US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Food and Nutrition Services (FNS) Cluster
Finding 2024-006 FNS Eligibility Determinations
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Section III - Federal Award Findings and Questioned Costs (continued)
AL No.: 10.551 and 10.561
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 nonfederal
entity is managing the Federal award in compliance with Federal statutes, regulations, and the
terms and conditions of the Federal award. The State has provided policies and procedures to ensure
that the County is meeting the federal guidance, relevant policies are:
Food and Nutrition Services Policy 305 describes the verification sources and requirements and the
FNS units primary responsibility for providing documentary evidence to support statements on
applications and recertifications and procedures required if the statements by applicant/beneficiary are
questionable.
Food and Nutrition Services Policy 300 describes the sources of income countable and not countable to
the household for determining financial eligibility.
Food and Nutrition Services Policy 310 describes the procedures related to verifying changes in
income (i.e. termination, end of contract, temporary, etc.).
There were a total of 8 errors found in our testing: 5 instances where there was an inadequate request
for information from the client or verification from electronic sources; 3 instances where income was
incorrectly caclculated or incorrect amount was entered in NCFAST. Of these 8 errors, 1 of these
could potentially be an eligibility error.
Due to the nature of the populations provided from which the samples were chosen, we are unable to
calculate questioned costs for the above mentioned potential eligibility issue.
We examined 25 of 29,653 FNS cases from a report of all active FNS 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.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
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.
Passed through the NC Dept of Health and Human Services
Medical Assistance Program (Medicaid; Title XIX)
Finding 2024-002 IV-D Cooperation with Child Support
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Section III - Federal Award Findings and Questioned Costs
AL No.: 93.778
In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and
referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency
(IV-D) can assist the family in obtaining financial and/or medical support or medical support
payments from the child’s non-custodial parent. Cooperation requirement with Social Services and
Child Support Agencies must be met or good cause for not cooperating must be established when
determining Medicaid eligibility.
There was 1 error discovered during our procedures that referrals between DSS and Child Support
Agencies were not properly made.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from a total of 1,459,263 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.
This is a repeat finding from the immediate previous audit, 2023-003.
Human error in reading the Automated Collection and Tracking System (ACTS) report and/or
ineffective case review process.
Files should be reviewed internally to ensure proper information is in place and necessary procedures
are taken when 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.
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Medical Assistance Program (Medicaid; Title XIX)
Finding 2024-003 Inaccurate Information Entry
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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.
This is a repeat finding from the immediate previous audit, 2023-004.
There was no known affect to eligibility and there were no known questioned costs.
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.
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 2 errors discovered during our procedures where income or household size was incorrectly
calculated or inaccurate information was entered into the case file.
AL No.: 93.778
We examined 60 cases from a total of 1,459,263 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.
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Medical Assistance Program (Medicaid; Title XIX)
Finding 2024-004 Inaccurate Resources Entry
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Section III - Federal Award Findings and Questioned Costs (continued)
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.
AL No.: 93.778
There were 6 errors discovered during our procedures where resources were imcorrectly calculated or
were not properly documented in 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 1,459,263 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 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 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.
The County agrees with the finding. See Corrective Action Plan in the following section.
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Medical Assistance Program (Medicaid; Title XIX)
Finding 2024-005 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
This is a repeat finding from the immediate previous audit, 2023-006.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources 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.
The County agrees with the finding. See Corrective Action Plan in the following section.
Section III - Federal Award Findings and Questioned Costs (continued)
AL No.: 93.778
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 13 errors discovered during our procedures where required information needed for
eligibility determinations were not requested or not requested timely at applications or
redeterminations.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 1,459,263 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 applicants could have been approved for benefits for
which they were not eligible.
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Food and Nutrition Services (FNS) Cluster
Finding 2024-006 FNS Eligibility Determinations
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Section III - Federal Award Findings and Questioned Costs (continued)
AL No.: 10.551 and 10.561
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 nonfederal
entity is managing the Federal award in compliance with Federal statutes, regulations, and the
terms and conditions of the Federal award. The State has provided policies and procedures to ensure
that the County is meeting the federal guidance, relevant policies are:
Food and Nutrition Services Policy 305 describes the verification sources and requirements and the
FNS units primary responsibility for providing documentary evidence to support statements on
applications and recertifications and procedures required if the statements by applicant/beneficiary are
questionable.
Food and Nutrition Services Policy 300 describes the sources of income countable and not countable to
the household for determining financial eligibility.
Food and Nutrition Services Policy 310 describes the procedures related to verifying changes in
income (i.e. termination, end of contract, temporary, etc.).
There were a total of 8 errors found in our testing: 5 instances where there was an inadequate request
for information from the client or verification from electronic sources; 3 instances where income was
incorrectly caclculated or incorrect amount was entered in NCFAST. Of these 8 errors, 1 of these
could potentially be an eligibility error.
Due to the nature of the populations provided from which the samples were chosen, we are unable to
calculate questioned costs for the above mentioned potential eligibility issue.
We examined 25 of 29,653 FNS cases from a report of all active FNS 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.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
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.
Passed through the NC Dept of Health and Human Services
Medical Assistance Program (Medicaid; Title XIX)
Finding 2024-002 IV-D Cooperation with Child Support
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Section III - Federal Award Findings and Questioned Costs
AL No.: 93.778
In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and
referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency
(IV-D) can assist the family in obtaining financial and/or medical support or medical support
payments from the child’s non-custodial parent. Cooperation requirement with Social Services and
Child Support Agencies must be met or good cause for not cooperating must be established when
determining Medicaid eligibility.
There was 1 error discovered during our procedures that referrals between DSS and Child Support
Agencies were not properly made.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from a total of 1,459,263 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.
This is a repeat finding from the immediate previous audit, 2023-003.
Human error in reading the Automated Collection and Tracking System (ACTS) report and/or
ineffective case review process.
Files should be reviewed internally to ensure proper information is in place and necessary procedures
are taken when 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.
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Medical Assistance Program (Medicaid; Title XIX)
Finding 2024-003 Inaccurate Information Entry
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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.
This is a repeat finding from the immediate previous audit, 2023-004.
There was no known affect to eligibility and there were no known questioned costs.
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.
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 2 errors discovered during our procedures where income or household size was incorrectly
calculated or inaccurate information was entered into the case file.
AL No.: 93.778
We examined 60 cases from a total of 1,459,263 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.
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Medical Assistance Program (Medicaid; Title XIX)
Finding 2024-004 Inaccurate Resources Entry
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Section III - Federal Award Findings and Questioned Costs (continued)
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.
AL No.: 93.778
There were 6 errors discovered during our procedures where resources were imcorrectly calculated or
were not properly documented in 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 1,459,263 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 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 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.
The County agrees with the finding. See Corrective Action Plan in the following section.
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Medical Assistance Program (Medicaid; Title XIX)
Finding 2024-005 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
This is a repeat finding from the immediate previous audit, 2023-006.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources 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.
The County agrees with the finding. See Corrective Action Plan in the following section.
Section III - Federal Award Findings and Questioned Costs (continued)
AL No.: 93.778
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 13 errors discovered during our procedures where required information needed for
eligibility determinations were not requested or not requested timely at applications or
redeterminations.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 1,459,263 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 applicants could have been approved for benefits for
which they were not eligible.