Finding 1169638 (2025-002)

2025-002 Significant Deficiency over Eligibility (Repeat Finding) Information on the Federal Program: Medicaid Cluster (Medicaid), Assistance Listing Number 93.778, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services (NCDHHS), Division of Medical Assistance. Criteria: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX) Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual), case files for individuals or families receiving assistance are required to retain documentation to service as evidence for the appropriate eligibility determination, including: • accurate computation of countable income and resources • verification of unearned income • verification of earned income Condition: We noted two instances where the total countable income for the applicant did not agree to the supporting documentation found in the applicant’s file. Context/Cause: The County did not retain required documentation in case files at the time eligibility was determined. We noted the above conditions in two out of the sixty case files inspected for applicable payments. Effects: Case files not containing all required documentation results in a risk that the County could provide services to individuals not eligible to receive such services or that such services could be denied to eligible individuals. For all two cases, subsequent to being notified that required documentation had not been retained in the case file, the County was able to obtain documentation to substantiate that the applicants tested were eligible to receive benefits. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policies and procedures in place to ensure that all eligibility determination documentation is completed and retained by the County. Auditee’s Response: We concur with the finding.