Finding 2023-001 Information on the Federal Program: Medical Assistance Program (Medicaid; Title XIX), ALN # 93.778, Grant Period 1/1/23 – 12/31/23. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only medically needy individuals, or families whose incomes and resources are insufficient to meet the costs of necessary medical services may receive Medicaid to cover the claims supported by medical records. Condition: There were multiple instances where eligibility files selected for review were either incomplete, ineligible for benefits, or unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Compliance Supplement, each individual who receives benefits under the Medicaid program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving Medicaid benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documentation were on file and available for audit review.
Finding 2023-002 Information on the Federal Program: Temporary Assistance for Needy Families (TANF), ALN # 93.558, Grant Period 1/1/23 – 12/31/23. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only a financially needy family that consists of, at a minimum, a minor child living with a parent or other caretaker relative, or a pregnant woman may receive TANF “assistance” or most maintenance-of-effort (MOE)-funded benefits, services, or “assistance” regardless of the TANF purpose that the expenditure is reasonably calculated to accomplish. Condition: There were multiple instances where eligibility files selected for review were either incomplete, ineligible for benefits, or unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Circular Compliance Supplement, each individual who receives benefits under the TANF program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving TANF benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documents were on file and available for audit review.
Finding 2023-003 Information on the Federal Program: Temporary Assistance for Needy Families (TANF), ALN # 93.558, Grant Period 1/1/23 – 12/31/23. Criteria or Specific Requirement: According to N.J.A.C. 10:90-4.1 “General work requirement provisions”, Each WFNJ adult recipient, teen parent, and 16 through 18 year old individual not attending school on a full time basis, unless specifically deferred or unless otherwise specified in this subchapter, shall cooperate with and participate in the WFNJ work requirements in accordance with Federal regulations, the Federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996, the New Jersey State Plan for Temporary Assistance for Needy Families, the Work First New Jersey Act, and the New Jersey SNAP Employment and Training State Plan, for up to 40 hours per week as a condition of eligibility for receipt of cash assistance benefits. Condition: There were multiple instances where eligibility files selected for review revealed the clients were not complying with the “General work requirement provisions”, yet continued to receive benefit payments. Questioned Costs: Unable to be determined. Context: According to N.J.A.C. 10:90-4.13 “Sanctions”, The failure of a recipient to cooperate with the Work First New Jersey program or participate in work activities under the program without good cause shall result in a loss of cash assistance benefits in accordance with the provisions of this section. Effect: By failing to monitor the “General work requirement provisions” of N.J.A.C. 10:90-4.1, instances were noted where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all program participants were adhering to the “General work requirement provisions” of N.J.A.C. 10:90-4.1.