U.S. Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: IV-E Foster Care and Adoption Assistance ClusterAL #: 93.658, 93.659Finding: 2022-006 Incorrect Family Assistance Unit DeterminationSIGNIFICANT DEFICENCYReportingCriteria: In accordance with the Child Welfare Manual, Foster Care Funding Appendix 3.5, The composition of the Aid to Families with Dependent Children (AFDC) family assistance unit must be determined first in establishing whether the child is financially needy. The family assistance unit is defined as a group of individuals whose income, resources, and needs are considered as a unit for purposes of determining AFDC eligibility. It consists of the child, natural or adoptive parents and the blood or adoptive siblings living in the same household. If the child lives with a specified relative other than a parent, the family unit will consist of only the child and any siblings that also live with the same specified relative.Condition: There were 10 errors discovered during our procedures that the family assistance unit was determined incorrectly.Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.Context: We examined 12 cases from 113 IV-E Foster Care Assistance applicants to re-determine eligibility. These findings are being reported with the financial statement audit a it relates to IV-E Foster Care administrative costs compliance audit.Effect: For those eligibility determination and re-determination, there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NCFAST) and a participant could have been approved for benefits for which they were not eligible.Cause: Rockingham started to use NC FAST for the Child Welfare as a pilot county, the system was initially not designed intuitively or in a way that was easy to use. There were multiple system issues in the area of FC Financials (including issues with printed forms & documentation) until the Fund Eligibility process was resolved in January of 2020, along with a system update completed in November of 2020 to provide the ability for users to now reassess the CW Fund Eligibility. Due to the system functionality issues, the case workers were not able to enter and document the household relationship properly.Recommendation: Workers should be retrained on NCFAST functions to ensure accurate and complete information is entered into system. Files should be reviewed internally to ensure proper documentation is in place for eligibility.Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details.
US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance Program (Medicaid; Title XIX)AL #: 93.778Finding: 2022-002 Inaccurate Information EntrySIGNIFICANT DEFICENCYEligibilityCriteria: 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.Condition: There were 7 errors discovered during our procedures that inaccurate information was entered when determining eligibility.Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.Context: We examined 60 of a total 1,085,259 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.Effect: 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.Cause: 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.Views of responsible officials and planned corrective actions: The County agrees with the finding. Please refer to the corrective action plan for details.
US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance Program (Medicaid; Title XIX)AL #: 93.778Finding: 2022-003 Inaccurate Resources EntrySIGNIFICANT DEFICENCYEligibilityCriteria: "In accordance with Medicaid Manual MA-2230, Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were donein 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."Condition: There was 3 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.Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.Context: We examined 60 of a total 1,085,259 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.Effect: 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.Cause: 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.Views of responsible officials and planned corrective actions: The County agrees with the finding. Please refer to the corrective action plan for details.
US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance Program (Medicaid; Title XIX)AL #: 93.778Finding: 2022-004 Untimely Review of SSI TerminationSIGNIFICANT DEFICENCYEligibilityCriteria: 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.Condition: 1 applicant was not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated.Questioned Costs: There was no known affect to eligibility and there were no known questioned costs..Context: We examined 60 of a total 1,085,259 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.Effect: 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.Cause: 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. Please refer to the corrective action plan for details.
US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance Program (Medicaid; Title XIX)AL #: 93.778Finding: 2022-005 Inadequate Request for InformationSIGNIFICANT DEFICENCYEligibilityCriteria: 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.Condition: There were 1 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations.Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.Context: We examined 60 of a total 1,085,259 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.Effect: 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.Cause: 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 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.Views of responsible officials and planned corrective actions: The County agrees with the finding. Please refer to the corrective action plan for details.
U.S. Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: IV-E Foster Care and Adoption Assistance ClusterAL #: 93.658, 93.659Finding: 2022-006 Incorrect Family Assistance Unit DeterminationSIGNIFICANT DEFICENCYReportingCriteria: In accordance with the Child Welfare Manual, Foster Care Funding Appendix 3.5, The composition of the Aid to Families with Dependent Children (AFDC) family assistance unit must be determined first in establishing whether the child is financially needy. The family assistance unit is defined as a group of individuals whose income, resources, and needs are considered as a unit for purposes of determining AFDC eligibility. It consists of the child, natural or adoptive parents and the blood or adoptive siblings living in the same household. If the child lives with a specified relative other than a parent, the family unit will consist of only the child and any siblings that also live with the same specified relative.Condition: There were 10 errors discovered during our procedures that the family assistance unit was determined incorrectly.Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.Context: We examined 12 cases from 113 IV-E Foster Care Assistance applicants to re-determine eligibility. These findings are being reported with the financial statement audit a it relates to IV-E Foster Care administrative costs compliance audit.Effect: For those eligibility determination and re-determination, there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NCFAST) and a participant could have been approved for benefits for which they were not eligible.Cause: Rockingham started to use NC FAST for the Child Welfare as a pilot county, the system was initially not designed intuitively or in a way that was easy to use. There were multiple system issues in the area of FC Financials (including issues with printed forms & documentation) until the Fund Eligibility process was resolved in January of 2020, along with a system update completed in November of 2020 to provide the ability for users to now reassess the CW Fund Eligibility. Due to the system functionality issues, the case workers were not able to enter and document the household relationship properly.Recommendation: Workers should be retrained on NCFAST functions to ensure accurate and complete information is entered into system. Files should be reviewed internally to ensure proper documentation is in place for eligibility.Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details.
US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance Program (Medicaid; Title XIX)AL #: 93.778Finding: 2022-002 Inaccurate Information EntrySIGNIFICANT DEFICENCYEligibilityCriteria: 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.Condition: There were 7 errors discovered during our procedures that inaccurate information was entered when determining eligibility.Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.Context: We examined 60 of a total 1,085,259 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.Effect: 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.Cause: 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.Views of responsible officials and planned corrective actions: The County agrees with the finding. Please refer to the corrective action plan for details.
US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance Program (Medicaid; Title XIX)AL #: 93.778Finding: 2022-003 Inaccurate Resources EntrySIGNIFICANT DEFICENCYEligibilityCriteria: "In accordance with Medicaid Manual MA-2230, Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were donein 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."Condition: There was 3 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.Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.Context: We examined 60 of a total 1,085,259 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.Effect: 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.Cause: 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.Views of responsible officials and planned corrective actions: The County agrees with the finding. Please refer to the corrective action plan for details.
US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance Program (Medicaid; Title XIX)AL #: 93.778Finding: 2022-004 Untimely Review of SSI TerminationSIGNIFICANT DEFICENCYEligibilityCriteria: 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.Condition: 1 applicant was not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated.Questioned Costs: There was no known affect to eligibility and there were no known questioned costs..Context: We examined 60 of a total 1,085,259 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.Effect: 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.Cause: 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. Please refer to the corrective action plan for details.
US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance Program (Medicaid; Title XIX)AL #: 93.778Finding: 2022-005 Inadequate Request for InformationSIGNIFICANT DEFICENCYEligibilityCriteria: 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.Condition: There were 1 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations.Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.Context: We examined 60 of a total 1,085,259 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.Effect: 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.Cause: 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 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.Views of responsible officials and planned corrective actions: The County agrees with the finding. Please refer to the corrective action plan for details.