Finding 1181439 (2025-002)

Criteria: Per the NC Department of Health and Human Services-Division of Health Benefits, the County Department of Social Services Agency is responsible for determining client eligibility in accordance with eligibility requirements defined in the approved State Plan (42 CFR Section 431.10). Condition and Context: Of the 77 claims tested we noted the following: 3 errors which resulted in ineligible benefits where the County failed to utilize the correct Form DSS-8110 (Notice of Modification, Termination, or Continuation of Public Assistance) notification generation procedures required to properly close a case and terminate benefits in the NCFAST system resulting in ineligible full Medicaid benefits for 3 individuals in the FY 24-25 audit period of availability. Of the 77 claims tested, we noted: 8 instances which included incorrect countable and/or non-countable income and/or incorrect budget calculations; 1 instance which included incorrect countable and/or non-countable resources and/or incorrect budget calculations; 3 instances which the State & Local Agency internal control policy required dictation/case notes were not completed and present in the case file documentation or if present, was not adequate supporting documentation; 2 instances in of incorrect program benefit determination. These noted agency technical errors did not result in ineligible benefits. Effect: Ineligible persons received benefits. Additionally, there is potential for additional ineligible persons to receive benefits. Cause: Administrative oversight.Identification of a Repeat Finding: The findings noted that resulted in ineligible benefits, and well as those that did not result in ineligible benefits are both repeat findings from the immediate previous audit, 2024-001. Questioned Costs: None noted. Recommendation: We recommend the County continue to implement training and oversight to ensure that all County staff are properly informed of applicable program requirements. Management’s Response: See corrective action plan.