Audit 369199

Information on the Federal Program U.S. Department of Health and Human Services, passed through New Jersey Department of Human Services, Division of Family Development and Division of Medical Assistance and Health Services – Medicaid Cluster, Medical Assistance Program (Medicaid; Title XIX), Assistance Listing No. 93.778 1/1/2024 – 12/31/2024 Criteria or Specific Requirement Per 42 CFR § 435.945(a) and § 435.948, state Medicaid agencies are required to verify income using electronic data sources to the extent available, and must ensure that eligibility determinations are based on accurate and verified information. Condition The GCDSS did not consistently verify income reported on the Medical Assistance applications prior to granting program eligibility to individuals. Questioned Costs Unknown. Context During our testing of eligibility determinations under the Medical Assistance program, we noted that for 3 out of 40 sampled cases, the income reported on the application was not verified prior to granting program eligibility. The documentation lacked evidence of income verification through acceptable sources such as pay stubs, employer statements, or data matches with state wage databases. Effect or Potential Effect Improper eligibility determinations may result in ineligible individuals receiving benefits, leading to questioned costs and potential disallowance by the federal agency. Cause The failure to verify income was attributed to a lapse in internal controls and staff oversight. In some cases, eligibility workers relied solely on self-attested income without initiating verification procedures. Identification as a Repeat Finding Not applicable. Recommendation We recommend that GCDSS strengthen its internal controls over eligibility determinations by consistently documenting income verification procedures prior to approval. View of Responsible Officials and Planned Corrective Action The responsible officials agree with the finding and will address the matter as part of their corrective action plan.