Finding Text
Johnston County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2025 Effect: Identification of a repeat finding: 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: Children's Health Insurance Program (CHIP) AL #: 93.767 Finding: 2025-004 Inaccurate Resources Entry MATERIAL WEAKNESS/MATERIAL NONCOMPLIANCE Eligibility Criteria: Section III. Federal Award Findings and Questioned Costs (continued) Federal regulations under 42 CFR § 457.340 - 457.353 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 for Family and Children Medicaid (CHIP is a different funding source but Eligibility is determined the same as Medicaid) mandates that all eligibility determinations include cross-verification of applicantprovided data against reliable external sources to ensure accuracy and prevent improper payments. 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. The County agrees with the finding and is implementing actions to correct these issues, which are further discussed in the corrective action plan. 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, 2024-001 and 2024-002. Note in FY 2025 Medicaid findings were combined into a single finding. 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. 226Johnston County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2025 Condition: Questioned Costs: Context: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: Section III. Federal Award Findings and Questioned Costs (continued) These control deficiencies and noncompliance increase the risk of improper CHIP payments, potentially resulting in overpayments to ineligible beneficiaries or underpayments to those who qualify. 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. The County agrees with the finding and is implementing actions to correct these issues, which are further discussed in the corrective action plan. There were a total of 15 errors found during our testing procedures: - There were 4 errors where income or household size was incorrectly calculated or inaccurate information was entered into the case file. In 1 instance, a failure resulted in a recipient being deemed eligible for Medicaid benefits when they were not, due to resources exceeding the eligibility threshold. - There was 1 error where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. - There were 10 errors where redeterminations of eligibility was not performed in accordance with program requirements. 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 157,915 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine eligibility. These findings are being reported with the financial statement audit as it relates to CHIP administrative cost compliance audit. 227