Audit 330742

FY End
2024-06-30
Total Expended
$19.02M
Findings
10
Programs
36
Organization: Brunswick County (NC)
Year: 2024 Accepted: 2024-12-03

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
512941 2024-001 Significant Deficiency Yes E
512942 2024-002 Significant Deficiency - E
512943 2024-003 Significant Deficiency Yes E
512944 2024-004 Significant Deficiency Yes E
512945 2024-005 Significant Deficiency - E
1089383 2024-001 Significant Deficiency Yes E
1089384 2024-002 Significant Deficiency - E
1089385 2024-003 Significant Deficiency Yes E
1089386 2024-004 Significant Deficiency Yes E
1089387 2024-005 Significant Deficiency - E

Programs

ALN Program Spent Major Findings
21.027 Coronavirus State and Local Fiscal Recovery Funds $5.25M Yes 0
93.778 Medical Assistance Program $3.27M Yes 4
14.871 Section 8 Housing Choice Vouchers $2.67M Yes 0
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $1.22M Yes 1
93.563 Child Support Services $1.15M Yes 0
93.658 Foster Care Title IV-E $1.13M Yes 0
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $685,227 - 0
93.558 Temporary Assistance for Needy Families $523,458 - 0
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $411,592 - 0
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $354,800 - 0
93.243 Substance Abuse and Mental Health Services Projects of Regional and National Significance $351,317 - 0
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $245,790 - 0
20.600 State and Community Highway Safety $244,154 - 0
93.667 Social Services Block Grant $220,626 - 0
93.767 Children's Health Insurance Program $215,069 - 0
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $189,278 - 0
20.106 Airport Improvement Program, Covid-19 Airports Programs, and Infrastructure Investment and Jobs Act Programs $166,287 - 0
12.107 Aiww $100,456 - 0
93.568 Low-Income Home Energy Assistance $77,086 - 0
66.468 Drinking Water State Revolving Fund $75,291 - 0
93.217 Family Planning Services $55,652 - 0
93.994 Maternal and Child Health Services Block Grant to the States $55,621 - 0
16.606 State Criminal Alien Assistance Program $52,331 - 0
93.268 Immunization Cooperative Agreements $51,804 - 0
21.032 Local Assistance and Tribal Consistency Fund $50,000 - 0
93.556 Marylee Allen Promoting Safe and Stable Families Program $41,976 - 0
93.069 Public Health Emergency Preparedness $34,182 - 0
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $30,780 - 0
93.991 Preventive Health and Health Services Block Grant $30,431 - 0
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $29,849 - 0
93.659 Adoption Assistance $14,489 Yes 0
15.226 Pilt $5,108 - 0
93.917 Hiv Care Formula Grants $680 - 0
93.977 Sexually Transmitted Diseases (std) Prevention and Control Grants $100 - 0
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $50 - 0
93.566 Refugee and Entrant Assistance State/replacement Designee Administered Programs $19 - 0

Contacts

Name Title Type
MJBMXLN9NJT5 Aaron Smith Auditee
9102532060 Alan Thompson Auditor
No contacts on file

Notes to SEFA

Accounting Policies: Expenditures reported in the SEFSA are reported on the modified accrual basis of accounting. Such expenditures are recognized following the cost principles contained in Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. Brunswick County has elected not to use the 10-percent de minimis indirect cost rate as allowed under the Uniform Guidance. De Minimis Rate Used: N Rate Explanation: N/A

