Finding Text
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2023-008 IV-D Cooperation with Child Support
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Identification of a repeat
finding:
Recommendation:
Views of responsible
officials and planned
corrective actions:
The County agrees with the finding.
In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated
and referred to the Child Support Enforcement Agency (IV-D). 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.
There were 2 errors discovered during our procedures that referrals between DSS and Child
Support Agencies were not properly made.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 804,789 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement audit as
it relates to Medicaid administrative cost compliance audit.
For those certifications/re-certifications there was a chance that information was not
properly documented and reconciled to North Carolina Families Accessing Services through
Technology (NC FAST) and a participant could have been approved for benefits for which
they were not eligible.
This is a repeat finding from the immediate previous audit, 2022-004.
Human error in reading the Automated Collection and Tracking System (ACTS) report
and/or ineffective case review process.
Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when determining eligibility. The results found or documentation
made in case notes should clearly indicate what actions were performed and the results of
those actions.