al members of the relevant service population. Ths percentage is applied to 
progr 
tota  costs to determe how much can be reimburse with SLIAG funds. 
Whle there is no quarel with the logic of FSA's definition of public assistace versus public 
health, the distiction crated serious adnistrtive and service delivery problems for public 
health agencies. These agencies, not the public assistace agencies, must develop and 
legal 
implement new proesses for identiying individual eligible  alens in order to 
document costs. Public health offcials in Florida ar concerned that askig patients about 
wi  tie. 
their legal status  seriously afect the wilingness of patients who ar ilegal 
residents to 
access public health servces. These peple oftn enter the countr with highly contagious 
imately. 
diseass such as Hepatitis B and nee tratment  The effect of this policy on the 
public health in genera is not known at ths 
Florida offcials pointed out that FSA offere no satisfactory explanation for requirng Dade 
County s Jackson Memorial Hospita (the prime public health provider for eligible legalize 
alens) to be considere engaged in public assistace rather than public health matters. This 
reuiement has resulted in Jackson Memorial Hospita havig to identify individual eligible
legaliz  progr 
aliens receivig servces and ask  eligibilty-oriented questions, which is a 
process not norally done at the public health intae phas. Jackson Memorial Hospita 
adsterig 
offcials find that the reuirment crates new and dicult problems in  the 
progr 
and tends to confse applicants for SLIAG-relate servces. 
To fulfill the FSA  SLIAG patient registrtion procedurs have been 
reuirment, new 
develope by Jackson Memorial Hospita indicatig the requir eligible legalze alen 
eligibilty documentation. The documents ar photocopied and retaned in the patient s me 
futu 
for  reference. These policies and proedurs have ben in effect since May 20, 1988.  Oter counties have reuested providers to keep reords documentig eligible legalze alen 
status. The counties ar also developing a handbok depictig the varous INS documents 
scrnig 
providers use in  applicants for servces. 
RECOMMENDATION: The FSA should reconsider its position to clasif certain public 
health services as public assistance and mae appropriate adjustmnts to 
thi position. 
Program Costs 
Intial progr costs were estiate using a population ratio formula based on what it now 
costs to provide servces. By 1990, actual data wi be used in calculatig costs. 
progr  wi  reui 
Some  costs  not  speifc documentig beause they were derived by a 
population ratio formula; other program costs must be documented by public health providers 
as "public assistace" to satisfy FSA reuirments. Trational method wi be use for 
ensurng that SLIAG funds ar use to provide servces only to the intende population and 
clai 
avoid duplicate  for reimburment. These method could include reuirng acceptable 
identication obtag supponig documntation, being famar with progr guidelies,
conducting tring, and monitoring. However, at the tie of the field visits, county offcials 
were unsur of the speific reuirments FSA may impose. 
legal 
Applications for public health assistace servces frm eligible  aliens ar processed 
no dierently than other patients. However, intae form ar coded to denote eligible
legaliz alens. In one county, a financial class cod is alo assigned These ar also the 
pricipal means for avoidig claimig reimburement from SLIG and other Federal 
progrs. No distiction is mad between alens who perform seasonal agrcultu services 
and those who have reside unlawflly in the Unite States prior to Januar 1, 1982, and are 
tempra 
adjusting their status to lawful  resident for establishing alowable costs. 
Identifyig eligible legalize aliens for State match to FedraState match progrs 
accomplished based on a class cod and the documentation in the client s fie. 
The counties also have a review proess in place for determng the allowabilty and 
accury of invoices frm contrtor and vendors in refugee progrs. This process wil 
accommodte SLIAG. A second review by county accountats is performed and a third 
review is done at the State level. These steps ar similar to those descbe previously under 
Public Assicstlaoce.s Ceontlryac tms aro cnosti-troeimrbeura.b le only and ar bas on perforance. Each

contrct is 
Admnistrators reponed that ordiarly, cash surluses, if any, accred by contrtors must b 
repo 
to the State. Any resultig interst must be included. In adtion, a prject number is 
thughout  progr. 
assigned to identiy the funds  the lie of the  Administratve Costs

