Audit 406763

Criteria: 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 non-countable resources and explained within the documentation. Condition: These technical errors consisted of twenty-one (21) instances of failure to comply with a policy requirement. Failure to comply with policy requirement - Ten (10) instances of failure to complete at least one compliance component. All identified missing or incomplete verification of facts or were improperly forced. Inaccurate Resource Calculation - Seven (7) instances of inaccurate resource calculations in NC FAST. The values entered in NC FAST evidence and used in the eligibility determination did not match the supporting documentation or was lacking any substantiating documentation. Inaccurate Budget Calculation - One (1) instance of inaccurate budget calculations in NC FAST. The values entered in NC FAST evidence and used in the eligibility determination did not matching the supporting documentation or was lacking any substantiating documentation. Failure to document/correct system issues - Three (3) instances of cases being forced when not force was not needed. Cases contained benefit histories that were not representative of the benefit that was issued. Questioned Costs: There was no affect to eligibility and there were no questioned costs related to those errors. Context: Of the 340,510 claims, we examined 60 Medicaid cases to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which affect countable resource and a participant could have been approved for benefits that they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2024-001. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will complete Monthly Second Party reviews for application approvals/denials and recertifications. These reviews will assist individual workers with noted case errors. Individual counseling will be held with the worker to assure their understanding of the errors.

Criteria: Food and Nutrition Services case files to require proper documentation be contained in the case record to verify eligibility. The case file should contain a completed, signed (telephonic signature is allowable) and dated Food and Nutrition Services application (DSS-8207 or electronically generated ePASS application). The form must be signed by an adult household member (or an authorized representative), and NC FAST captures the user ID which serves as the worker’s electronic signature. Additionally, employment program participation is required for specified applicants. Eligibility criteria further outlined in Food and Nutrition Services Certification Manual, Section 305 through Section 350. Condition: There were Four (4) cases lacking the required signature or date certifying the documentation, and One (1) case in which the clock tracking time limits for receiving were not engaged in NC FAST. Questioned Costs: There was no affect to eligibility and there were no questioned costs related to those errors. Context: We examined 60 out of 1,924 Food and Nutrition Services case files active during the fiscal year to ensure verifications used to determine eligibility were properly documented. Effect: For the active cases, there was a chance that information was not adequately documented or were not accessible NC FAST which affect general adherence to prescribed guidelines. Identification of a repeat finding: This is not a repeat finding. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: 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 supporting documentation used for eligibility verification be reviewed for completeness and reconciled to the information provided in worker dictation. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations.