Audit 54380

U.S. Department of Health & Human Services Passed-through the N.C. Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) Grant Number: XXXX Finding: 2022-003 SIGNIFICANT DEFICIENCY Eligibility Criteria: The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child?s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. Condition: One case file did not have documentation of referral for IV-D child support. Cause: Error in reading the ACTS report and/or ineffective case review process. Effect: For the certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST, and applicants could have been approved for benefits for which they were not eligible. Questioned Costs: There were no known affects to eligibility and there were no known questioned costs. Context: We examined 91 Medicaid applicants from the Medicaid Beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to the Medicaid administrative cost compliance audit. Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determine eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Views of responsible officials and planned corrective actions: The County agrees with the finding and plans corrective actions.

U.S. Department of Health & Human Services Passed-through the N.C. Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) Grant Number: XXXX Finding: 2022-003 SIGNIFICANT DEFICIENCY Eligibility Criteria: The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child?s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. Condition: One case file did not have documentation of referral for IV-D child support. Cause: Error in reading the ACTS report and/or ineffective case review process. Effect: For the certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST, and applicants could have been approved for benefits for which they were not eligible. Questioned Costs: There were no known affects to eligibility and there were no known questioned costs. Context: We examined 91 Medicaid applicants from the Medicaid Beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to the Medicaid administrative cost compliance audit. Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determine eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Views of responsible officials and planned corrective actions: The County agrees with the finding and plans corrective actions.