Condition:
Questioned Cost:
Context:
Effect:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Food and Nutrition Services (FNS) Cluster
AL # 10.551 and 10.561
Finding: 2024-006 FNS Eligibility Determinations
SIGNIFICANT DEFICENCY
Eligibility
Criteria: 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.).
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.
Section III - Federal Award Findings and Questioned Costs (Continued)
There were 1 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid when
their SSI benefits were terminated.
There were no known affects to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 997,008 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.
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.Condition:
Questioned Cost:
Context:
Effect:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
None reported.
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 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.
Section III - Federal Award Findings and Questioned Costs (Continued)
There were a total of 5 errors found in our testing: 1 instances where there was an inadequate
documentation of the purchasing and preparing food separatelyrequirement for a Simplified Nutritional
Assistance Program (SNAP) case; 1 instance where the caseworker did not request adequate information
from the recipient related to self-employment income; 2 instances where the caseworker did not request
adequate information from the recipient related to an expense deduction; 1 instance where an incorrect
expense deduction was entered in NCFAST.
There were no known affects to eligibility and there were no known questioned costs.
We examined 25 of 12,226 FNS/SNAP cases from a report of all active FNS/SNAP beneficiaries
provided by the County's Department of Social 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.
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2024-001 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Section II - Financial Statement Findings
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 997,008 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 and Questioned Costs
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.
Section I - Summary of Auditors' Results (continued)
There were 3 errors discovered during our procedures where income or household size was incorrectly
calculated or inaccurate information was entered into the case file.Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-002 Inaccurate Resource Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Section III - Federal Award Findings and Questioned Costs (Continued)
There were 1 errors discovered during our procedures where resources were imcorrectly calculated or were
not properly documented in the case file.
There was no affect to eligibility and there were no questioned costs.
We examined 60 cases from of a total of 997,008 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.
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.
This is a repeat finding from the immediate previous audit, 2023-002.
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.
This is a repeat finding from the immediate previous audit, 2023-001.
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.
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.
The County agrees with the finding. See Corrective Action Plan in the following section.
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-002 Inaccurate Resource Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Section III - Federal Award Findings and Questioned Costs (Continued)
There were 1 errors discovered during our procedures where resources were imcorrectly calculated or were
not properly documented in the case file.
There was no affect to eligibility and there were no questioned costs.
We examined 60 cases from of a total of 997,008 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.
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.
This is a repeat finding from the immediate previous audit, 2023-002.
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.
This is a repeat finding from the immediate previous audit, 2023-001.
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.
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.
The County agrees with the finding. See Corrective Action Plan in the following section.Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-003 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
Case files should be reviewed internally to ensure correct calculations of resources are made, proper
information is included in the case file, 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.
The County agrees with the finding. See Corrective Action Plan in the following section.
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 5 errors discovered during our procedures where required information needed for eligibility
determinations were not requested or not requested timely at applications or redeterminations.
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.
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 all required verifications have been completed and
information requested from the applicant/beneficiary or through various systems have been included 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.
The County agrees with the finding. See Corrective Action Plan in the following section.
This is a repeat finding from the immediate previous audit, 2023-003.
We examined 60 cases from of a total of 997,008 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.
There were no known affects to eligibility and there were no known questioned costs.
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-003 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
Case files should be reviewed internally to ensure correct calculations of resources are made, proper
information is included in the case file, 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.
The County agrees with the finding. See Corrective Action Plan in the following section.
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 5 errors discovered during our procedures where required information needed for eligibility
determinations were not requested or not requested timely at applications or redeterminations.
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.
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 all required verifications have been completed and
information requested from the applicant/beneficiary or through various systems have been included 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.
The County agrees with the finding. See Corrective Action Plan in the following section.
This is a repeat finding from the immediate previous audit, 2023-003.
We examined 60 cases from of a total of 997,008 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.
There were no known affects to eligibility and there were no known questioned costs.
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-004 Non-Cooperation with Child Support Procedures
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-005 Untimely Review of SSI Terminations
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Section III - Federal Award Findings and Questioned Costs (Continued)
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.
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.
Error in reading the 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 in the following section.
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 noncustodial
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 the County's Medicaid and
Child Support Agencies were not properly made.
There were no known affects to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 997,008 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.
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-004 Non-Cooperation with Child Support Procedures
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-005 Untimely Review of SSI Terminations
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Section III - Federal Award Findings and Questioned Costs (Continued)
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.
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.
Error in reading the 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 in the following section.
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 noncustodial
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 the County's Medicaid and
Child Support Agencies were not properly made.
There were no known affects to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 997,008 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.Condition:
Questioned Cost:
Context:
Effect:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Food and Nutrition Services (FNS) Cluster
AL # 10.551 and 10.561
Finding: 2024-006 FNS Eligibility Determinations
SIGNIFICANT DEFICENCY
Eligibility
Criteria: 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.).
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.
Section III - Federal Award Findings and Questioned Costs (Continued)
There were 1 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid when
their SSI benefits were terminated.
There were no known affects to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 997,008 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.
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.
Condition:
Questioned Cost:
Context:
Effect:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Food and Nutrition Services (FNS) Cluster
AL # 10.551 and 10.561
Finding: 2024-006 FNS Eligibility Determinations
SIGNIFICANT DEFICENCY
Eligibility
Criteria: 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.).
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.
Section III - Federal Award Findings and Questioned Costs (Continued)
There were 1 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid when
their SSI benefits were terminated.
There were no known affects to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 997,008 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.
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.Condition:
Questioned Cost:
Context:
Effect:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
None reported.
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 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.
Section III - Federal Award Findings and Questioned Costs (Continued)
There were a total of 5 errors found in our testing: 1 instances where there was an inadequate
documentation of the purchasing and preparing food separatelyrequirement for a Simplified Nutritional
Assistance Program (SNAP) case; 1 instance where the caseworker did not request adequate information
from the recipient related to self-employment income; 2 instances where the caseworker did not request
adequate information from the recipient related to an expense deduction; 1 instance where an incorrect
expense deduction was entered in NCFAST.
There were no known affects to eligibility and there were no known questioned costs.
We examined 25 of 12,226 FNS/SNAP cases from a report of all active FNS/SNAP beneficiaries
provided by the County's Department of Social 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.
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2024-001 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Section II - Financial Statement Findings
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 997,008 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 and Questioned Costs
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.
Section I - Summary of Auditors' Results (continued)
There were 3 errors discovered during our procedures where income or household size was incorrectly
calculated or inaccurate information was entered into the case file.Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-002 Inaccurate Resource Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Section III - Federal Award Findings and Questioned Costs (Continued)
There were 1 errors discovered during our procedures where resources were imcorrectly calculated or were
not properly documented in the case file.
There was no affect to eligibility and there were no questioned costs.
We examined 60 cases from of a total of 997,008 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.
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.
This is a repeat finding from the immediate previous audit, 2023-002.
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.
This is a repeat finding from the immediate previous audit, 2023-001.
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.
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.
The County agrees with the finding. See Corrective Action Plan in the following section.
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-002 Inaccurate Resource Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Section III - Federal Award Findings and Questioned Costs (Continued)
There were 1 errors discovered during our procedures where resources were imcorrectly calculated or were
not properly documented in the case file.
There was no affect to eligibility and there were no questioned costs.
We examined 60 cases from of a total of 997,008 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.
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.
This is a repeat finding from the immediate previous audit, 2023-002.
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.
This is a repeat finding from the immediate previous audit, 2023-001.
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.
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.
The County agrees with the finding. See Corrective Action Plan in the following section.Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-003 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
Case files should be reviewed internally to ensure correct calculations of resources are made, proper
information is included in the case file, 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.
The County agrees with the finding. See Corrective Action Plan in the following section.
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 5 errors discovered during our procedures where required information needed for eligibility
determinations were not requested or not requested timely at applications or redeterminations.
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.
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 all required verifications have been completed and
information requested from the applicant/beneficiary or through various systems have been included 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.
The County agrees with the finding. See Corrective Action Plan in the following section.
This is a repeat finding from the immediate previous audit, 2023-003.
We examined 60 cases from of a total of 997,008 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.
There were no known affects to eligibility and there were no known questioned costs.
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-003 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
Case files should be reviewed internally to ensure correct calculations of resources are made, proper
information is included in the case file, 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.
The County agrees with the finding. See Corrective Action Plan in the following section.
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 5 errors discovered during our procedures where required information needed for eligibility
determinations were not requested or not requested timely at applications or redeterminations.
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.
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 all required verifications have been completed and
information requested from the applicant/beneficiary or through various systems have been included 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.
The County agrees with the finding. See Corrective Action Plan in the following section.
This is a repeat finding from the immediate previous audit, 2023-003.
We examined 60 cases from of a total of 997,008 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.
There were no known affects to eligibility and there were no known questioned costs.
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-004 Non-Cooperation with Child Support Procedures
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-005 Untimely Review of SSI Terminations
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Section III - Federal Award Findings and Questioned Costs (Continued)
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.
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.
Error in reading the 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 in the following section.
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 noncustodial
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 the County's Medicaid and
Child Support Agencies were not properly made.
There were no known affects to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 997,008 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.
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-004 Non-Cooperation with Child Support Procedures
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-005 Untimely Review of SSI Terminations
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Section III - Federal Award Findings and Questioned Costs (Continued)
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.
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.
Error in reading the 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 in the following section.
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 noncustodial
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 the County's Medicaid and
Child Support Agencies were not properly made.
There were no known affects to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 997,008 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.Condition:
Questioned Cost:
Context:
Effect:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Food and Nutrition Services (FNS) Cluster
AL # 10.551 and 10.561
Finding: 2024-006 FNS Eligibility Determinations
SIGNIFICANT DEFICENCY
Eligibility
Criteria: 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.).
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.
Section III - Federal Award Findings and Questioned Costs (Continued)
There were 1 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid when
their SSI benefits were terminated.
There were no known affects to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 997,008 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.
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.