Finding 1187096 (2025-002)

US Department of Health and Human Services Passed through the N.C. Dept. of Health and Human Services Program Name: Medicaid Cluster AL # 93.778 Grant Number: XIX-MAP24 Finding: 2025-002 NON-MATERIAL NON-COMPLIANCE MATERIAL WEAKNESS- ELIGIBILITY Criteria: In accordance with 42 CFR 431, benefits should be terminated timely to prevent payment errors. In accordance with 2 CFR 200, management should have an adequate system of internal control procedures in place to ensure that benefits are properly terminated when a case is no longer eligible. Condition: One casefile was not properly terminated when it no longer met resource requirements. As a result, covid extensions continued past the deadline. Context: Of the 1,167,414 benefit payments valued at $596,429,470, we examined 60 payment records ($28,996 value) and determined that one (2% valued at $25) of the participants received benefits after the covid extension deadline. Effect: Benefits not being properly terminated could cause the County to expend funds over the eligible amount. Cause: The caseworker did not review to ensure that benefits were properly terminated. 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 $25 (federal share $22 and state share $3) in questioned costs, if tests were extended to the entire population, questioned costs could exceed $25,000. Recommendation: Caseworkers should review cases to ensure that benefits are properly terminated when eligibility requirements are no longer met. Name of Contact Person: Candice Gobble, DSS Director Views of Responsible Officials and Planned Corrective Action: Management concurs with this finding. Please refer to the Corrective Action Plan.