FAC Explorer

Finding 309 (2022-011)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2022
Accepted
2023-10-02
Audit: 581
Organization: Hyde County (NC)
Auditor: Thompson Price Scott Adams & CO P A

AI Summary

  • Core Issue: There was a significant deficiency in the eligibility review process for Medicaid, leading to a beneficiary being incorrectly approved after their SSI benefits were terminated.
  • Impacted Requirements: Compliance with Medicaid Manual MA-3365, which mandates timely evaluations and referrals to the Child Support Enforcement Agency for cooperation in determining eligibility.
  • Recommended Follow-Up: Conduct internal reviews of case files to ensure accurate documentation and adherence to eligibility procedures, and improve the case review process to prevent future errors.

Finding Text

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program CFDA #: 93.778 Finding: 2022-011 IV-D Child Support Non-Cooperation SIGNIFICANT DEFICIENCY Eligibility Criteria: In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determine Medicaid eligibility. Condition: There was 1 error in which a beneficiary was not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 cases from of a total of 43,722 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. Identification of a Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-011. Cause: Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determine eligibility. The results found or documentation made in case notes that clearly indicates what actions were performed and the results of those actions. Views of responsible officials: The county agrees with the finding. Please refer to the corrective action plan for details.

Corrective Action Plan

Finding: 2022-011: IV-D Child Support Non-Cooperation Name of Contact Person: Laurie Potter, DSS Director Corrective Action: Temporary Supervisor has been providing one-on-one support to the MAGI workers & completing 2nd party reviews on cases. A new supervisor is going to be hired who will be provided with training for themselves, will complete 2nd party reviews & training with the staff. Standard Operating Procedure put in place. Proposed Completion Date: 10/31/23.

Categories

Eligibility Significant Deficiency

Other Findings in this Audit

  • 306 2022-008
    Significant Deficiency Repeat
  • 307 2022-009
    Significant Deficiency Repeat
  • 308 2022-010
    Significant Deficiency Repeat
  • 310 2022-012
    Significant Deficiency Repeat
  • 576748 2022-008
    Significant Deficiency Repeat
  • 576749 2022-009
    Significant Deficiency Repeat
  • 576750 2022-010
    Significant Deficiency Repeat
  • 576751 2022-011
    Significant Deficiency Repeat
  • 576752 2022-012
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $394,201
21.027 Coronavirus State and Local Fiscal Recovery Funds $184,082
93.658 Foster Care_title IV-E $142,412
93.563 Child Support Enforcement $98,723
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $74,887
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $53,937
97.042 Emergency Management Performance Grants $48,584
93.268 Immunization Cooperative Agreements $43,572
93.069 Public Health Emergency Preparedness $29,718
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $27,047
93.991 Preventive Health and Health Services Block Grant $25,803
93.217 Family Planning_services $25,361
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $24,727
93.568 Low-Income Home Energy Assistance $20,917
14.228 Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii $19,525
93.994 Maternal and Child Health Services Block Grant to the States $17,462
20.106 Airport Improvement Program $14,500
11.419 Coastal Zone Management Administration Awards $13,500
93.053 Nutrition Services Incentive Program $11,686
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $11,637
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $3,250
20.513 Enhanced Mobility of Seniors and Individuals with Disabilities $2,963
93.767 Children's Health Insurance Program $2,329
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $1,958
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $1,125
93.667 Social Services Block Grant $1,022
93.558 Temporary Assistance for Needy Families $966
93.566 Refugee and Entrant Assistance_state Administered Programs $429
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $105
93.659 Adoption Assistance $12