Finding 1181350 (2025-002)

Material Weakness Repeat Finding
Requirement
E
Questioned Costs
-
Year
2025
Accepted
2026-03-18

AI Summary

  • Core Issue: There were 27 technical errors in Medicaid case records, leading to discrepancies between county documentation and NC FAST resources.
  • Impacted Requirements: Documentation must accurately reflect verifications and resource calculations to ensure eligibility determinations are correct.
  • Recommended Follow-Up: Conduct internal reviews of files, retrain staff on documentation standards, and ensure all records align with NC FAST data.

Finding Text

Criteria: Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the applicationandtheseitemswillagreetoreports intheNCFAST system. Inthisprocess,documentation shouldbepresentandagreebacktothe records in the NC FAST system. Any items discovered in the process should be considered resources and explained within the documentation. Condition: There were twenty-seven (27) technical errors discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. The errors were as follows: Ten (10) cases had instances of failure to complete atleast one compliance component, Ten (10) cases of inaccurate resource calculations in NC FAST, and Seven (7) cases of inaccurate budget calculations in NC FAST. Questioned Costs: There was no affect to eligibility and there were no questioned costs. Context:Weexamined120Medicaidtransactionsoutof637,152tore-determineeligibility. Thesefindingsweredisclosedinaseparatelyissued spreadsheet to the North Carolina Department of Health and Human Services and are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which affect countable resource and a participant could have been approved for benefits that they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2024-002. Cause:Ineffectiverecordkeepingandineffectivecasereviewprocess,incomplete documentation,andincorrectapplicationofrulesforpurposes of determining eligibility. Recommendation:Filesshouldbereviewedinternallytoensureproperdocumentationisinplaceforeligibility.Workersshouldberetrainedon what files should contain and the importance of complete and accurate record keeping.Werecommend thatall filesinclude online verifications, documented resources of income and those amounts agree to information in NC FAST. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviewstoensureproperdocumentationiscontainedinfilestosupporteligibilitydeterminations.Workerswillberetrainedonwhatinformation should be maintained incase files,the importance of complete and accurate record keeping,and reserve calculations. The County finance office will also participate in the review process.

Corrective Action Plan

Name of contact Person: Brittany Naylor, Director of Social Services Corrective Action: This finding is listed as a repeat finding on Technical Errors cited finding in previous audit 2024-002 and continues to be an area of improvement for Lenoir County. Lenoir County takes immediate action to correct any findings and ensure that workers are made aware of job duties and expectations. Lenoir County has effectively maintained the required accuracy standards rate of 95% or higher when determining eligibility for case actions, approvals, terminations and denials. The findings in this area equate to a 98.12% overall accuracy rating. The following changes have been implemented to help alleviate the continued non-compliance in this area. Staff meeting will be held Wednesday, February 18,2026 and the following training materials will be discussed and provided to the Medicaid staff to ensure continued understanding and knowledge of program requirements. Training materials will include but not limited to the following: Learning Gateway modules Magi Budgeting, Magi Budgeting: Income Determination, NC DHHS Medicaid Manual, etc. Modules are given in self learning type atmosphere and then followed up with classroom discussions and activities in an effort to enhance the retainability of information learned to the worker. Provide new budgeting tool that helps with calculating resource and budgetary areas of concern to reduce errors related to incorrect budgeting and resource calculations. Providing staff with copies of the Single County Audit findings, the Corrective Action plan and staff expectations to ensure that staff is well informed of the findings and what is expected from the Corrective Action Plan implementation. Filling the vacant Lead Worker position and provide assistance to the assist the team with applying correct case actions to determine eligibility. Supervisor and Lead Workers will assist staff with utilizing NC Fast Help Job Aids, NC DHHS policy for Medicaid for Families and Children or for Medicaid for the Aged, Blind, and Disabled manuals for reference material to reference, review and retain knowledge to ensure effective training knowledge that is applied to case actions. Supervisors and Lead Workers will complete 2nd party review and evaluate case actions with an increased emphasis on actions cited. Lead Workers turn in 2d party reviews at least once or twice a week to be evaluated and corrections must be made. Supervisors and Lead Workers will continue to monitor case actions and provide monthly statistical data detailing case findings. The Supervisor and Lead Worker will provide a list of findings and maintain scheduled monthly meetings with staff to provide feedback and coaching to ensure continued compliance of program requirements. The meetings held will consist of staff unit meetings and/or individual conferences provided by the Supervisors in an effort to effectively catch and manage error trends that have been discovered from 2nd party review findings. All documentation will be submitted to the Administrator for review and will be discussed and reviewed with the Supervisors during monthly conference meetings. The Administrator will provide monthly updates on case actions and findings to the Director. Proposed Completion Date: Training will be held with Medicaid Staff on Wednesday, February 18, 2026 for eligibility issues cited. Corrective Action Plan will be implemented immediately after training and significant improvement of all areas cited must be maintained by June 30, 2026.