State and county offcials indicated that actual adnistrtive costs for each progr
(includig SLIAG) is based on a percentage of anual fundig. That percentage had not yet 
ben determed at the tie of the site viits. The costs must be diectly related to the SLIAG 
progr.  claig  adsse 
State  of progr adstrtive costs is  in the 
fial regulation at 
45 CF 402.22. 
Drawdown of Funds and Cash Balanes 
Predurs 
for trsferrg SLIAG fuds from the State to the county ar in place and ar, 
accordig to county offcials, being followed However, the form instrments governing 
SLIAG implementation have not yet ben negotiated by the State, the counties, or providers. 
adstrto repo 
In Dad County, a hospita  that SLIAG funds for reimburment will 
be trsfen-ed frm the county to Jackson Memoral Hospita bas on monthy billings. It is 
expete that ths item wi be stipulate in the contrt or operatig agrment to be entere 
into between the State and the hospita. 
EDUCATION 
Assistance or Serve Activities 
progr  wi 
Major educational  that  incur SLIG-related costs include kinderganen though 
gre 12, Adult Basic Literacy, English as a Second Language, Citizenship, and History. 
Educational servces to adults wi be provide priary by the 58 school distrcts and 13 
unity colleges designate as the adult education local providers. Educational servces
wi  bas 
also be avaible thugh community- organiztions, both public and private, and 
imgrt 
qualfied designate entities concerned with adult genera education and  education. 
nee 
An overl  assessment wi be done though meetigs with distrct 
education offcials 
and the Fedra progrs coonator to determe if new progr ar requir Thus far, 
progr 
only one new  for adults (Citizenship) has ben crate due to the avaiabilty of 
SLIAG funds. Ths cour assists eligible legalize alens in metig the reuirments related 
to the English language and knowledge of the history and Govemment of the United States to
att 
lawfl permanent resident status. 
Stas 
Documentaton of Eligible Legalized Alien 
Servces under SLIAG will only be provide to those students who were born outside the 
United States and have complete less than 3 academic year of schooling in this countr.
Stada 
enrllment and registrtion proedurs ar followed as pan of the eligibilty proess. 
Eligible legalize aliens are reuir to prouce acceptable identity documents, e.g., evidence 
of lawfl temporar residence (fonn 1-688, Tempora Resident Card) at that tie. Prviders 
mata 
are reuired to  speific documentation on each eligible legalze alen to receive  reimburement A brohure explaig SLIAG has ben produced and distrbuted statewide 
by the Deparent of Education. 
Program Costs 
The Deparent of Education exclusively uses the data provide by the INS (by way of FSA) 
legal 
to determe the number of eligible  alens. Payments to providers ar mad on the 
basis of the lesser of $500 per student or the providers ' actual costs. 
Workshops with the distrcts ar now being planed to develop applications for submission to 
the Deparnt of Education to implement SLIAG educational servces. 
State offcials 
strctug 
advise that they ar followig the law and regutions in  the applications. Fund 
source cod numbers to be incorrated in the S  te automated system wil be used to ensur 
that SLIAG-relate costs wi not be mistaenly claied under SLIAG and other grts. 
Administratve Costs

adstrtive  lit 
The SLIAG  costs ar determed by using the 1.5 percent  for education 
Immgrt 
cited in the Emergency  Education Act of 1984. Ths limit is incorprated into the 
progrs 
SLIAG regulation. The SLIAG costs ar distinguished from costs for other ongoing 
indit 
by using a system of titles and cods. As osf Maach l31a, 198r8, ean  s. cost rate of 17 
percent was fied by the cognizat Fedra agency. This rate covers a porton of items such as 
sta 
utities, rent, and, in some instaces, 
Deparent of Education offcials advise that local education agencies will be audited 
anually. The audits wi focus on doumntig (1) adstrtion of distrct progrs, (2) 
student eligibilty identication, (3) fuds budgete and alocate (4) progr curculum and 
progr. 
servces, and (5) evaluation of students and 
Drawdown of Funds and Cash Balances 
State education offcials advise that no modcations to prsent accounting systems are 
planed to drw down and documnt SLIAG education fuds. 
The method ordiary use to imlement education prgrs is a grt frm the Deparent 
of Education to the distrcts. Trasfer of fuds is ac,omplished by stadad accounting 
joural entres. Drwdown follows State proedurs previously descrbe 
Although no contracts for delivery of SLIAG educational servces had ben let at the time of 
the field visits, monitorig and compliace of such contrts wi be contrlled at the distrct 
Stada 
level.  contract compliance crteria ar followed For example, if a contrctor 
reuir 
reuests an advance for working capita, a wrttn repon of cash on hand is  before the 
Durg 
advance is authorize.  the contrt review proess, if large cash balances 
discovered, a full review is conducted, a corrtive action plan is develope, and close 
monitoring is perfonned by the distrct thereafr.  CROSSCUTTNG ISSUES 
adstrtors 
Intervews with State and local  disclose that certn aspets of SLIAG 
progr
implementation were perceived to have had profound effects that reached beyond 
th 
lies. Below ar the major issues that afected al  programs. 
ha 
FINDING: At the time of the insectin, Florida  only broad, informl guidelines from 
FSA on the allowability of SUAG costs and the documntation requirements which it could 
share with the counties. 
Florida counties indicate that they had reeived litte guidace on acceptable SLIAG costs
frm the State. The State advise that FSA had provided no form dition on the 
alowabilty of costs or the documentation reuirments for such costs. As a result, guidelines 
determg  progr 
for  the alowabilty and amount of actual  costs had not ben develope 
for distrbution thoughout the State. In the interim, the gudelines for preparg the SLIAG 
Estiate 
application were being use by Florida offcials.  costs for FY 1990 and FY 1991 
wi be develope from FY 1988 and FY 1989 actual costs. 
adistrtor 
A hospita  expresse concern over the hospita's abilty to retroactively identiy 
many patients who applied for and reeived trtmnt, but who did not have a form 1-688, 
Tempora Resident Car or 1-688A, Employment Authorization Car when the tratmnt was 
rendere Likewise, it would also be dicult to retroactively document costs for servces to 
these patients. It was only later that the hospita leared from FSA that reimbursement for 
tratment must be documente by form 1-688 or 1-688A. Hospita offcias ar anous that 
reuir 
audit disalowances for reimburement could result beause of lack of  doumentation. 
The aformentioned national confernces held by FSA and its publication of "Question and 
Answer" issuances have provided some guidace to the State and counties on the alowabilty 
of SUAG costs. However, a nee contiues for foral gudelies on acceptable methods for 
adistrtive 
documentig SLIG progr and ' costs. 
RECOMMENDATION: The FSA should issue written guidelines for determning and
documntng SUAG costs. In tun, Florid should ensure diseminating informtion for 
determining and documentng SUAG program and adinistrative costs to the counties. 
nuer 
FINDING: The FSA applicatin review process created a  of signifcant problems for
Florid. 
Also, the FSA's application review process interfered with the State s ability to plan 
for services

