Finding Text
Issue: Noncompliance with Uniform Guidance Section 1137(d) of the Social Security Act, not verifying individual was a U.S. Citizen or Qualified Non-Citizen.
Federal Agency: U.S. Department of Health and Human Services
Federal Program: Medical Assistance Program/Medicaid Cluster
Assistance Listing Number: 93.778 Pass-Through Agency : NYS Department of Health
Criteria:
Part of the eligibility requirements for Medicaid notes the individual must be a US citizen or a qualified non-citizen.
Condition:
We noted for three of the 40 cases selected, that verification of status as a U.S. citizen or qualified Non-Citizen was not documented. All three cases were approved by the State. In the case of State approval, the system will note the status has been verified, verified with issues, or unverified. In all three cases the State did not note verification of status and the County failed to check that the individual was properly verified in the system.
Cause:
The State did not update the system to show that individuals' status was verified. The County failed to check that the individual was properly verified in the system.
Effect or Potential Effect:
The County could be paying Medicaid expense for ineligible individuals.
Questioned Costs:
None.
Context:
Three out of 40 individuals selected were unverified.
Repeat Finding:
This is not a repeat finding.
Recommendation:
We recommend the County verify that all individuals’ Citizenship status has been properly documented in the system.
Views of Responsible Officials of the Auditee: In response to the finding, the Unit Supervisor is working with the NYS Department of Health for the correct process to receive notifications when the verification remains blank. Supervisors are currently monitoring for cases that are not verified and reaching out to the individuals for proof of citizenship.