Finding Details

U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2024-001 Inaccurate Information Entry SIGNIFICANT DEFICENCY ELIGIBILITY Criteria: Section III. Federal Award Findings and Questioned Costs Section I. Summary of Auditors' Results (continued) Section II. Financial Statement Findings Type of auditors' report issued on compliance for major State programs: 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: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2024-002 Inadequate Request For Information SIGNIFICANT DEFICENCY ELIGIBILITY Criteria: Section III. Federal Award Findings and Questioned Costs (continued) There were 7 errors discovered during our procedures where income or household size was incorrectly calculated or inaccurate information was entered into the case file. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 1,176,385 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. 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. The County agrees with the finding. See Corrective Action Plan in the following section. This is a repeat finding from the immediate previous audit, 2023-001. 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: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2024-002 Inadequate Request For Information SIGNIFICANT DEFICENCY ELIGIBILITY Criteria: Section III. Federal Award Findings and Questioned Costs (continued) There were 7 errors discovered during our procedures where income or household size was incorrectly calculated or inaccurate information was entered into the case file. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 1,176,385 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. 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. The County agrees with the finding. See Corrective Action Plan in the following section. This is a repeat finding from the immediate previous audit, 2023-001. 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: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: Section III. Federal Award Findings and Questioned Costs (continued) The County agrees with the finding. See Corrective Action Plan in the following section. 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. This is a repeat finding from the immediate previous audit, 2023-003. 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. We examined 60 cases from of a total of 1,176,385 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. There was no known affect to eligibility and there were no known questioned costs. There were 2 errors discovered during our procedures where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations.
U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2024-003 Non-cooperation with Child Support Procedures SIGNIFICANT DEFICENCY ELIGIBILITY Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: This is a repeat finding from the immediate previous audit, 2023-004. 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 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. We examined 60 cases from of a total of 1,176,385 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 applicants could have been approved for benefits for which they were not eligible. Section III. Federal Award Findings and Questioned Costs (continued) Error in reading the ACTS report and/or ineffective case review process. The County agrees with the finding. See Corrective Action Plan in the following section. 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.
U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2024-004 Untimely Review of SSI Terminations SIGNIFICANT DEFICENCY ELIGIBILITY Criteria: Condition: Questioned Costs: Context: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: Section III. Federal Award Findings and Questioned Costs (continued) 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 ex-parte review. This information was not shared with other departments in DSS from which the recipient was also receiving benefits. Any State communications related to applicants/beneficiaries 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. The County agrees with the finding. See Corrective Action Plan in the following section. In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a participant is no longer eligible under a SSI determination. The County has a certain time period to initiate an ex-parte review to determine whether the recipient qualifies for Medicaid under any other coverage group, such as Family and Children's Medicaid, North Carolina Health Choice for Children, Work First Family Assistance, or Medicaid for the Aged, Blind and Disabled. There was 1 applicant/beneficiary not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 1,176,385 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.
U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Food and Nutrition Services (FNS) Cluster AL #: 10.551 and 10.561 Finding: 2024-005 Internal Controls Related to FNS Eligibility Determinations SIGNIFICANT DEFICENCY ELIGIBILITY Criteria: Condition: Questioned Costs: Context: Effect: Section III. Federal Award Findings and Questioned Costs (continued) Per Section 200.303 of the Uniform Grant Guidance, a non-federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. The State has provided policies and procedures to ensure that the County is meeting the federal guidance, relevant policies are: Food and Nutrition Services Policy 305 describes the verification sources and requirements and the FNS units primary responsibility for providing documentary evidence to support statements on applications and recertifications and procedures required if the statements by applicant/beneficiary are questionable. Food and Nutrition Services Policy 300 describes the sources of income countable and not countable to the household for determining financial eligibility. Food and Nutrition Services Policy 310 describes the procedures related to verifying changes in income (i.e. termination, end of contract, temporary, etc.). There were a total of 5 errors found in our testing: 1 instance where child support income was incorrectly calculated and entered in NCFAST, 1 instance where earned income was incorrectly caclculated and entered in NCFAST, 1 instance where an OVS report was not included in the case file, 1 instance where a work work registration was not completed, and 1 instance where a mortgage payment was entered into NCFAST but evidence shows that the absent parent was paying mortgage in lieu of child support. There was no known affect to eligibility and there were no known questioned costs. We examined 25 of 96,362 FNS cases from a report of all active FNS beneficiaries provided by Brunswick County's Department of Human Services. The finding is being reported with the financial statement audit as it relates to FNS 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. Cause: Recommendation: Views of responsible officials and planned corrective actions: AL #: 93.778 SIGNIFICANT DEFICENCY: Findings 2024-001, 2024-002, 2024-003, and 2024-004 also apply to State requirements and State Awards. Section IV. State Award Findings and Questioned Costs Program Name: Medical Assistance Program (Medicaid; Title XIX) Section III. Federal Award Findings and Questioned Costs (continued) Due to the errors noted, eligibility cannot be sufficiently substantiated and there is a risk that the County could provide funding and/or benefits to individuals who are not program eligible. The County should provide training of management and staff on the program's eligibility requirements, proper case review process, and required verifications for eligibility. Also, the County should ensure that their formal internal review process is adequately completed to identify and correct errors in case reviews. The County agrees with the finding. See Corrective Action Plan in the following section.