Delay in FSA issuig the implementig regulation resulted in the State 
inabilty to properly plan for SLIAG.  Numerous policy misinterpretations and disagrments resulted beause the FSA 
had not provide definitive wrtten instrctions to assist Florida in understading 
SLIAG application reuirments. 
The tie fres were too shon for submittg the initial SLIAG application 
FSA review and comment, and revision of the application proess. 
Implementig SLIAG-funde progrs was delayed beause of a signifcant 
delay in notiying Florida of the grt awar 
No formal appeals proess exists if program costs ar denied in the fIrst level 
review. 
plag 
State and local SLIAG  effons had to be delayed pendig release of the fial rules. 
Ths setback, coupled with problems in the grt application approval proess and the belated 
scblig
reeipt of the FY 1988 grt awar cause last minute " " by the State and counties 
to implement SLIAG. 
Accordig to fmal reguations published Marh 10, 1988, States had to submit the FY 1988 
application by May 16, 1988. Revisions were due by July 15, 1988, and the FY 1989 
tie fres, 
application had to be submitted by July 15, 1989. Due largely to these short  FSA 
provided no formal feeback on revisions necessar in Florida's FY 1988 application. The 
inoration was trsmitted verbally by telephone or personal conferences. 
The FSA would not grt paral fundig nor would FSA conditionaly approve applications. 
ma  enti 
If changes were not  in accordce with FSA's suggestions, the  application was 
disapproved 
State offcials reponed that instead of providig wrttn 
gudelines, FSA encourged Florida to 
inti 
be "crative" in the State  application. Two subseuen! submitts of the application 
were reuir by FSA before an "approvable" version was fially accepted A senior county 
offcial said, "I was shocked at the waste of time and effon expende by the county to comply 
with FSA demands, only to be told that in the end the FSA-supplied population 
data and no 
other, must be used in the application. 
Thus, the confused application proess resulted in planng and adistrtive problems and 
delays plus frstrtion by State and local offcial in respondig to changig FSA 
requirements. 
adnistrtors 
Addtionally, State and county  believe that cuts in the eligible legalize alien 
population estites by FSA were, as one put it, "arbitr and capricious." Ofcials who 
were intervewed assened that FSA gave no reason for the reuctions except that the figues 
were too high. In one county, an adnistsrator said, "The Fed are in a no-risk situation with 
SLIAG, yet rejected goo faith eligible legaliz alien estimates by a county which has been  ver close to the refugee population for a long tie, and in the best position to assess the 
demogrphics of that population. The FSA's action has resulted in lost revenue to the county. 
However, dierences exist between refugees and the eligible legalize alien population. 
The FSA did not provide Florida with an appeals proess when program, costs, or 
methodologies were not approved Thus, Florida had no choice other than to accept the FSA 
deision or foreit al of the SLIG funds for that flScal year. 
RECOMMENDATION: The FSA should mae its application and grant process more 
orderly. Specifcally FSA shoul 
provide defiitive wrttn instrctions on the SLIAG application reuirments 
and establish a dialogue with Florida on SLIAG policy, compliance, and 
reponig issues to mimie the confusion that occur in the intial application 
process; 
tie 
ensur that sufficient  is alotted to the application process including 
Florida' s initial application, FSA' s review and formal comment, Florida' 
consideration of FSA comments and negotition of disputes, and its submission 
of the revised application for FSA approval; 
develop an appeals proess to use if program or costs associated with providing 
servces ar denied in the initial application proess; and 
revise the grant award proess for approved applications so that the notice of 
grt awar reaches Florida pror to the beging of the fiscal year.  OIG RESPONSE TO COMMENTS 
drt 
The FSA and the State of Florida both commente on the  repon. 
The FSA 
agr 
The FSA has generay  with the OIG repon fidings and recommndations (see 
Appendi B). The FSA has taen a number of steps to improve implementation of the SLIAG 
progr 
includig clarg progr policies and proedurs. We have moded cenan 
asts 
of the repon based on the commnts reeived from FSA. 
The FSA questioned the statement that the new population would signcantly incras public 
assistace and public health assistace servces. 
Early estites indicate that large numbers of alens would qualy to access the SLIAG 
progr. The repon reognze that inormtion obtaed durg the review determed that 
substatial incrases in workoad and expenditus could occur in these aras as well as in 
education. However, we understad frm reent discussions with States ' offcials that demand 
for servces is falg behid earlier projections. 
The FSA's defition of public assistace included some public health activities, which created 
adistrtive and servce delivery problems for Florida public health agencies. The OIG 
reommende that FSA reonsider ths position. 
priy 
The FSA replied that they se this  as an issue of cost identication and that they wil 
work with the States to develop method of documentig costs which ar consistent with 
FSA' s respnsibilties as stewar of public fuds. We believe that FSA's actions to identiy 
responsive to our concerns. 
alternative method is 
We contiue to believe that a strct interpretation which permts public health costs to be
clai  spc 
only for  eligible legalze alens is burnsome to the States and, in may 
cass, would reuir considerable revisions to the State s system or statutory reuirments. 
agr 
However, we do  that FSA's use of alternative systems, such as the Cost Doumentation 
System and a revised population ratio method system which reflects usage, would be a 
reuig 
positive effon to enhance cost effectiveness without  States to develop new systems 
or mae considerable revisions to present systems. The population ratio method could be 
revised to consider not only eligible legalize alens in the servce population but use of those 
seces by the eligible legalize alien population bas on informtion alady obtaned from 
progr 
experience. Where appropriate, other alternatives might be use which would 
adss 
prouce a more effcient system for the States and  congrssional intent that 
the States 
would not be reuired to establish new or elaborate systems.  repo  progr 
We  that no formal appeals proess exists if  costs ar denied in the fIrst level 
review. 
agr 
We  with FSA's statement that the Grat Appeals Boar does have juridiction over 
mattrs for witholdig and repaymnt of SLIAG fuds. However, it was the State s concern 
progr 
that an effective appeals mechanism be in place for issues involvig  or costs at the 
fit level of FSA's review in the application proess. 
TIu Stae Of Florida 
agr 
The State has generay  with our fidigs and reommndations (se Appendi C). 
Since the tie of the on-site review, the State has also taen signifcant steps to effectively 
implement the SLIAG progr thugh proedur and system changes.  APPENDIX A 
GOOD PRACTICES 
A number of  ben identied that other States could shar. 
prtices have 
Prgr 
1. The Refugee  Admistrto for the Deparnt of Health and Rehabiltative 
Servces is the single point of contat in Florida The Governor s placement of the single 
point of contat in the deparent ensurs high viibilty for SLIAG. 
2. 
Florida sureyed its public assistace, public health assistace, and educational servces 
progr 
to assess the overa nee in providig expande assistace to eligible
legal 
alens. 
3. To assist eligible legalze alens meet educational reuirments for perment resident 
progr 
status, Florida develope a new educational  caled "Citizenship. 
4. 
rao 
St. Lucie County and a local  station ar workg jointly to broadast available 
seces (includig those under SLIAG) in Crle to reach a lare Hatian population. 
adstrtors 
5. Browar County  conducte a ZI cod analysis to determe where 
concentrtions of eligible legaliz alens reside in the county. Thus, local servce 
delivery centers liely to be afecte most frequently can be quickly identied and aras 
carng 
where providers ar neeed can be tagete Ths tool is usefu for the county in 
out its progr assessment and plang functions for expandig existig progrs. 
6. 
Jackson Memoral Hospita has develope new SLIG patient registrtion proedures 
indicatig the reuir documentation for eligible legalze alens. 
7. 
Plans for imlementig SLIAG include developing form contrts, grts, or operatig 
agreements with servce providers such as the counties, a major hospita, and the 
Deparent of Education. Expenditu and disbursement contrls will be an integral pan 
of the form agrments. The SLIG servces ar provide on a cost-reimbursable basis. 
8. No cash advances or cash balances ar anticipate Contrct compliance wil be closely 
monitore according to established State stadads.  APPENDIX B

