Audit 291952

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Section III - Federal Award Findings and Questioned Costs (continued) Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-007. Views of Responsible Officials and Planned Corrective Actions: The county agrees with this finding. See corrective action plan. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and applicants could have been approved for benefits for which they were not eligible. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 402,727 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Program Names: Medical Assistance AL # 93.778 Finding: 2022-006 Inadequate Request for Information 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 22 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. Questioned Costs: 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 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. 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 Finding: 2022-007 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: The County agrees with the finding. See corrective action plan. Program Names: Medical Assistance AL # 93.778 Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determine eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Section III - Federal Award Findings and Questioned Costs (continued) We examined 60 cases from of a total of 402,727 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine 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 North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. IV-D Non-Cooperation Views of Responsible Officials and Planned Corrective Actions: In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). 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 3 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-008.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2022-008 NONCOMPLIANCE / SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Section III - Federal Award Findings and Questioned Costs (continued) AL # 93.778 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. The results found or documentation made in case notes that clearly indicates what actions were performed and the results of those actions. Inaccurate Information Entry 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. 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 9 errors discovered during our procedures that inaccurate information was entered when determining eligibility. One applicant received assistance although the family income were above the State provided income Standard. $569.12. This amount was determined by totaling all the aid received by the applicant who was not eligible. Questioned Costs: The County agrees with the finding. See corrective action plan. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-009. Views of Responsible Officials and Planned Corrective Actions: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Program Names: Medical Assistance We examined 60 cases from of a total of 402,727 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine 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 which could affect countable resource. Therefore, a participant could have been approved to receive benefits for which they were not eligible.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services AL # 93.778 Finding: 2022-009 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Questioned Costs: The total questioned costs for the ineligibility error noted above did not meet the miniumum threshold for reporting. We examined 60 cases from of a total of 402,727 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine 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. 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. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Section III - Federal Award Findings and Questioned Costs (continued) Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-010. Program Names: Medical Assistance In accordance with Medicaid Manual MA-2230, 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 noncountable resources and explained within the documentation. There were 10 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. Of these, one beneficiary received assistance for which the recipient was not eligible. Inaccurate Resource Calculation Views of Responsible Officials and Planned Corrective Actions: The County agrees with the finding. See corrective action plan.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services AL # 93.778 Finding: 2022-010 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Ineffective communication between departments within the Department of Social Services. One area within DSS received State communications that applicants would no longer be eligible for SSI benefits and the County needed to conduct an application process. This information was not shared with other departments in DSS from which the recipient was also receiving benefits. Recommendation: Any State communications related to applicants’ benefits received by any DSS department should be shared with all areas from which the participant receives benefits. State files should be reviewed internally to ensure all actions have been properly closed and the corrective action has been taken. Workers should be retrained on what process needs to be followed when State communications are received. Views of Responsible Officials and Planned Corrective Actions: The County agrees with the finding. See corrective action plan. In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a participant is no longer eligible under Supplemental Security Income (SSI) determination, the County is required to initiate the ex parte review within 5 workdays of the date the termination appears on the SSI Termination Report, and complete the redetermination within 4 months of the month the case appears on the SSI Termination Report and notify the recipient about applicant's ongoing eligibility for Medicaid. There was 2 applicant/beneficiary not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated, for which the recipient was not eligible. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 402,727 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. The County did not initiate ex parte review timely, therefore, no eligibility review was completed in the required time period. The lack of follow up and certification lead to applicants receiving Medicaid benefits for which they were not eligible.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Section III - Federal Award Findings and Questioned Costs (continued) Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-007. Views of Responsible Officials and Planned Corrective Actions: The county agrees with this finding. See corrective action plan. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and applicants could have been approved for benefits for which they were not eligible. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 402,727 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Program Names: Medical Assistance AL # 93.778 Finding: 2022-006 Inadequate Request for Information 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 22 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. Questioned Costs: 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 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. 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 Finding: 2022-007 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: The County agrees with the finding. See corrective action plan. Program Names: Medical Assistance AL # 93.778 Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determine eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Section III - Federal Award Findings and Questioned Costs (continued) We examined 60 cases from of a total of 402,727 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine 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 North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. IV-D Non-Cooperation Views of Responsible Officials and Planned Corrective Actions: In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). 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 3 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-008.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2022-008 NONCOMPLIANCE / SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Section III - Federal Award Findings and Questioned Costs (continued) AL # 93.778 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. The results found or documentation made in case notes that clearly indicates what actions were performed and the results of those actions. Inaccurate Information Entry 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. 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 9 errors discovered during our procedures that inaccurate information was entered when determining eligibility. One applicant received assistance although the family income were above the State provided income Standard. $569.12. This amount was determined by totaling all the aid received by the applicant who was not eligible. Questioned Costs: The County agrees with the finding. See corrective action plan. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-009. Views of Responsible Officials and Planned Corrective Actions: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Program Names: Medical Assistance We examined 60 cases from of a total of 402,727 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine 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 which could affect countable resource. Therefore, a participant could have been approved to receive benefits for which they were not eligible.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services AL # 93.778 Finding: 2022-009 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Questioned Costs: The total questioned costs for the ineligibility error noted above did not meet the miniumum threshold for reporting. We examined 60 cases from of a total of 402,727 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine 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. 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. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Section III - Federal Award Findings and Questioned Costs (continued) Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-010. Program Names: Medical Assistance In accordance with Medicaid Manual MA-2230, 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 noncountable resources and explained within the documentation. There were 10 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. Of these, one beneficiary received assistance for which the recipient was not eligible. Inaccurate Resource Calculation Views of Responsible Officials and Planned Corrective Actions: The County agrees with the finding. See corrective action plan.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services AL # 93.778 Finding: 2022-010 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Ineffective communication between departments within the Department of Social Services. One area within DSS received State communications that applicants would no longer be eligible for SSI benefits and the County needed to conduct an application process. This information was not shared with other departments in DSS from which the recipient was also receiving benefits. Recommendation: Any State communications related to applicants’ benefits received by any DSS department should be shared with all areas from which the participant receives benefits. State files should be reviewed internally to ensure all actions have been properly closed and the corrective action has been taken. Workers should be retrained on what process needs to be followed when State communications are received. Views of Responsible Officials and Planned Corrective Actions: The County agrees with the finding. See corrective action plan. In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a participant is no longer eligible under Supplemental Security Income (SSI) determination, the County is required to initiate the ex parte review within 5 workdays of the date the termination appears on the SSI Termination Report, and complete the redetermination within 4 months of the month the case appears on the SSI Termination Report and notify the recipient about applicant's ongoing eligibility for Medicaid. There was 2 applicant/beneficiary not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated, for which the recipient was not eligible. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 402,727 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. The County did not initiate ex parte review timely, therefore, no eligibility review was completed in the required time period. The lack of follow up and certification lead to applicants receiving Medicaid benefits for which they were not eligible.