U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2024-001 Inaccurate Information Entry SIGNIFICANT DEFICENCY ELIGIBILITY Criteria: Section III. Federal Award Findings and Questioned Costs Section I. Summary of Auditors' Results (continued) Section II. Financial Statement Findings Type of auditors' report issued on compliance for major State programs: 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: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2024-002 Inadequate Request For Information SIGNIFICANT DEFICENCY ELIGIBILITY Criteria: Section III. Federal Award Findings and Questioned Costs (continued) There were 7 errors discovered during our procedures where income or household size was incorrectly calculated or inaccurate information was entered into the case file. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 1,176,385 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. 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. The County agrees with the finding. See Corrective Action Plan in the following section. This is a repeat finding from the immediate previous audit, 2023-001. 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: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2024-002 Inadequate Request For Information SIGNIFICANT DEFICENCY ELIGIBILITY Criteria: Section III. Federal Award Findings and Questioned Costs (continued) There were 7 errors discovered during our procedures where income or household size was incorrectly calculated or inaccurate information was entered into the case file. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 1,176,385 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. 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. The County agrees with the finding. See Corrective Action Plan in the following section. This is a repeat finding from the immediate previous audit, 2023-001. 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: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: Section III. Federal Award Findings and Questioned Costs (continued) The County agrees with the finding. See Corrective Action Plan in the following section. 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. This is a repeat finding from the immediate previous audit, 2023-003. 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. We examined 60 cases from of a total of 1,176,385 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. There was no known affect to eligibility and there were no known questioned costs. There were 2 errors discovered during our procedures where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations.
U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2024-003 Non-cooperation with Child Support Procedures SIGNIFICANT DEFICENCY ELIGIBILITY Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: This is a repeat finding from the immediate previous audit, 2023-004. 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 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. We examined 60 cases from of a total of 1,176,385 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 applicants could have been approved for benefits for which they were not eligible. Section III. Federal Award Findings and Questioned Costs (continued) Error in reading the ACTS report and/or ineffective case review process. The County agrees with the finding. See Corrective Action Plan in the following section. 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.
U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2024-004 Untimely Review of SSI Terminations SIGNIFICANT DEFICENCY ELIGIBILITY Criteria: Condition: Questioned Costs: Context: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: Section III. Federal Award Findings and Questioned Costs (continued) 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 ex-parte review. This information was not shared with other departments in DSS from which the recipient was also receiving benefits. Any State communications related to applicants/beneficiaries 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. The County agrees with the finding. See Corrective Action Plan in the following section. In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a participant is no longer eligible under a SSI determination. The County has a certain time period to initiate an ex-parte review to determine whether the recipient qualifies for Medicaid under any other coverage group, such as Family and Children's Medicaid, North Carolina Health Choice for Children, Work First Family Assistance, or Medicaid for the Aged, Blind and Disabled. There was 1 applicant/beneficiary not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 1,176,385 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.
U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Food and Nutrition Services (FNS) Cluster AL #: 10.551 and 10.561 Finding: 2024-005 Internal Controls Related to FNS Eligibility Determinations SIGNIFICANT DEFICENCY ELIGIBILITY Criteria: Condition: Questioned Costs: Context: Effect: Section III. Federal Award Findings and Questioned Costs (continued) Per Section 200.303 of the Uniform Grant Guidance, a non-federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. The State has provided policies and procedures to ensure that the County is meeting the federal guidance, relevant policies are: Food and Nutrition Services Policy 305 describes the verification sources and requirements and the FNS units primary responsibility for providing documentary evidence to support statements on applications and recertifications and procedures required if the statements by applicant/beneficiary are questionable. Food and Nutrition Services Policy 300 describes the sources of income countable and not countable to the household for determining financial eligibility. Food and Nutrition Services Policy 310 describes the procedures related to verifying changes in income (i.e. termination, end of contract, temporary, etc.). There were a total of 5 errors found in our testing: 1 instance where child support income was incorrectly calculated and entered in NCFAST, 1 instance where earned income was incorrectly caclculated and entered in NCFAST, 1 instance where an OVS report was not included in the case file, 1 instance where a work work registration was not completed, and 1 instance where a mortgage payment was entered into NCFAST but evidence shows that the absent parent was paying mortgage in lieu of child support. There was no known affect to eligibility and there were no known questioned costs. We examined 25 of 96,362 FNS cases from a report of all active FNS beneficiaries provided by Brunswick County's Department of Human Services. The finding is being reported with the financial statement audit as it relates to FNS 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. Cause: Recommendation: Views of responsible officials and planned corrective actions: AL #: 93.778 SIGNIFICANT DEFICENCY: Findings 2024-001, 2024-002, 2024-003, and 2024-004 also apply to State requirements and State Awards. Section IV. State Award Findings and Questioned Costs Program Name: Medical Assistance Program (Medicaid; Title XIX) Section III. Federal Award Findings and Questioned Costs (continued) Due to the errors noted, eligibility cannot be sufficiently substantiated and there is a risk that the County could provide funding and/or benefits to individuals who are not program eligible. The County should provide training of management and staff on the program's eligibility requirements, proper case review process, and required verifications for eligibility. Also, the County should ensure that their formal internal review process is adequately completed to identify and correct errors in case reviews. The County agrees with the finding. See Corrective Action Plan in the following section.