Family Support Administratn Comments
 . :( 

APPENDIX B 
DEPARTMENT OF HEALTH II HUMAN SERVICES  Family Suppon Admlnlstratl 
Offce of Refugee Ruetllerr 
Memorandu 
Refer to: 
D.tl:  duly 11. 1989 
Acting Assistant Secretary
From  for Family Support 
OIG Draft Reportl Implementation of the State Legalization
Subjet:  Impact Assistance Grants Under the Immigration Refor. and 
'J'- '5j 
Control Act of 1986 - Florida  (IJA.r-
To:	 Richard P. Kusserow 
Inspector General 
Attached are the Family Support Administration coments on 
coments are technical in 
the above report. Many of our 
nature due to the complexity of the legislation and the fact 
that the SLIAG program was very new at the time of the
review. 
We appreciate the assistance and cooperation we have

onduct this

received from you in response to our request to 	
round of r views of the SLIAG program. The reports we

received are very useful to us in understanding how States

are impleme ting the program.

. Attachment 
B-1
 OIG DRA REPORT:

Implementation of the state Legalization Impact Assistance Grants 
Under the Immigration Reform and Control Act of 1986: 
FLORIDA 
The Family Support Administration' 
s comments are divided into
three sections: 
Comments on background information and other 
narrative material that does not relate directly to the draft
report' 
s findings, comments on the findings, and responses to the 
draft report's recommendations. 
Narrative: 
Page 1 (Background) -- The draft report says, "This new

population will increase the demand for State public assistance

and public health assistance services significantly.  The draft

report isn't clear whose conclusion this is or upon what data and

acnlaalyrsiifsy t hteh ceonscleus ipon oisin btasse.d . The final report should

In the course of implementing SLIAG, we have discovered that 
neither state and local public health programs nor, with few 
exceptions, public assistance programs, inquire about legal
status. 
This suggests that at least some aliens were using these 
services before legalization and that newly legalized aliens do
not represent a "
new population" for public assistance and public 
heal th assistance services. Preliminary cost data from States
suggests that newly legalized aliens are accessing public 
assistance services at rates far lower than the general
population. 
There are indications that a backlog of public 
health needs existed and was identified during the medical 
examinations required of all applicants for legalizations.
However, there is no data to suggest that, other than this 
temporary bulge in demand for public health services, newly 
legalized aliens will generate a significant increase in demand 
for public health assistance or public assistance services. 
Page 4 (Findings and Recommendations) -- The draft report says,
"Since 1987, FSA has held national conferences and issued 
information to states on implementing the SLIAG program.  Since 
the OIG's onsite visits in August 1988, we have continued to 
provide assistance to States. We have conducted several more 
workshops and meetings to assist states in implementation. In
October 
1988, we issued a compendium incorporating the extensive 
formal guidance previously provided to states on methods of cost 
documentation. We also have provided assistance to individual 
States in the form of correspondence, telephone consultation, and
onsite technical assistance. 
We are in the process of conducting 
initial program reviews of the major States, and intend to visit

