Audit 1638

Significant Deficiency US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA #: 93.778 Finding: 2022-01 Eligibility For the Year Ended June 30, 2022 Schedule of Findings and Questioned Costs (Continued) DUPLIN COUNTY, NORTH CAROLINA Criteria: Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application/recertification and these items will agree to reports in the NC FAST system. In this process, documentation should be present and agree back to the records in the NC FAST system. Any items discovered in the process should be considered in regards to a specific eligibility requirement and explained within the documentation. Condition: There were seven (7) technical errors discovered during our procedures that verifications in the County documentation and the representative data contained in NC FAST were not the same amounts or files containing policy requirements were not properly documented to be considered in compliance with program control requirements. The errors were as follows: Three (3) did not have a completed recertification and the case was rolled forward by the system, however no QC noted per review of admin letters. One (1) did not have completed recertification for case that was transferred from another county, however no QC noted per review of admin letters. One (1) contained an untimely recertification and was forced eligibility due to Hawkins v. Choen extension, however no QC noted per review of admin letters. One (1) contained an error where the system automatically updated unearned income after the recertification was completed resulting in the budget not agreeing to the amounts in NCFAST. Recertification appeared to be completed properly and we considered this to be an NCFAST error and not a County error. One (1) recertification was originally completed properly, however budget calculations were erroneously updated after the recertification was completed by a caseworker resulting in NCFAST numbers disagreeing to the budget. There was no QC as the participant was properly noted as eligible. Questioned Costs (QC): There was no affect to eligibility and there were no questioned costs. Context: We examined 120 Medicaid applicants to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which affect countable resource or program specific requirements and a participant could have been approved for benefits that they were not eligible. Identification of repeat finding: This is a repeat finding from the immediate previous audit, 2021-002. Cause: Ineffective record keeping and ineffective case review process. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST.

Significant Deficiency US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA #: 93.778 Finding: 2022-01 Eligibility For the Year Ended June 30, 2022 Schedule of Findings and Questioned Costs (Continued) DUPLIN COUNTY, NORTH CAROLINA Criteria: Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application/recertification and these items will agree to reports in the NC FAST system. In this process, documentation should be present and agree back to the records in the NC FAST system. Any items discovered in the process should be considered in regards to a specific eligibility requirement and explained within the documentation. Condition: There were seven (7) technical errors discovered during our procedures that verifications in the County documentation and the representative data contained in NC FAST were not the same amounts or files containing policy requirements were not properly documented to be considered in compliance with program control requirements. The errors were as follows: Three (3) did not have a completed recertification and the case was rolled forward by the system, however no QC noted per review of admin letters. One (1) did not have completed recertification for case that was transferred from another county, however no QC noted per review of admin letters. One (1) contained an untimely recertification and was forced eligibility due to Hawkins v. Choen extension, however no QC noted per review of admin letters. One (1) contained an error where the system automatically updated unearned income after the recertification was completed resulting in the budget not agreeing to the amounts in NCFAST. Recertification appeared to be completed properly and we considered this to be an NCFAST error and not a County error. One (1) recertification was originally completed properly, however budget calculations were erroneously updated after the recertification was completed by a caseworker resulting in NCFAST numbers disagreeing to the budget. There was no QC as the participant was properly noted as eligible. Questioned Costs (QC): There was no affect to eligibility and there were no questioned costs. Context: We examined 120 Medicaid applicants to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which affect countable resource or program specific requirements and a participant could have been approved for benefits that they were not eligible. Identification of repeat finding: This is a repeat finding from the immediate previous audit, 2021-002. Cause: Ineffective record keeping and ineffective case review process. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST.