Finding 1172798 (2025-001)

Criteria: In accordance with 2 CFR 200, management should have an adequate system of internal control procedures in place to ensure that casefile evidence is appropriately updated. In accordance with 45 CFR 435, documentation must be maintained to support eligibility determinations. Condition: When Medicaid staff received the task notification from NC FAST for a transfer-in case, the applicant was no longer a North Carolina resident; therefore, benefits should have been terminated. Context: Of the 212,825 benefit payments valued at $113,872,460, we examined 60 payment records ($25,921 value) and determined that one casefile (2%, valued at $26) should have been terminated. Upon further review the applicant was deemed ineligible to receive benefits, therefore questioned costs were reported. Effect: Applicants could receive benefits for which they are not eligible. Cause: Eligibility was not terminated timely. Identification of a Repeat Finding: This is modified and a repeat of Finding 2024-001 from the immediate previous audit. Questioned Costs: In accordance with 2 CFR 200, auditors are required to report known questioned costs when likely questioned costs are greater than $25,000. Even though the sample results only identified $26 (federal share $23 and state share $3) in questioned costs, if tests were extended to the entire population, questioned costs could exceed $25,000. Recommendation: When task notifications are received in NC FAST, follow-up and perform task on a timely basis. Views of Responsible Officials and Planned Corrective Actions: See Corrective Action Plan submitted with this report.