selected other States as well. We request that the final report

reflect this continuing dialoge with States.  Page 4 (Findings and Recommendations) -- The draft report lists a 
number of steps Florida took to identify "organizational and
program needs. 
(Many of these steps also are featured in the
Appendix, "Good Practices, " which the draft report suggests could 
be emulated by other States.  It is not clear from the 
description of these steps that the statute and regulation limit 
use of SLIAG funds for public assistance and public health 
assistance to activities that are "generally available.  This 
means that states may not use SLIAG funds to set up public 
assistance or public health assistance programs specifically for 
eligible legalized aliens.  The final report should make clear

how this requirement relates to the state actions featured in the

draft report.

Page 6 (Pulic Assistance) -- The draft report states, "state 
officials indicated that no new programs for eligible legalized 
aliens are anticipated.  The draft report also says that the 
Broward County zip code analysis of eligible l galized aliens in 
the county could be used to "identify areas where providers of 
services will be needed.  It is important to note that all 
First 
programs of public assistance must meet three criteria. 
they must be generally available to the population of the State.
Secondly, they must be means-tested. 
Lastly, they must provide 
for the subsistence or health of the individual. As noted above, 
the requirement that the programs be generally available would 
eligible
preclude the state from developing any programs for "
legalized aliens. 
The final report should make that point
clear. 
Page 9 (Public 
Health Assistance) -- The draft report says, "In 
one county, officials have tentatively identified one new program 
due to the availability of SLIAG funds.  As noted above, the 
statute and regulation require that programs of public health 
assistance be generally available to the population. The final 
report should make clear how the proposed new program would 
conform to that requirement. 
Page 11 (Administrative 
Costs) -- The draft report says that 
actual administrative costs for each program (including SLIAG) 
are based on a percent of annual funding. That percent had not 
yet been determined at the time of the site visits.  The final 
report should note that acceptable methods for determining SLIAG 
and program administrative costs are outlined in Federal
regulation. 
Several methods for determining the share of 
administrative costs in ongoing programs that are allocable to 
a priori are specified in the 
SLIAG and which are acceptable 
 22. 
regulation at 4S CFR 402. This section of the regulation also 
permi ts use of other methods for determining program 
administrative costs that will document that these costs are 
allowable, allocable to SLIAG, and reasonable.  The process of

determining SLIAG administrative costs, like all costs associated
 with administering HHS grants, is governed by 45 CFR Parts 74 and

92 and relevant OMB circulars.

Page 12 (Education) -- The draft report says that the Department 
of Education "exclusively uses the data provided by INS (by way 
of FSA) to determine the allowable amount of SLIAG funds 
available to providers who serve the eligible legalized alien
population. 
We assume that this description applies to the way 
the state determines funding priorities, and is not descriptive 
providers. 
of its basis for paying  Because the IRCA and federal 
regulations specify 11mi ts on the use of SLIAG funds for
education purposes (the 
lesser of $500 per student or actual 
costs) the state Department of Education is required to make 
payments on the basis of providers' costs. The draft report 
should make this point clear. 
Findinas 
Finding: 
The FSA's definition of public assistance includes some

public health activities which creates administrative

and service delivery problems for Florida public health

agencies. 
Comment: 
We question how the definitions of public health and 
public assistance create service delivery problems for
Florida public health agencies. 
By statute and 
regulation, all programs or activities under both 
categories must be generally available. In practice, 
this means that SLIAG funds are available only to 
reimburse costs in ongoing, generally available
programs. In 
most programs, immigration status is not 
a condition of eligibility. (The draft report notes 
that undocumented aliens access public health
assistance services. 
If the alien is eligible for 
services, he or she would receive those services 
regardless of whether they were reimbursed under SLIAG. 
The final report should clarify this point. 
Page 9 of the draft report notes that "there is no

quarrel with the logic of FSA's definition of public

assistance versus public health, 
" but does not explain 
that logic or why the OIG recommends that FSA reverse 
its logic. The final report should explain that the 
regulatory definitions of public assistance and public 
heal th assistance are based directly on section 204 of 
the Immigration Reform and Control Act of 1986 (IRCA), 
which created SLIAG.  Programs of public assistance are defined as programs
that "
provide for cash, medical or other
assistance.. . 
designed to meet the basic subsistence or 
health needs of individuals" (section 204 (j) (2) (A) 
explicit
emphasis added). Consistent with IRCA' s 
inclusion of medical assistance under the public 
assistance category, state or locally funded programs 
that provide medical treatment to needy individuals are 
considered by FSA to be public assistance. 
IRCA defines programs of public health assistance as

programs which "provide public health services, 
including immunizations for immunizable diseases,

testing and treatment for tuberculosis and sexually-

transmitted diseases, and family planning services"

(section 204 (j) (3) (A) J. These statutory definitions 
and the legislative history indicate that Congress 
intended to allow certain traditional public health 
functions under the public health assistance category 
and medical assistance to the needy under the public
assistance category. In 
implementing SLIAG, we have
followed that statutory framework. 
We have defined 
public health assistance as, among other things, 
programs or activities that "are provided for the 
primary purpose of protecting the health of the general
pUblic" , (4S CFR 402. 2 J . The scope of programs included 
in that regulatory definition of public health 
assistance goes far beyond the specific activities 
listed in the IRCA. 
Regarding the draft report's concern, on pages 9-10,

that aliens "often enter the country with highly

contagious diseases and need treatment immediately, 
the final report should note that the treatment of

dangerous contagious diseases, including tuberculosis

and sexually transmitted diseases, is included in the

statutory and regulatory definition of public health

assistance. 
The public assistance/public health assistance

categorization issue is. primarily 
one of cost 
documentation requirements, not the a11owabi1ity of

costs associated with any particular health program.

