Audit 368152

Criteria: The requirements of the Memorandum of Understanding between State of New Jersey Department of Human Services and MCBSS state that client applications are to be entered into the Worker Portal within three (3) business days and for application status’s to be timely updated. Eligibility determinations are to be performed within applicable time requirements (except in unusual circumstances, eligibility must be determined within 45 days unless the person applies for Medicaid on the basis of disability in which case the time frame is 90 days maximum). Condition and Context: For one of sixty cases tested, MCBSS did not process both the application or complete the eligibility determination in accordance with the applicable time requirements. Cause: Understaffing in MCBSS’ Medicaid Department resulted in a delay of processing theapplication and completing the eligibility determination. Effect and Potential Impact: Failure to timely process redeterminations could result in ineligible individuals receiving benefits. Questioned Costs: None Recommendation: We recommend that MCBSS management ensure that the Medicaid department is sufficiently staffed to meet demand of incoming cases and to monitor incoming cases to ensure they are processed within the required timeframe.