Audit 333693

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: 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 373,631 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: 2024-002 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 6 errors discovered during our procedures where required information needed for eligibility determinations were not requested or not requested timely at applications 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-005. Section III - Federal Award Findings and Questioned Costs Views of Responsible Officials and Planned Corrective Actions: The county agrees with this finding. See corrective action plan.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2024-003 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Questioned Costs: Identification of a repeat finding: Section III - Federal Award Findings and Questioned Costs (continued) 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 was 1 error 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 373,631 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. This is a repeat finding from the immediate previous audit, 2023-006. Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. 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. 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 Finding: 2024-004 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: 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. Of these 7 errors, one was determined to be an eligibility error with known questioned costs. As a result of the lack of a proper eligibility determination, federal funds were distributed to ineligible recipients leading to known questioned costs totaling $663. This may result in disallowed costs that will need to be repaid to the federal awarding agency. Questioned Costs: We examined 60 cases from of a total of 373,631 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. 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-007. 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 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. 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 Finding: 2024-005 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Inaccurate Resource Calculation Views of Responsible Officials and Planned Corrective Actions: 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, 2023-008. 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 3 errors discovered during our procedures where resources were imcorrectly calculated or were not properly documented in the case file. Program Names: Medical Assistance AL # 93.778 We examined 60 cases from of a total of 373,631 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.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2024-006 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Untimely Review of SSI Terminations 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 1 applicants/beneficiary 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. We examined 60 cases from of a total of 373,631 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. 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-009.

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: 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 373,631 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: 2024-002 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 6 errors discovered during our procedures where required information needed for eligibility determinations were not requested or not requested timely at applications 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-005. Section III - Federal Award Findings and Questioned Costs Views of Responsible Officials and Planned Corrective Actions: The county agrees with this finding. See corrective action plan.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2024-003 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Questioned Costs: Identification of a repeat finding: Section III - Federal Award Findings and Questioned Costs (continued) 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 was 1 error 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 373,631 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. This is a repeat finding from the immediate previous audit, 2023-006. Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. 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. 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 Finding: 2024-004 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: 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. Of these 7 errors, one was determined to be an eligibility error with known questioned costs. As a result of the lack of a proper eligibility determination, federal funds were distributed to ineligible recipients leading to known questioned costs totaling $663. This may result in disallowed costs that will need to be repaid to the federal awarding agency. Questioned Costs: We examined 60 cases from of a total of 373,631 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. 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-007. 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 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. 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 Finding: 2024-005 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Inaccurate Resource Calculation Views of Responsible Officials and Planned Corrective Actions: 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, 2023-008. 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 3 errors discovered during our procedures where resources were imcorrectly calculated or were not properly documented in the case file. Program Names: Medical Assistance AL # 93.778 We examined 60 cases from of a total of 373,631 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.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2024-006 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Untimely Review of SSI Terminations 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 1 applicants/beneficiary 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. We examined 60 cases from of a total of 373,631 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. 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-009.