Finding Text
Washington County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2025 Identification of major State programs: Program Name Medical Assistance Program Public School Building Capital Fund - Needs Based Grant Dollar threshold used to determine a State major program $ 500,000 Auditee qualified as State low-risk auditee? X yes no None reported. U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid) AL #: 93.778 Finding: 2025-001 SIGNIFICANT DEFICENCY Internal Controls related to Medicaid Eligibility Determination Process Criteria: Condition: Questioned Costs: Due to the nature of the populations provided from which the samples were chosen, we are unable to calculate questioned costs for the above mentioned potential eligibility and noncompliance errors. There were a total of 10 errors found during our testing procedures: - There were 2 errors where income or household size was incorrectly calculated or inaccurate information was entered into the case file. In one notable instance, a failure resulted in a recipient being deemed eligible for Medicaid benefits when they were not, due to income exceeding the eligibility threshold. - There was 2 error where resources were incorrectly calculated or were not properly documented in the case file. - There were 6 errors where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. Federal regulations under 42 CFR § 435.956 require states to verify eligibility factors using electronic data sources where available, and to obtain documentation for unverifiable information. Additionally, the state's Medicaid manual (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual) mandates that all eligibility determinations include cross-verification of applicant-provided data against reliable external sources to ensure accuracy and prevent improper payments. Section II. Financial Statement Findings Section III. Federal Award Findings and Questioned Costs Section I. Summary of Auditors' Results (continued) 134Washington County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2025 Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: Program Name: Medical Assistance Program (Medicaid) AL # 93.778 SIGNIFICANT DEFICENCY: Finding 2025-001 also apply to State requirements and State Awards. These control deficiencies and noncompliance increase the risk of improper Medicaid payments, potentially resulting in overpayments to ineligible beneficiaries or underpayments to those who qualify. We recommend that management enhance internal controls by: (1) Providing comprehensive training to staff on the program's eligibility requirements and procedures outlined in the State's Medicaid manuals; (2) Ensuring that there is a formal internal review process and that it is adequately completed to identify and correct errors and monitor compliance; and (3) Communicating all program or policy changes clearly and timely across all departments who oversee eligibility determinations for federal funded programs. Section IV - State Award Findings and Question Costs The County agrees with the finding and is implementing actions to correct these issues, which are further discussed in the corrective action plan. We examined 60 cases from of a total of 95,520 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 deficiencies and noncompliance reported above are caused from ineffective record keeping and case review processes due to insufficient training of staff, lack of oversight from management, and/or inadequate communication between departments resulting in inconsistencies in data sharing and delayed information exchanges. Section III. Federal Award Findings and Questioned Costs (continued) This is a repeat finding from the immediate previous audit, 2024-001 and 2024-002. Note in FY 2025 Medicaid findings were combined into a single finding. 135