Medical Assistance Program (Medicaid, Title XIX), CFDA #93.778, Grant Period 1/1/23-12/31/23. Context: As per the Federal OMB Uniform Guidance Circular Compliance Supplement, each individual who receives benefits under the Medicaid program should have a complete eligibility determination on file, wh...
Medical Assistance Program (Medicaid, Title XIX), CFDA #93.778, Grant Period 1/1/23-12/31/23. Context: As per the Federal OMB Uniform Guidance Circular Compliance Supplement, each individual who receives benefits under the Medicaid program should have a complete eligibility determination on file, which is available for audit review. Corrective Action: PCBSS has implemented additional enhancements to support the DIMS Unit, where case files are scanned and electronically stored. The agency increased staffing dedicated to document scanning and streamlined the transfer process from worker units to the DIMS Unit. These improvements help ensure that cases are properly identified, organized, and maintained, and that supporting documentation is uploaded timely and accurately. Additionally, several Medicaid cases identified during the review were initially established by the State of New Jersey and/or third-party vendors contracted by the State prior to being transferred to the county for ongoing case management responsibilities. As a result, PCBSS did not possess the original applications or supporting eligibility documentation because the initial eligibility determination and enrollment process had already been completed before the cases were transferred to the county. Moving forward, PCBSS will provide auditors with system-generated portal documentation identifying the originating agency responsible for the initial case establishment. Implementation Date: Commenced in 2023 and ongoing.