Audit 340308

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Section II - Financial Statement Findings Section I - Summary of Auditors' Results (continued) Section III - Federal Award Findings and Questioned Costs Finding: 2024-001 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. 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. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from a total of 46,508 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. Questioned Cost: 151Effect: Identification of a repeat finding: Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: We examined 60 cases from a total of 46,508 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. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Views of responsible officials: This is a repeat finding from the immediate previous audit 2023-007. 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. The county agrees with the finding. Please refer to the corrective action plan for details. There was no known affect to eligibility and there were no known questioned costs. Inaccurate Resource Calculation Section III - Federal Award Findings and Questioned Costs (continued) Finding: 2024-002 SIGNIFICANT DEFICIENCY Questioned Costs: There were 1 errors discovered during our procedures where resources were imcorrectly calculated or were not properly documented in the case file. 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. 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.

Effect: Identification of a repeat finding: Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: We examined 60 cases from a total of 46,508 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. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Views of responsible officials: This is a repeat finding from the immediate previous audit 2023-007. 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. The county agrees with the finding. Please refer to the corrective action plan for details. There was no known affect to eligibility and there were no known questioned costs. Inaccurate Resource Calculation Section III - Federal Award Findings and Questioned Costs (continued) Finding: 2024-002 SIGNIFICANT DEFICIENCY Questioned Costs: There were 1 errors discovered during our procedures where resources were imcorrectly calculated or were not properly documented in the case file. 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. 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.Identification of a repeat finding: Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: Section III - Federal Award Findings and Questioned Costs (continued) Recommendation: We examined 60 cases from a total of 46,508 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 North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Finding: 2024-003 Inadequate Request for Information SIGNIFICANT DEFICIENCY 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 1 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: There was no known affect to eligibility and there were no known questioned costs. Views of responsible officials: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. The county agrees with the finding. Please refer to the corrective action plan for details. This is a repeat finding from the immediate previous audit, 2023-008. 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: Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: Section III - Federal Award Findings and Questioned Costs (continued) Recommendation: We examined 60 cases from a total of 46,508 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 North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Finding: 2024-003 Inadequate Request for Information SIGNIFICANT DEFICIENCY 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 1 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: There was no known affect to eligibility and there were no known questioned costs. Views of responsible officials: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. The county agrees with the finding. Please refer to the corrective action plan for details. This is a repeat finding from the immediate previous audit, 2023-008. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility.US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources and income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Views of responsible officials: The county agrees with the finding. Please refer to the corrective action plan for details. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Finding: 2024-004 Non-Cooperation With Child Support Procedures SIGNIFICANT DEFICIENCY In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. There were 1 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from a total of 46,508 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 Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources and income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Views of responsible officials: The county agrees with the finding. Please refer to the corrective action plan for details. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Finding: 2024-004 Non-Cooperation With Child Support Procedures SIGNIFICANT DEFICIENCY In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. There were 1 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from a total of 46,508 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit.Effect: Cause: U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Views of responsible officials: The county agrees with the finding. Please refer to the corrective action plan for details. Section III - Federal Award Findings and Questioned Costs (continued) Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determining eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. SIGNIFICANT DEFICENCY: Finding 2024-001, 2024-002, 2024-003, 2024-004 also apply to State requirements and State Awards. Section IV - State Award Findings and Questioned Costs 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.

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Section II - Financial Statement Findings Section I - Summary of Auditors' Results (continued) Section III - Federal Award Findings and Questioned Costs Finding: 2024-001 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. 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. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from a total of 46,508 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. Questioned Cost: 151Effect: Identification of a repeat finding: Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: We examined 60 cases from a total of 46,508 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. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Views of responsible officials: This is a repeat finding from the immediate previous audit 2023-007. 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. The county agrees with the finding. Please refer to the corrective action plan for details. There was no known affect to eligibility and there were no known questioned costs. Inaccurate Resource Calculation Section III - Federal Award Findings and Questioned Costs (continued) Finding: 2024-002 SIGNIFICANT DEFICIENCY Questioned Costs: There were 1 errors discovered during our procedures where resources were imcorrectly calculated or were not properly documented in the case file. 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. 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.

Effect: Identification of a repeat finding: Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: We examined 60 cases from a total of 46,508 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. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Views of responsible officials: This is a repeat finding from the immediate previous audit 2023-007. 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. The county agrees with the finding. Please refer to the corrective action plan for details. There was no known affect to eligibility and there were no known questioned costs. Inaccurate Resource Calculation Section III - Federal Award Findings and Questioned Costs (continued) Finding: 2024-002 SIGNIFICANT DEFICIENCY Questioned Costs: There were 1 errors discovered during our procedures where resources were imcorrectly calculated or were not properly documented in the case file. 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. 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.Identification of a repeat finding: Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: Section III - Federal Award Findings and Questioned Costs (continued) Recommendation: We examined 60 cases from a total of 46,508 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 North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Finding: 2024-003 Inadequate Request for Information SIGNIFICANT DEFICIENCY 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 1 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: There was no known affect to eligibility and there were no known questioned costs. Views of responsible officials: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. The county agrees with the finding. Please refer to the corrective action plan for details. This is a repeat finding from the immediate previous audit, 2023-008. 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: Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: Section III - Federal Award Findings and Questioned Costs (continued) Recommendation: We examined 60 cases from a total of 46,508 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 North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Finding: 2024-003 Inadequate Request for Information SIGNIFICANT DEFICIENCY 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 1 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: There was no known affect to eligibility and there were no known questioned costs. Views of responsible officials: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. The county agrees with the finding. Please refer to the corrective action plan for details. This is a repeat finding from the immediate previous audit, 2023-008. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility.US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources and income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Views of responsible officials: The county agrees with the finding. Please refer to the corrective action plan for details. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Finding: 2024-004 Non-Cooperation With Child Support Procedures SIGNIFICANT DEFICIENCY In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. There were 1 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from a total of 46,508 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 Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources and income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Views of responsible officials: The county agrees with the finding. Please refer to the corrective action plan for details. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Finding: 2024-004 Non-Cooperation With Child Support Procedures SIGNIFICANT DEFICIENCY In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. There were 1 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from a total of 46,508 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit.Effect: Cause: U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Views of responsible officials: The county agrees with the finding. Please refer to the corrective action plan for details. Section III - Federal Award Findings and Questioned Costs (continued) Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determining eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. SIGNIFICANT DEFICENCY: Finding 2024-001, 2024-002, 2024-003, 2024-004 also apply to State requirements and State Awards. Section IV - State Award Findings and Questioned Costs 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.