Finding Text
Hertford County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2024-006 Untimely Review of SSI Termination
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
There were 1 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid
when their SSI benefits were terminated.
There was no known affect to eligibility and there were no known questioned costs.
Any State communications related to applicants’ benefits received by any DSS department should be
shared with all areas from which the participant receives benefits. State files should be reviewed
internally to ensure all actions have been properly closed and the corrective action has been taken.
Workers should be retrained on what process needs to be followed when State communications are
received.
Section III. Federal Award Findings and Questioned Costs
The State sends notification to the County when a participant is no longer eligible under SSI
determination. The County has a certain time period to initiate an ex parte review to determine
whether the recipient qualifies for Medicaid under any other coverage group, such as Family and
Children's Medicaid, North Carolina Health Choice for Children, Work First Family Assistance, or
Medicaid for the Aged, Blind and Disabled.
We examined 60 cases from of a total of 353,314 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.
The County agrees with the finding. See the response in the corrective action plan.
The County did not initiate ex parte review timely, therefore, no eligibility review was completed in
the required time period. The lack of follow up and certification could lead to applicants receiving
Medicaid benefits for which they were not eligible.
Ineffective communication between departments within the Department of Social Services. One area
within DSS received State communications that applicants would no longer be eligible for SSI
benefits and the County needed to conduct an application process. This information was not shared
with other departments in DSS from which the recipient was also receiving benefits.
This is a repeat finding from the immediate previous audit, 2023-007.
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