Medicaid Cluster (Medicaid), Assistance Listing Number 93.778, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services (NCDHHS), Division of Medical Assistance.
Criteria: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX) Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual), case files for individuals or families receiving assistance are required to retain documentation to serve as evidence for the appropriate eligibility determination, including:
• verification of date of birth
• verification of United States citizenship
• verification of Social Security Number (SSN)
• accurate record of non‐custodial parent
• accurate record of household members and relationships
• accurate computation of countable income
• verification of unearned income
• verification of earned income
The Child Support Enforcement Agency (IV-D) can assist families in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirements with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility.
Condition: We noted one instance where the earned income was not appropriately calculated. We noted three instances where the case worker did not perform the required register of deeds search and one of those same cases the liquid asset verification was not performed. We noted one case where the case worker did not end-date the pregnancy of the mother after birth of the child. We noted one case where the referral between the Department of Social Services and the Child Support Agencies were not properly made.
Context/Cause: The County did not retain required documentation in case files at the time eligibility was determined. We noted the above conditions in 6 out of the 60 case files inspected for applicable payments.
Effects: Case files not containing all required documentation results in a risk that the County could provide services to individuals not eligible to receive such services or that such services could be denied to eligible individuals. For all 6 cases, subsequent to being notified that required documentation had not been retained in the case file, the County was able to obtain documentation to substantiate that the applicants tested were eligible to receive benefits.
Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policies and procedures in place to ensure that all eligibility determination documentation is completed and retained by the County.
Auditee’s Response: We concur with the findings.
Low Income Housing Assistance Program (Section 8), Assistance Listing Number 14.871, U.S. Department of Housing and Urban Development.
Criteria: Public Housing Agencies (PHAs) are required to maintain complete and accurate accounts. In addition, the Annual Contribution Contracts (ACCs) requires PHA to properly account for program activity. Proper accounting requires that (1) account balances are properly maintained, (2) records and accounting transactions support a proper roll-forward of equity, and (3) errors are corrected as detected.
Condition: We noted the County received a waiver to completing their annual report but did complete a Voucher Management System (VMS) report for June 2022 which did not agree to the County’s equity balances in the Section 8 fund. Upon further investigation, the VMS report for June 2021 also did not agree to the County’s equity balances in the Section 8 fund.
Context/Cause: The County did not reconcile their June 2021 and June 2022 VMS reports to the trial balance for the Section 8 fund. The June 2021 equity balances on the VMS report did not agree to the trial balance for the Section 8 fund by $172,169 and the June 2022 equity balances on the VMS report did not agree to the trial balance for the Section 8 fund by $79,981.
Effects: The reports were submitted incorrectly. The VMS report for June 2022 was subsequently amended to agree to the trial balance of the Section 8 fund. The VMS report for June 2021 could not be amended.
Recommendation: We recommend that the County perform a review of all inputs into the VMS report to ensure the inputs properly align with the trial balance and other supporting documentation.
Auditee’s Response: We concur with the findings.
DSS Crosscutting, NC Department of Health and Human Services
Criteria: Expenditures and costs reported on the Form 1571 should be adequately supported and properly classified.
Condition: For the December 2021 Form 1571, we noted a difference between the general ledger detail and the Part I expenditures on the 1571 report of $8.86. For the February 2022 Form 1571, we noted a difference between the general ledger detail and the Part I expenditures on the 1571 report of $3,886.30 and Part II expenditures on the 1571 report of $16,189.07.
Context/Cause: Improper retention of records and supporting schedules and improper review of the 1571 reconciliation.
Effects: The costs reported on the Part I and Part II of the DSS-1571 reports were overstated. We noted the instances above in 2 of the 4 DSS-1571 reports reviewed.
Amount of Questioned Costs: $20,084.23
Recommendation: We recommend that the County implement an effective record keeping system in which all files to support costs reported on the DSS-1571 reports are properly maintained. We also recommend a more thorough review of costs reported ties back to source documents and to ensure costs are adequately supported.
Auditee’s Response: We concur with the findings.
