Audit 382614

2025-002 Significant Deficiency over Eligibility (Repeat Finding) Information on the Federal Program: Medicaid Cluster (Medicaid), Assistance Listing Number 93.778, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services (NCDHHS), Division of Medical Assistance. Criteria: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX) Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual), case files for individuals or families receiving assistance are required to retain documentation to service as evidence for the appropriate eligibility determination, including: • accurate computation of countable income and resources • verification of unearned income • verification of earned income Condition: We noted two instances where the total countable income for the applicant did not agree to the supporting documentation found in the applicant’s file. Context/Cause: The County did not retain required documentation in case files at the time eligibility was determined. We noted the above conditions in two out of the sixty case files inspected for applicable payments. Effects: Case files not containing all required documentation results in a risk that the County could provide services to individuals not eligible to receive such services or that such services could be denied to eligible individuals. For all two cases, subsequent to being notified that required documentation had not been retained in the case file, the County was able to obtain documentation to substantiate that the applicants tested were eligible to receive benefits. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policies and procedures in place to ensure that all eligibility determination documentation is completed and retained by the County. Auditee’s Response: We concur with the finding.

2025-003 Significant Deficiency over Activities Allowed and Unallowed and Allowable Costs/Cost Principle (Repeat Finding) Information on the federal program: Medicaid Cluster (Medicaid), Assistance Listing Number 93.778, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services (NCDHHS), Division of Medical Assistance. Criteria: Per the NCDHHS policy manual, salaries, wages, and fringe benefits of Department of Social Service employees hired under the state merit system are allowable. Salaries shall be allocated to programs by time distribution methods and supported by payroll and attendance records for individuals. Condition: Employee’s time is tracked through the use of day sheets in which employees track their time by service code in 6-minute increments. Day sheets are used to complete weekly timesheets which are approved by supervisors. We noted five out of sixty sheets selected for Medicaid had more program minutes than what was reported on the employee’s approved time sheet. Context/Cause: As the day sheets included more program time than was included on the employee’s approved timesheet, the time spent on this program was understated during the 1571 monthly reimbursement request to the State. We noted the above condition in five out of sixty sheets selected for Medicaid. Effects: Inaccurate reporting of time coded to programs affects the total federal and state reimbursement for the program. Recommendation: We recommend that the County implements a review control over weekly timesheets to ensure the timesheets include all program time coded on the day sheets. Auditee’s Response: We concur with the finding.