Condition: There were 2 errors discovered during our procedures that referrals between the County's Department
of Social Services and Child Support Agencies were not properly made.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 1,005,637 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.
Section III. Federal Award Findings (continued)
Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer
to the corrective action plan for details.
Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when determine eligibility. The results found or documentation made in case notes should
clearly indicate what actions were performed and the results of those actions.
Criteria: 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 9 errors discovered during our procedures where income or household size was incorrectly
calculated or inaccurate information was entered into the case file.
Questioned Costs: There was no known affect to eligibility and there were
Condition: There were 2 errors discovered during our procedures that referrals between the County's Department
of Social Services and Child Support Agencies were not properly made.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 1,005,637 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.
Section III. Federal Award Findings (continued)
Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer
to the corrective action plan for details.
Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when determine eligibility. The results found or documentation made in case notes should
clearly indicate what actions were performed and the results of those actions.
Criteria: 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 9 errors discovered during our procedures where income or household size was incorrectly
calculated or inaccurate information was entered into the case file.
Questioned Costs: There was no known affect to eligibility and there were
Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-005 Inaccurate Resource Calculation
SIGNIFICANT DEFICIENCY
ELIGIBILITY
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 1,005,637 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-005.
Section III. Federal Award Findings (continued)
Criteria: 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 non-countable resources and explained within the documentation.
Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer
to the corrective action plan for details.
Condition: There was 1 error 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.
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.
Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-006 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
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.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
Effect: 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, applicants could have received
assistance for which they were not eligible.
Context: We examined 60 cases from of a total of 1,005,637 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-006.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Criteria: 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 12 errors discovered during our procedures where required information needed for
eligibility determinations were not requested or not requested timely at applications or redeterminations.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-007.
Section III. Federal Award Findings (continued)
Questioned Costs: As a result of the lack of a proper eligibility determination, federal funds were distributed to
ineligible recipients. Due to the nature of these types of eligibility determinations and the lack of a proper review
by the department, the auditor is unable to determine the known or likely questioned costs.
Context: We examined 60 cases from of a total of 1,005,637 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.
Criteria: 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: There were 3 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid
when their SSI benefits were terminated. Of these 3 errors, two were determined to be an eligibility error with
potential questioned costs.
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.
Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer
to the corrective action plan for details.
Section III. Federal Award Findings (continued)
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-008.
Condition: There were 2 errors discovered during our procedures that referrals between the County's Department
of Social Services and Child Support Agencies were not properly made.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 1,005,637 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.
Section III. Federal Award Findings (continued)
Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer
to the corrective action plan for details.
Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when determine eligibility. The results found or documentation made in case notes should
clearly indicate what actions were performed and the results of those actions.
Criteria: 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 9 errors discovered during our procedures where income or household size was incorrectly
calculated or inaccurate information was entered into the case file.
Questioned Costs: There was no known affect to eligibility and there were
Condition: There were 2 errors discovered during our procedures that referrals between the County's Department
of Social Services and Child Support Agencies were not properly made.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 1,005,637 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.
Section III. Federal Award Findings (continued)
Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer
to the corrective action plan for details.
Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when determine eligibility. The results found or documentation made in case notes should
clearly indicate what actions were performed and the results of those actions.
Criteria: 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 9 errors discovered during our procedures where income or household size was incorrectly
calculated or inaccurate information was entered into the case file.
Questioned Costs: There was no known affect to eligibility and there were
Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-005 Inaccurate Resource Calculation
SIGNIFICANT DEFICIENCY
ELIGIBILITY
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 1,005,637 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-005.
Section III. Federal Award Findings (continued)
Criteria: 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 non-countable resources and explained within the documentation.
Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer
to the corrective action plan for details.
Condition: There was 1 error 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.
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.
Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-006 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
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.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
Effect: 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, applicants could have received
assistance for which they were not eligible.
Context: We examined 60 cases from of a total of 1,005,637 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-006.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Criteria: 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 12 errors discovered during our procedures where required information needed for
eligibility determinations were not requested or not requested timely at applications or redeterminations.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-007.
Section III. Federal Award Findings (continued)
Questioned Costs: As a result of the lack of a proper eligibility determination, federal funds were distributed to
ineligible recipients. Due to the nature of these types of eligibility determinations and the lack of a proper review
by the department, the auditor is unable to determine the known or likely questioned costs.
Context: We examined 60 cases from of a total of 1,005,637 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.
Criteria: 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: There were 3 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid
when their SSI benefits were terminated. Of these 3 errors, two were determined to be an eligibility error with
potential questioned costs.
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.
Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer
to the corrective action plan for details.
Section III. Federal Award Findings (continued)
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-008.