Finding Text
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program
AL #: 93.778
Eligibility
Criteria:
Condition:
Context:
Recommendation: Files should be reviewed internally to ensure proper documentation is in place
for eligibility. Workers should be retrained on what files should contain and the
importance of complete and accurate record keeping. We recommend that all
files include online verifications, documented resources and income and those
amounts agree to information in NC FAST. The results found or documentation
made in case notes should clearly indicate what actions were performed and the
results of those actions.
Views of responsible officials: The county agrees with the finding. Please refer to the corrective action plan for
details.
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
Finding: 2024-004 Non-Cooperation With Child Support Procedures
SIGNIFICANT DEFICIENCY
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 1 errors discovered during our procedures that referrals between
DSS and Child Support Agencies were not properly made.
Questioned Costs: There was no known affect to eligibility and there were no known questioned
costs.
We examined 60 cases from a total of 46,508 Medicaid claims from the
Medicaid beneficiary report provided by NC Department of Health and Human
Services to re-determine eligibility. These findings are being reported with the
financial statement audit as it relates to Medicaid administrative cost compliance
audit.Effect:
Cause:
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program
AL #: 93.778
Views of responsible officials: The county agrees with the finding. Please refer to the corrective action plan for
details.
Section III - Federal Award Findings and Questioned Costs (continued)
Human error in reading the Automated Collection and Tracking System (ACTS)
report and/or ineffective case review process.
Recommendation: 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.
SIGNIFICANT DEFICENCY: Finding 2024-001, 2024-002, 2024-003, 2024-004 also apply to State requirements and
State Awards.
Section IV - State Award Findings and Questioned Costs
For those certifications/re-certifications there was a chance that information was
not properly documented and reconciled to NC FAST and applicants could have
been approved for benefits for which they were not eligible.