Audit 290432

US Department of Treasury Program Names: Coronavirus State and Local Fiscal Recovery Fund Finding 2023-002 Untimely Adoption of Policy SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance Program (Medicaid; Title XIX) Finding 2023-003 IV-D Cooperation with Child Support SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: The County agrees with the finding. See Corrective Action Plan in the following section. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. We examined 60 from a total of 1,380,866 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. AL No.: 21.027 In accordance with the U.S. Department of Treasury 31 CFR Part 35, Coronavirus State and Local Fiscal Recovery Funds Final Rule and the Uniform Guidance, Eligible Projects Determination & Documentation Policy, Cost Principles/Allowable Costs Policy, Civil Rights Compliance / Nondiscrimination Policy, are required to be adopted as condition of receiving the funds. The County did not adopt required policies timely. The County could use the funds for unallowable costs that were prohibited by the Final Rule. County oversight of the new federal grant requirements to have the stated policies in place. Section III - Federal Award Findings and Questioned Costs The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. There were 1 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. There was no known affect to eligibility and there were no known questioned costs. AL No.: 93.778 The finance office should review the grant agreement and the Uniform Guidance more carefully to ensure all compliance requirements are meet.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance Program (Medicaid; Title XIX) Finding 2023-003 IV-D Cooperation with Child Support SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: The County agrees with the finding. See Corrective Action Plan in the following section. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. We examined 60 from a total of 1,380,866 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. AL No.: 21.027 In accordance with the U.S. Department of Treasury 31 CFR Part 35, Coronavirus State and Local Fiscal Recovery Funds Final Rule and the Uniform Guidance, Eligible Projects Determination & Documentation Policy, Cost Principles/Allowable Costs Policy, Civil Rights Compliance / Nondiscrimination Policy, are required to be adopted as condition of receiving the funds. The County did not adopt required policies timely. The County could use the funds for unallowable costs that were prohibited by the Final Rule. County oversight of the new federal grant requirements to have the stated policies in place. Section III - Federal Award Findings and Questioned Costs The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. There were 1 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. There was no known affect to eligibility and there were no known questioned costs. AL No.: 93.778 The finance office should review the grant agreement and the Uniform Guidance more carefully to ensure all compliance requirements are meet. This is a repeat finding from the immediate previous audit, 2022-002.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance Program (Medicaid; Title XIX) Finding 2023-004 Inaccurate Information Entry SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: Error in reading the ACTS report, and ineffective case review process. Section III - Federal Award Findings and Questioned Costs (continued) Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determining eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. 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. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. This is a repeat finding from the immediate previous audit, 2022-003. There was no known affect to eligibility and there were no known questioned costs. The County agrees with the finding. See Corrective Action Plan in the following section. In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. In accordance with 2 CFR 200, management should have an adequate system of internal controls procedures in place to ensure an applicant is properly determined or redetermined for benefits. There were 1 errors discovered during our procedures that inaccurate information was entered when determining eligibility. The County agrees with the finding. See Corrective Action Plan in the following section. AL No.: 93.778 We examined 60 from a total of 1,380,866 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance Program (Medicaid; Title XIX) Finding 2023-005 Inaccurate Resources Entry SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: There were 1 errors discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. There was no known affect to eligibility and there were no known questioned costs. We examined 60 from a total of 1,380,866 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and applicants could have been approved for benefits for which they were not eligible. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. 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 and income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. The County agrees with the finding. See Corrective Action Plan in the following section. Section III - Federal Award Findings and Questioned Costs (continued) Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application and these items will agree to reports in the NC FAST system. In this process, the countable resources should be calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the verification process should be considered countable or non-countable resources and explained within the documentation. AL No.: 93.778 This is a repeat finding from the immediate previous audit, 2022-004.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance Program (Medicaid; Title XIX) Finding 2023-006 Inadequate Request for Information SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: Program Name: Medical Assistance Program (Medicaid; Title XIX) Section IV - State Award Findings and Questioned Costs Section III - Federal Award Findings and Questioned Costs (continued) AL No.: 93.778 In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. Electronic matches are required at applications and redeterminations. There were 10 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. There was no known affect to eligibility and there were no known questioned costs. We examined 60 from a total of 1,380,866 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and applicants could have been approved for benefits for which they were not eligible. SIGNIFICANT DEFICENCY: Finding 2023-003, 2023-004, 2023-005, 2023-006 also apply to State requirements and State Awards. 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 and income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. The County agrees with the finding. See Corrective Action Plan in the following section. This is a repeat finding from the immediate previous audit, 2022-005. AL No.: 93.778 Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility.