The report notes that Florida officials feel that

because of this issue, "states will not be able to

claim reimbursement for their costs, which will have

the effect of sequestering funds.  Without the

distinction between categories, Florida would likely

use the population ratio method to establish costs for

all programs run by the Commission on Public Health.

Implicit in this method is the assumption that eligible

. legalized aliens will access programs in the same

B-S
 frequency and at the same cost as the general

population. We do not believe this assumption to be

appropriate for medical assistance programs that

provide treatment to needy individuals. To the

contrary, the information that we have to date

indicates that allowing use of the population ratio

method for these programs generally would overstate

costs, dramatically in some cases. However, we would

be willing to allow use of the population ratio method

emDirical basis

for any program for which there is an 
to indicate that doing so would not overstate costs.

FSA realizes that many public assistance and public 
heal th programs do not routinely collect information on 
immigration status but has found many do collect social
security numers. 
That is why we funded and devoted 
substantial staff resources to developing a system that 
will match the social security numers of program 
participants with those of newly leqalized aliens. 
This system gives states information on the numer of 
newly legalized aliens participating in a program and
the' cost of services to them. 
It is now available and 
allows states to establish costs for FY 1988 as well as

current and future years. Recently, we sent state

SLIAG Single Points of Contact suggestions for other

possible methods for establishing costs. None of these

alternative methods requires setting up new

administrative mechanisms or checking status of all

program participants. 

The draft report on page 10 says, wFlorida officials 
pointed out that FSA offered no satisfactory 
explanation for requiring Dade County' s Jackson
Memorial Hospital.. . to be engaged in public assistance 
rather than public health matters.  FSA informed
Florida that the .
activities in question did not meet 
the statutory and regulatory criteria for public health
assistance. In 
addition, guidance on allowable 
activities issued to states on June 17, 1988 described 
in great detail the kinds of activities which met the 
criteria for public health assistance and those that 
met the criteria for public assistance and how to
distingu 
sh between the two categories. 
We will continue to work closely with Florida to

develop methodologies to document costs for all

programs in its approved applications.

Finding:

At the time of the inspection, Florida had only broad,

informal guidelines from FSA on the allowability of
 SLIAG costs and the documentation requirements which it

could share with counties. 
Comment: 
As the draft report notes, at the time of the 
inspection, FSA already had held several national 
conferences, beginning in 1987, and had provided states 
th "
wi  Question and Answer" issuances, which dealt with 
specific questions about allowability of costs.
June . 1988, we issued detailed guidance on kinds of 
activities that met the statutory and regulatory
cri teria 
for each of the three categories of services 
(public assistance, 
for which SLIAG funds may be used 
public health assistance, and educational services). 
The regulation and its preamble provided guidance both 
about allowabili ty of costs and requirements for 
establishing costs. Additionally, Federal staff spent 
with\ state officials
extensive time in conversations 
answering questions about cost allowabili 
ty and cost 
documentation. The final report should include this
information. 
Finding: 
n process created a numer of 
The FSA applicati 
significant problems for Florida. Also, the FSA'
application review process interfered with the State' 
ability to plan for services.

Comment: 
The draft report on page 14 says that the time period

for submission, review, " t-evision and approval of the 
initial application was too short. We agree that it

would have been preferable to have had a longer period

of time between the publication of the final regulation

and the deadline for submission and approval of FY 1988

and FY 1989 applications. However, one reason for the

compressed timeframe was that IRCA required that we

allocate funds in part on the ratio of each state' 
estimated costs to total estimated costs for all
states. 
This meant that we could not allocate funds 
until we approved estimates for all states. The final 
report should note this factor.

The draft report on page 14 says that -numerous policy 
misinterpretations and disagreements resulted because 
FSA did not provide definitive written instructions to 
assist Florida in understanding SLIAG application 
requirements. " Had there been more time, we would have 
communicated more extensively in writing. (As noted  above, FSA did issue written guidance concerning
allowability of costs. 
Comments on Florida's FY 1989 
application were made in writing in response to
Florida' 
s request. 
The report on page 15 says no formal appeals process

exists if programs or costs are denied. The final

report should note that the Grant Appeals Board has

jurisdiction over issues related to the witholding and

repayment of funds. For other matters, the State may

follow normal procedures for disagreeing with an agency

finding. 
The draft report on page 15 quotes State and county

officials who "asserted that no reason was given by FSA

for the reductions (in estimated costs) except that the

figures were too high.  In cases in which we did not

accept initial State cost estimates, we communicated to 
the state that it had not provided data to back up its
estimates. 
Because funding is based in pa  on each
State' s share of total estimated costs for all States,
an individual state' 
s cost estimates impact not only on 
its allocation, but also on all other States'
allocations. (If 
one State's cost estimates were 
unrealistically high, it would receive more than its 
fair share of funds, which would mean 'other states 
would receive less than their fair share.  Therefore, 
it was necessary for us to apply consistent standards 
for evaluating the reasonableness of state estimates. 
(These standards are specified in the preamble to the 
regulation, 53 lB March 10, 1988, page 7855.  The 
draft report also quotes a county administrator who 
compares the eligible legalized alien population to 
. refugees. It should be pointed out in the final report

that these two populations are not necessarily

analogous because of differences in the circumstances

under which they entered the United States and in their

demographic characteristics.

Recommendations 
Recommendation: 
The FSA should issue written guidelines for determining

and documenting SLIG costs. 
Response: 
FSA has issued such guidance. In October 1988, we

issued a comprehensive compendium of guidance on

"Establishing and Reporting Actual Costs, " which we

upda te as needed.
 since the OIG inspection, we have continued to provide

specific quidance to states through national and

regional meetings, through additional written quidance

distributed to States, and through correspondence and

conversations with individual state officials.

Recommendation: 
The FSA should reconsider its position to classify

certain public health services as public assistance and

make appropriate adjustments to this position.

Response: 
As discussed above, the primary issue relating to the 
definitions of public assistance and public health
assistance is one of cost documentation. 
States would 
like to use the population ratio method for all 
departents. 
programs run by their health  The final 
report should clarify whether the OIG is recommending 
that we allow use of the population ratio in programs 
where, as discussed above , its use would likely
overstate actual costs. 
We believe that using the population method for all 
programs run by State health departments would be 
inconsistent with our responsibility to exercise 
fiscal responsibility in administering SLIAG funds. 
However, we recognize that some States may encounter 
difficulties in establishing actual costs, especially 
where ELAs are a small percentage of a State' 
population or for programs that few ELAs access. We 
' to 
will continue to work with states ensure that a 
method is available to allow them to establish actual 
costs for each program in their approved applications, 
consistent with our responsibilities as stewards of 
public funds. 
Recommendation: 
The FSA grant process should be made more orderly.

Response:	 The draft report' 
s recommendation refers to the 
FSA grant process, but the specifics indicate 
that it is referring to the SLIAG application 
and grant award process. The lanquage of the 
recommendation should be more specific. 
We agree that the appl ication process should be

conducted in a more orderly fashion than was the case

for the initial submissions. As the draft report

B-9  indicates, the timeframes for the FY 1988 and FY 1989 
application processes were necessarily short. 
effect, the states and FSA had to complete two 
application processes in less than a year. We do not 
expect similar problems for the FY 1990 and FY 1991
appl ication processes. 
To ensure that states have adequate time to prepare 
their FY 1990 applications based on empirical data, we 
have extended the deadline from July 15 to October 
Addi tionally, we have encouraged states to submit as 
early as possible any questions, issues, or 
descriptions of new programs, and have advised them 
that they may submit all or portions of their 
applications at any time. In order to reduce the 
possibility of misunderstanding, we have advised 
states that we will communicate all substantive 
questions and concerns on their FY 1990 applications in

wri ting, as was done for States' end- year reports.
We issued extensive written guidance on th, FY 1990 
application process and the standards we will apply. 
The draft report on page 16 recommends that we "revise 
the grant award process for approved application so 
that notice of grant award reaches Florida prior to the 
beginning of the fiscal year.  Under the regulation,
that is not possible. 
For FY 1990, the deadline for 
submitting applications is October 1, 1989, and

applications must be approvable by December 15, 1989.

While we cannot run the allocation formula or award

grants until all states' applications are approved, we

expect to run the formula in January 1990. 
However, 
States have told us that, because they have FY 1988 and 
FY 1989 funding that they can carry over into FY 1990, 
them. 
the delay will not be a problem for  For FY 1991, 
the deadline for filing applications is July 15, 1990, 
and applications must be approvable by October 
1990. We expect to run the allocation formula and 
prepare grant awards early in FY 1991. 
The draft report also recommends that we develop an 
appeals process to use if programs or costs associated 
with providing services are denied in the initial
application process. 
We do not believe such a process 
is necessary. The Department' s Grant Appeals Board has 
jurisdiction over cases involving the repayment or 
withholding of funds. Normal channels within the 
Department are open to States that disagree with 
decisions made during the course of application review. 
B-IO  .. 
APPENDIX C

Flori' 
s Comments
 . .
,. 
-(.
; .  -"  .,,-. ( 
APPENDIX C

FLRIDA 
STATE OF 
DEPARTMEN OF HEALll AND REABIUTAllYE SERV1CrS 
c;, 
July 7, 1989 

4! ;, 
tp.. 
'.;0 
Mr. 'Richard P. Kusserow
Inspector General 
services

Department of Health ' Human 
Office of Inspector General

Washington, DC 20201' 
Dear Hr. Russerow: 

Your report entitled "Implementation of the state

Legalization Impact Assistance Grants Under the Immigration

Reform and Control Act of 1986 - State of Florida" has been sent

y office for review and response. The report generally 
to  the state and 
reflects an accurate understanding of the situation .
the u. s. Family Support Administration (FSA) faced at the 
inception of implementation of the State Legalization Impact
Assistance Grant (SLIAG) program. From the states perspective, 
s final SLIAG regulation had

it is important to note that FSA'
only been released five months prior to the Inspector General'

review and the state's application was not approved by FSA.

Since that time, both the state and FSA have made enormous

strides in implementing SLIAG. Below are our comments to the

various findings of this report.