Medicaid Cluster (Medicaid), Assistance Listing Number 93.778, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services (NCDHHS), Division of Medical Assistance.
Criteria: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX) Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual), case files for individuals or families receiving assistance are required to retain documentation to serve as evidence for the appropriate eligibility determination, including:
• verification of date of birth
• verification of United States citizenship
• verification of Social Security Number (SSN)
• accurate record of non‐custodial parent
• accurate record of household members and relationships
• accurate computation of countable income
• verification of unearned income
• verification of earned income
The Child Support Enforcement Agency (IV-D) can assist families in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirements with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility.
Condition: We noted one instance where the earned income was not appropriately calculated. We noted three instances where the case worker did not perform the required register of deeds search and one of those same cases the liquid asset verification was not performed. We noted one case where the case worker did not end-date the pregnancy of the mother after birth of the child. We noted one case where the referral between the Department of Social Services and the Child Support Agencies were not properly made.
Context/Cause: The County did not retain required documentation in case files at the time eligibility was determined. We noted the above conditions in 6 out of the 60 case files inspected for applicable payments.
Effects: Case files not containing all required documentation results in a risk that the County could provide services to individuals not eligible to receive such services or that such services could be denied to eligible individuals. For all 6 cases, subsequent to being notified that required documentation had not been retained in the case file, the County was able to obtain documentation to substantiate that the applicants tested were eligible to receive benefits.
Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policies and procedures in place to ensure that all eligibility determination documentation is completed and retained by the County.
Auditee’s Response: We concur with the findings.
Low Income Housing Assistance Program (Section 8), Assistance Listing Number 14.871, U.S. Department of Housing and Urban Development.
Criteria: Public Housing Agencies (PHAs) are required to maintain complete and accurate accounts. In addition, the Annual Contribution Contracts (ACCs) requires PHA to properly account for program activity. Proper accounting requires that (1) account balances are properly maintained, (2) records and accounting transactions support a proper roll-forward of equity, and (3) errors are corrected as detected.
Condition: We noted the County received a waiver to completing their annual report but did complete a Voucher Management System (VMS) report for June 2022 which did not agree to the County’s equity balances in the Section 8 fund. Upon further investigation, the VMS report for June 2021 also did not agree to the County’s equity balances in the Section 8 fund.
Context/Cause: The County did not reconcile their June 2021 and June 2022 VMS reports to the trial balance for the Section 8 fund. The June 2021 equity balances on the VMS report did not agree to the trial balance for the Section 8 fund by $172,169 and the June 2022 equity balances on the VMS report did not agree to the trial balance for the Section 8 fund by $79,981.
Effects: The reports were submitted incorrectly. The VMS report for June 2022 was subsequently amended to agree to the trial balance of the Section 8 fund. The VMS report for June 2021 could not be amended.
Recommendation: We recommend that the County perform a review of all inputs into the VMS report to ensure the inputs properly align with the trial balance and other supporting documentation.
Auditee’s Response: We concur with the findings.
DSS Crosscutting, NC Department of Health and Human Services
Criteria: Expenditures and costs reported on the Form 1571 should be adequately supported and properly classified.
Condition: For the December 2021 Form 1571, we noted a difference between the general ledger detail and the Part I expenditures on the 1571 report of $8.86. For the February 2022 Form 1571, we noted a difference between the general ledger detail and the Part I expenditures on the 1571 report of $3,886.30 and Part II expenditures on the 1571 report of $16,189.07.
Context/Cause: Improper retention of records and supporting schedules and improper review of the 1571 reconciliation.
Effects: The costs reported on the Part I and Part II of the DSS-1571 reports were overstated. We noted the instances above in 2 of the 4 DSS-1571 reports reviewed.
Amount of Questioned Costs: $20,084.23
Recommendation: We recommend that the County implement an effective record keeping system in which all files to support costs reported on the DSS-1571 reports are properly maintained. We also recommend a more thorough review of costs reported ties back to source documents and to ensure costs are adequately supported.
Auditee’s Response: We concur with the findings.