Finding 1093588 (2024-002)

2024-002 Inadequate Documentation Maintained. U.S. Department of Health and Human Services Passed through NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid Cluster) ALN #93.778 Criteria: In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. In accordance with 2 CFR 200, manageemnt should have an adequate system of internal control procedures in place to ensure an applicant is properly determined or redetermined for benefits. Condition: There were four errors noted during our procedures that showed information was not properly documented when determining or redetermining eligibility. Questioned Costs: There was no known effect to eligibility and there were no known questioned costs. Cause: Ineffective case review process and/or incomplete documentation for purposes of determining or redetermining eligibility benefits. Effect: For the affected certifications and recertifications, there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility determination. Additional training should be provided to case workers to ensure proper documentation is maintained and proper review procedures are in place. In addition, we recommend all case files include online verifications, documented resources of income and resources and those amounts agree to information within the NC FAST system. The results found or documentation made in case files should clearly indicate what actions were performed and the results of those actions. Views of the responsible officials: The County agrees with this finding. Corrective Action: The County will provide additional training to case workers to ensure documentation requirements and appropriate review procedures are in place.