Finding 1186772 (2025-003)

Person County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2025 Finding: 2025-002 Budget Violations SIGNIFICANT DEFICENCY; NONCOMPLIANCE Criteria: Condition: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: 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: 2025-003 SIGNIFICANT DEFICENCY Eligibility Criteria: Section III. Federal Award Findings and Questioned Costs 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 (continued) In accordance with North Carolina General Statutes § 143C, Budget revisions must be requested and approved prior to any commitment and/or expenditure that would exceed the amount budgeted. Entities should not overspend the authorized budget. The County reported expenditures in excess of the budget in the Insurance Fund (Internal Service Fund) in the amount of $220,015. The Insurance Fund had a higher-than-anticipated volume and magnitude of insurance claims that were incurred during the fiscal year but reported and processed after year-end. These claims were required to be accrued as payables. The Board spent funds that were not available for those respective departments and funds. The timing and severity of these claims were not known during the budget year and therefore could not be reasonably anticipated. The budget should be reviewed and appropriate amendments made during the year. The County agrees with this finding. Please refer to the corrective action plan for details. 153Person County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2025 Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: Section III. Federal Award Findings and Questioned Costs (continued) 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. 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. 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. We examined 60 cases from of a total of 278,467 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. 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. This is a repeat finding from the immediate previous audit, 2024-003 and 2024-005. Note in FY 2025 Medicaid findings were combined into a single finding. There were a total of 7 errors found during our testing procedures: - There was 1 error where living arrangement was incorrectly entered into the case file for incarcerated individual. - There was 3 error where resources were incorrectly calculated or were not properly documented in 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 were 3 errors where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. The County agrees with the finding and is implementing actions to correct these issues, which are further discussed in the corrective action plan. 154