Audit 23195

Federal Award Findings and Questioned Costs U.S. Department of Health and Human Services Passed through the N.C. Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Grant Number: XIX-MAP22 2022-004 Significant Deficiency Nonmaterial Noncompliance Criteria: In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific income standards, and documentation must be maintained to support eligibility determinations. Management should have an adequate system of internal control procedures in place to ensure an applicant is properly determined or re-determined for benefits. Condition: Due to lack of documentation provided to Stokes County DSS regarding ex-parte review, one applicant had been properly terminated in NC Fast following the adequate timeframe, per the Medicaid manual. Upon review in the current fiscal year, it was determined that the applicant's case had been reopened within NC Fast, unbeknownst to the County. Therefore, applicant had been receiving benefits without Stokes County?s knowledge. Context: Of the 209,482 benefit payments valued at $81,600,088, we examined 60 payment records ($18,825 value) and determined that one applicants? file (2%, valued at $5) lacked the documentation to support benefit payments received. Upon further review, the client was deemed ineligible to receive benefits, therefore questioned costs were reported. Effect: Applicants could receive benefits for which they are not eligible. Cause: Eligibility was not redetermined. Questioned Costs: In accordance with 2 CFR 200, auditors are required to report known questioned costs when likely questioned costs are greater than $25,000. Even though the sample results only identified $5 (federal share $5 and state share $0) in questioned costs, if tests were extended to the entire population, questioned costs could exceed $25,000. Recommendation: Caseworkers should perform ex parte reviews on a timely basis. Views of Responsible Officials and Planned Corrective Actions: The County agrees with this finding, however, many factors not discussed above contribute to the finding. Please refer to the Corrective Action Plan section of this report.

Federal Award Findings and Questioned Costs U.S. Department of Health and Human Services Passed through the N.C. Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Grant Number: XIX-MAP22 2022-004 Significant Deficiency Nonmaterial Noncompliance Criteria: In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific income standards, and documentation must be maintained to support eligibility determinations. Management should have an adequate system of internal control procedures in place to ensure an applicant is properly determined or re-determined for benefits. Condition: Due to lack of documentation provided to Stokes County DSS regarding ex-parte review, one applicant had been properly terminated in NC Fast following the adequate timeframe, per the Medicaid manual. Upon review in the current fiscal year, it was determined that the applicant's case had been reopened within NC Fast, unbeknownst to the County. Therefore, applicant had been receiving benefits without Stokes County?s knowledge. Context: Of the 209,482 benefit payments valued at $81,600,088, we examined 60 payment records ($18,825 value) and determined that one applicants? file (2%, valued at $5) lacked the documentation to support benefit payments received. Upon further review, the client was deemed ineligible to receive benefits, therefore questioned costs were reported. Effect: Applicants could receive benefits for which they are not eligible. Cause: Eligibility was not redetermined. Questioned Costs: In accordance with 2 CFR 200, auditors are required to report known questioned costs when likely questioned costs are greater than $25,000. Even though the sample results only identified $5 (federal share $5 and state share $0) in questioned costs, if tests were extended to the entire population, questioned costs could exceed $25,000. Recommendation: Caseworkers should perform ex parte reviews on a timely basis. Views of Responsible Officials and Planned Corrective Actions: The County agrees with this finding, however, many factors not discussed above contribute to the finding. Please refer to the Corrective Action Plan section of this report.