Pulic 
Assistance 
Pindinq 1: Florida's planned modification of its

automated accounting system to control SLIAG
expendi tures and disbursements had not been 
implemented. 
Recommendation: Florida should complete its planned 
modification of the automated system to control SLIAG 
disbursements. 
expenditures an 
Comment: At the time of this review, the state had not 
system. 
However, this system 
modified its accounting 
is now operational and the necessary control of SLIAG
. expenditures and disbursements is in place. 
t: 
Pindinq 2  The necessary formal operating agreements
betw  en the state, counties, and maj or providers
containing the details for implementing SLXAG had not
IVED yet been formalized.
JUL 2 
11999 
OFFICE OF 
SPECTOR  BLVD. . TA  LAIiASSEE  FL 32399-700 
GENEF7 WINEWOOD 
--- .....-.... """I'  GRGOY L. COLE. SECRrIMY  ,. 

Recommendation: Florida should develop SLIAG operating

agreements with the counties and providers as soon as

possible. 
Comment: As the report indicates, Florida was delayed

in developing SLIAG operating agreements with the

counties because of the application approval process.

Florida received a letter on July 11, 1988 approving

the states original FY 1988 application. However, this

application was amended with the 1989 application and

approval was not received until October 24, 1988.

Florida uses a formal contract agreement with the

counties and these agreements could not be executed

without an approved application.

The contract language for SLIAG was not developed at

the time of this review. 
Today, we have executed 
Departent of 
contracts with the state  Education and 
all but a few participating counties.

Pulic 
Health Assistance 
inding 3  The FSA's definition of public assistance

ncludes some public health activities which creates

administrative and service delivery problems for

Florida public health agencies.

Recommendation: The FSA should reconsider its position

to classify certain pUblic health services as public

assistance and make appropriate adjustments to this

position. 
Comment: Florida concurs with this recommendation. 
are. 
Our public health agencies  still wrestling with
this issue. 
Documenting public health costs to the 
uinndiivtsid.u al defeats the purpose of public health 8ervice
These units are to provide public health 
services to those in need in order to protect the
public from contagious health hazards. Asking 
immigration status of those requiring services sends a

different message to the public.

We understand that FSA is interpreting the Immigration 
Reform and Control Act of 1986 to the best of its
abili ty, but 
action should be taken to correct this
situation. 
Otherwise, States will shoulder the health 
amesty program. 
costs of this federal 
Finding 4: At the time of the inspection, Florida had 
only broad, informal guidelines from FSA on the 
allowabili ty of SLIAG costs and the documentation 
counties. 
requirements which it could share with the  . .
Recommendation: The FSA should issue written 
costs. 
guidelines for determining and documenting SLIAG 
In turn, Florida should ensure the dissemination of

docuenting 
information for determining and  SLIAG 
program and administrative costs to the counties. 
Comment: Since this review, FSA has issued a detailed 
A copy of 
manual covering SLIAG cost documentation. 
FSA' s manual has been sent to participating counties
and the Departent 
of Education. 
Findinq 5  . The -FSA application process created a
numer of siqnificant 
problems for Florida. Also, the 
FSA' s application review process interfered with the
States' a ability to plan for aervic8.. 
Delay in FSA issuing the implementinq regulation

resulted in the state' 
a inability to properly plan 
for SLIAG. 
Numerous policy misinterpretations and disagreements 
resulted because the FSA had not provided definitive
wri tten 
instructions to assist Florida in 
understanding SLIAG application requirements. 
The time frames for submitting the initial SLIAG

application, FSA review and comment, and revision of

the application process were too short.

The implementation of SLIAG-funded programs was 
delayed because of a siqnificant delay in notifying 
rd. 
Florida of the qrant aw 
There is no formal appeals process if program costs

are denied in the first level review.

Recommendation  The FSA grant process ahould be made 
more orderly. Specifically FSA should: 
provide definitive written instructions on the SLIAG

application requirements and establish a dialogue

with Florida on SLIAG policy, compliance, and

reporting issues to minimize the confusion that

occurred in the initial application process;

ensure that sufficient time is allotted to the
application process including Florida' s initial 
application, FSA' s review and formal comment,
Florida' s consideration of FSA comments ' and 
negotiation of disputes, and its submission of the 
revised application for FSA approval;  .. 
develop an appeals process to use if program or

costs associated with providing services are denied

in the initial application process; and

revise the grant award process for approved

applications 80 that the notice of grant award

reaches Florida prior to the beginning of the fiscal

year. 
Comment: Since this review, FSA has established
wri tten 
instructions on the SLIAG application 
requirements, the review criteria and approval process. 
In addition, FSA has extended the FY 1990 application 
deadline to ensure states have sufficient time to 
submit their applications. The extension also allows 
states to document more cost, since the FY 1990 
application is based on actual FY 1988 recorded costs. 
FSA has been attentive to both federal and state needs 
in this area since the first application. 
The findings identified were real problems during the first

and second applications. We believe both FSA and states learned

a great deal as a result. Hopefully the FY 1990 application 
one. 
process will be a smooth 
Florida strongly suggests that this report be u.ed to inform 
Congress of the hardships states experienced in implementing
SLIAG. states had little or no time to begin implementing SLIAG 
until applications were approved and grant awards were received 
let alone document costs. 
This report could be an effective tool to dissuade Congress 
States have incurred ,costs but due 
from cutting SLIAG funding. 
to slow implementation on the Federal level, states have not been 
due. 
able to show costs when the first report to Congress was 
Thank you for the opportunity to comment on this draft
report. 
Should you have any questions, please contact me or Gary 
Crawford at (904) 488-3791 
With kind regards, 
istrator 
NKW: cym