Categories

Eligibility

Other Findings in this Audit

  • 1181349 2025-001
    Material Weakness Repeat
  • 1181351 2025-003
    Material Weakness Repeat
  • 1181352 2025-004
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
93.778 MEDICAL ASSISTANCE PROGRAM $2.14M
93.563 CHILD SUPPORT SERVICES $1.23M
10.561 STATE ADMINISTRATIVE MATCHING GRANTS FOR THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM $807,809
97.044 ASSISTANCE TO FIREFIGHTERS GRANT $491,874
10.557 WIC SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN $456,752
16.838 COMPREHENSIVE OPIOID, STIMULANT, AND OTHER SUBSTANCES USE PROGRAM $354,827
20.526 BUSES AND BUS FACILITIES FORMULA, COMPETITIVE, AND LOW OR NO EMISSIONS PROGRAMS $301,200
20.509 FORMULA GRANTS FOR RURAL AREAS AND TRIBAL TRANSIT PROGRAM $236,792
16.585 TREATMENT COURT DISCRETIONARY GRANT PROGRAM $164,119
93.596 CHILD CARE MANDATORY AND MATCHING FUNDS OF THE CHILD CARE AND DEVELOPMENT FUND $146,978
93.268 IMMUNIZATION COOPERATIVE AGREEMENTS $128,073
93.767 CHILDREN'S HEALTH INSURANCE PROGRAM $116,858
93.568 LOW-INCOME HOME ENERGY ASSISTANCE $68,322
93.217 FAMILY PLANNING SERVICES $55,528
93.917 HIV CARE FORMULA GRANTS $53,337
93.994 MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT TO THE STATES $49,859
93.354 PUBLIC HEALTH EMERGENCY RESPONSE: COOPERATIVE AGREEMENT FOR EMERGENCY RESPONSE: PUBLIC HEALTH CRISIS RESPONSE $40,000
93.069 PUBLIC HEALTH EMERGENCY PREPAREDNESS $35,958
93.967 CENTERS FOR DISEASE CONTROL AND PREVENTION COLLABORATION WITH ACADEMIA TO STRENGTHEN PUBLIC HEALTH $33,804
93.991 PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANT $30,741
93.667 SOCIAL SERVICES BLOCK GRANT $24,556
93.116 PROJECT GRANTS AND COOPERATIVE AGREEMENTS FOR TUBERCULOSIS CONTROL PROGRAMS $24,251
93.558 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES $14,800
93.645 STEPHANIE TUBBS JONES CHILD WELFARE SERVICES PROGRAM $13,126
93.898 CANCER PREVENTION AND CONTROL PROGRAMS FOR STATE, TERRITORIAL AND TRIBAL ORGANIZATIONS $8,125
93.658 FOSTER CARE TITLE IV-E $4,646
93.556 MARYLEE ALLEN PROMOTING SAFE AND STABLE FAMILIES PROGRAM $3,411
21.027 CORONAVIRUS STATE AND LOCAL FISCAL RECOVERY FUNDS $3,000
16.606 STATE CRIMINAL ALIEN ASSISTANCE PROGRAM $2,219
93.110 MATERNAL AND CHILD HEALTH FEDERAL CONSOLIDATED PROGRAMS $2,000
93.674 JOHN H. CHAFEE FOSTER CARE PROGRAM FOR SUCCESSFUL TRANSITION TO ADULTHOOD $1,500
93.977 SEXUALLY TRANSMITTED DISEASES (STD) PREVENTION AND CONTROL GRANTS $100