Two state departments didn't have enough documentation to justify the state's spending of approximately $8.4 billion in federal dollars, State Auditor Nicole Galloway reported Tuesday.
One of them was cited a seventh consecutive year for doling out funds without making sure recipients were eligible.
The findings are part of the federally required "Single Audit" of federal funds the auditor does each year.
Galloway said the auditor's office is allowed to use "sampling" of data on the programs with the highest risk of spending or record-keeping issues, rather than doing a complete review of every federal dollar spent by every state agency that gets the money.
"(Sampling) is a very common audit tool," she told reporters at a news conference in her Capitol office, "because there is no way that we would be able to review, in a timely fashion, every single payment and every single piece of documentation."
She explained, "As the Legislature and governor are making deep cuts, the state simply must do a better job managing taxpayer dollars.
"State agencies have an obligation to eliminate waste - and it's frustrating when we continue to find the same things year after year."
The new audit covered the 2015-16 state business year that ended last June 30.
Five of the six major findings in the report, Galloway said, "were repeated from prior years. Some of the concerns have been raised several years in a row - including one that has been repeated since 2010."
Based on a review of just 60 payments, she said, Missouri's Department of Mental Health did not keep records to support the nearly $1 million in payments to group homes for individuals with developmental disabilities, the audit reported - and approximately $1.6 million over the last two years.
Galloway said 21 of the 60 payments reviewed didn't "include the documentation necessary to justify the daily rates that were paid," involving approximately $938,000 in federal funds.
In the Social Services department, she said, the child care program "lacked safeguards to prevent inappropriate payments" among the more than $135 million spent to cover child care services for approximately 64,000 needy Missouri children.
"For the seventh year in a row, the auditors found caregivers may have received inappropriate payments due to the department's inability to prevent payments to ineligible clients or child care providers."
Although they didn't get any money from the state, Galloway said the audit found "39 closed pharmacies were still enrolled and authorized to receive Medicaid and Children's CHIP" (Children's Health Insurance Program) from the Social Services department.
Missouri gets approximately $11 billion from the federal government each year, and roughly $10 billion helps the state pay for the various parts of the Medicaid program handled by several different state departments.
The auditor said the new report doesn't allege fraud or theft, but only points to inadequate or improper paperwork that, if done properly, would verify only appropriate payments are being made.
She said the annual report is submitted to the federal government, and the state agencies cited report their plans for addressing problems to the federal government - which may or may not decide to seek paybacks for spending that wasn't documented properly.
Galloway reminded reporters: "Tax dollars cannot go to doctors, hospitals or other health care providers who are not eligible to receive the payments. Scarce resources mean fewer Missouri families and children may be able to access health care because of the inefficiencies and waste we continue to find" in the annual audits.
She said the single audit is the first in a series of audits that will be related to budget oversight and accountability - and "will examine contributing factors to the current budget crisis, including areas with a high risk of inappropriate spending or misuse of funds."