Views of Responsible Officials and Planned Corrective Actions: The Department of Human Services is in agreement with the findings related to missing application/renewal forms for the 3 noted cases. Since receipt of the clarification from the state regarding Medicaid record retention, staff have been...
Views of Responsible Officials and Planned Corrective Actions: The Department of Human Services is in agreement with the findings related to missing application/renewal forms for the 3 noted cases. Since receipt of the clarification from the state regarding Medicaid record retention, staff have been informed to retain all documents used in determining eligibility for the life of an active case. To prevent inadvertent removal of these documents, procedures have been put in place to ensure required materials are maintained during the transition of older paper case records to a paperless format within the Virginia Case Management System (VaCMS). A case purging checklist procedure was implemented in September 2020. The checklist was created to assist staff in ensuring that required documents are maintained and submitted for scanning to the electronic record. Case record materials for Medicaid began being scanned into the VaCMS/DMIS system at application in 2015 so there is less of a chance that cases established after that time will be missing an application or other required documents. The case purging checklist procedure implemented in September 2020 continues to be a requirement as cases are transitioned to an electronic record in the Virginia Case Management System (VaCMS). In an effort to prevent further findings related to this issue, staff were instructed to ensure all required documents are present in the system, including an application, as part of the manual Medicaid renewal process. Since the Federal Public Health Emergency (PHE) related to COVID-19 began in March 2020 state procedures regarding the completion of Medicaid renewals and actions have been modified. To ensure Medicaid recipients did not lose or have a reduction in coverage during the PHE they were not penalized for failure to complete the Medicaid renewal process and beginning in March 2021 the state called for localities to cease processing Medicaid renewals entirely. Therefore, while staff handled the unprecedented increase in applications and cases for all benefit programs, they were not completing the Medicaid renewal process and as a result reviewed less cases for missing documents including applications during this period. As of December 2021 the state Medicaid program continues to operate under these modified procedures. In order to ensure the application review process continues staff have been advised to evaluate for required Medicaid applications when completing any case action on any benefit program (not just a Medicaid case action). Monthly supervisor monitoring will include monitoring for compliance with this procedure. In addition, for cases that are automatically renewed through the exparte process, with no intervention from staff, available state exparte reports continue to be utilized to identify cases that may not contain an application. For these cases staff will request new/renewal applications to bring the case into compliance. The monthly exparte reports contain thousands of cases so the expectation is that not all cases are able to be assessed through this process. Responsible Officials: Lisa Calloway, Chief of Eligibility Anticipated Completion Date: Due to the volume of Medicaid cases, correction of this issue will be ongoing. The above processes will be continued as necessary to correct identified deficiencies. Monitoring for compliance will be performed on an ongoing basis.