US Department of Treasury Program Names: Coronavirus State and Local Fiscal Recovery Fund Finding 2023-002 Untimely Adoption of Policy SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance Program (Medicaid; Title XIX) Finding 2023-003 IV-D Cooperation with Child Support SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: The County agrees with the finding. See Corrective Action Plan in the following section. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. We examined 60 from a total of 1,380,866 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. AL No.: 21.027 In accordance with the U.S. Department of Treasury 31 CFR Part 35, Coronavirus State and Local Fiscal Recovery Funds Final Rule and the Uniform Guidance, Eligible Projects Determination & Documentation Policy, Cost Principles/Allowable Costs Policy, Civil Rights Compliance / Nondiscrimination Policy, are required to be adopted as condition of receiving the funds. The County did not adopt required policies timely. The County could use the funds for unallowable costs that were prohibited by the Final Rule. County oversight of the new federal grant requirements to have the stated policies in place. Section III - Federal Award Findings and Questioned Costs The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. There were 1 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. There was no known affect to eligibility and there were no known questioned costs. AL No.: 93.778 The finance office should review the grant agreement and the Uniform Guidance more carefully to ensure all compliance requirements are meet.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance Program (Medicaid; Title XIX) Finding 2023-003 IV-D Cooperation with Child Support SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: The County agrees with the finding. See Corrective Action Plan in the following section. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. We examined 60 from a total of 1,380,866 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. AL No.: 21.027 In accordance with the U.S. Department of Treasury 31 CFR Part 35, Coronavirus State and Local Fiscal Recovery Funds Final Rule and the Uniform Guidance, Eligible Projects Determination & Documentation Policy, Cost Principles/Allowable Costs Policy, Civil Rights Compliance / Nondiscrimination Policy, are required to be adopted as condition of receiving the funds. The County did not adopt required policies timely. The County could use the funds for unallowable costs that were prohibited by the Final Rule. County oversight of the new federal grant requirements to have the stated policies in place. Section III - Federal Award Findings and Questioned Costs The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. There were 1 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. There was no known affect to eligibility and there were no known questioned costs. AL No.: 93.778 The finance office should review the grant agreement and the Uniform Guidance more carefully to ensure all compliance requirements are meet. This is a repeat finding from the immediate previous audit, 2022-002.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance Program (Medicaid; Title XIX) Finding 2023-004 Inaccurate Information Entry SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: Error in reading the ACTS report, and ineffective case review process. Section III - Federal Award Findings and Questioned Costs (continued) Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determining eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. 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. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. This is a repeat finding from the immediate previous audit, 2022-003. There was no known affect to eligibility and there were no known questioned costs. The County agrees with the finding. See Corrective Action Plan in the following section. In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. In accordance with 2 CFR 200, management should have an adequate system of internal controls procedures in place to ensure an applicant is properly determined or redetermined for benefits. There were 1 errors discovered during our procedures that inaccurate information was entered when determining eligibility. The County agrees with the finding. See Corrective Action Plan in the following section. AL No.: 93.778 We examined 60 from a total of 1,380,866 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance Program (Medicaid; Title XIX) Finding 2023-005 Inaccurate Resources Entry SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: There were 1 errors discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. There was no known affect to eligibility and there were no known questioned costs. We examined 60 from a total of 1,380,866 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and applicants could have been approved for benefits for which they were not eligible. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. 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 and income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. The County agrees with the finding. See Corrective Action Plan in the following section. Section III - Federal Award Findings and Questioned Costs (continued) Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application and these items will agree to reports in the NC FAST system. In this process, the countable resources should be calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the verification process should be considered countable or non-countable resources and explained within the documentation. AL No.: 93.778 This is a repeat finding from the immediate previous audit, 2022-004.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance Program (Medicaid; Title XIX) Finding 2023-006 Inadequate Request for Information SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: Program Name: Medical Assistance Program (Medicaid; Title XIX) Section IV - State Award Findings and Questioned Costs Section III - Federal Award Findings and Questioned Costs (continued) AL No.: 93.778 In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. Electronic matches are required at applications and redeterminations. There were 10 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. There was no known affect to eligibility and there were no known questioned costs. We examined 60 from a total of 1,380,866 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and applicants could have been approved for benefits for which they were not eligible. SIGNIFICANT DEFICENCY: Finding 2023-003, 2023-004, 2023-005, 2023-006 also apply to State requirements and State Awards. 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 and income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. The County agrees with the finding. See Corrective Action Plan in the following section. This is a repeat finding from the immediate previous audit, 2022-005. AL No.: 93.778 Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility.