Finding 3155 (2023-005)

Significant Deficiency
Requirement
E
Questioned Costs
-
Year
2023
Accepted
2023-12-04
Audit: 5141
Organization: Yadkin County (NC)

AI Summary

  • Core Issue: Medicaid cases are not being properly referred to the Child Support Enforcement Agency, leading to potential eligibility concerns.
  • Impacted Requirements: Compliance with Medicaid Manual MA-3365, which mandates cooperation with Child Support Agencies for eligibility determination.
  • Recommended Follow-up: Implement internal reviews of case files to ensure accurate documentation and adherence to eligibility procedures.

Finding Text

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2023-005 IV-D Cooperation with Child Support SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: Program Name: Medical Assistance Program (Medicaid; Title XIX) AL# 93.778 SIGNIFICANT DEFICENCY: Finding 2023- 002, 2023-003, 2023-004, 2023-005 also apply to State requirements and State Awards. Section IV - State Award Findings and Questioned Costs Section III. Federal Award Findings and Questioned Costs (continued) 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 determining Medicaid eligibility. There were 3 errors discovered during our procedures that referrals between Department of Social Services (DSS) and Child Support Agencies were not made. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 370,977 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. 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. The County agrees with the finding. See Corrective Action Plan in the following section. Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. 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.

Corrective Action Plan

Finding: 2023-005 Name of contact person: Corrective Action: Proposed Completion Date: YCHSA has revamped onboarding of new Medicaid staff to include individual staffing's with employee and their supervisor at least three times each week for a minimum of four months. These staffing's would include direct education on when Child Support referrals are necessary and how to document. YCHSA is in the process of hiring an Eligibility Trainer to assist with onboarding of new staff, provide refresher trainings for established staff and conduct second party reviews. When issues are noted by the Trainer, they will notify the respective supervisor and provide follow-up training as needed (either in an individual or group setting). Knowledge checks will be administered following group training to determine if knowledge has increased. If not, supervisors will follow up with individual training on appropriate Child Support referrals. YCHSA will continue to utilize policy portal for needed clarification on policy interpretation. YCHSA will send training requests to the Operational Support Team at least quarterly. The onboarding process for YCHSA is an ongoing process. A training will be provided on the Single County Audit findings before 11/30/23. YCHSA will begin the hiring process for the Eligibility Trainer during the week of 10/30/23.

Categories

Eligibility

Other Findings in this Audit

  • 3152 2023-002
    Significant Deficiency Repeat
  • 3153 2023-003
    Significant Deficiency Repeat
  • 3154 2023-004
    Significant Deficiency Repeat
  • 579594 2023-002
    Significant Deficiency Repeat
  • 579595 2023-003
    Significant Deficiency Repeat
  • 579596 2023-004
    Significant Deficiency Repeat
  • 579597 2023-005
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $825,086
93.658 Foster Care_title IV-E $464,277
93.563 Child Support Enforcement $275,706
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $200,657
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $85,905
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $81,890
93.977 Preventive Health Services_sexually Transmitted Diseases Control Grants $59,134
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $53,460
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $49,739
93.994 Maternal and Child Health Services Block Grant to the States $47,762
10.916 Watershed Rehabilitation Program $45,962
93.268 Immunization Cooperative Agreements $43,325
93.217 Family Planning_services $34,773
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $31,639
93.767 Children's Health Insurance Program $29,113
93.991 Preventive Health and Health Services Block Grant $28,828
93.053 Nutrition Services Incentive Program $26,095
93.556 Promoting Safe and Stable Families $26,091
93.110 Maternal and Child Health Federal Consolidated Programs $23,161
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $22,186
93.069 Public Health Emergency Preparedness $21,721
93.659 Adoption Assistance $17,918
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $15,399
97.042 Emergency Management Performance Grants $12,500
93.667 Social Services Block Grant $12,210
93.645 Stephanie Tubbs Jones Child Welfare Services Program $8,558
93.568 Low-Income Home Energy Assistance $7,117
93.000 Foster Care $4,295
93.558 Temporary Assistance for Needy Families $4,025
21.027 Coronavirus State and Local Fiscal Recovery Funds $299
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $34
93.566 Refugee and Entrant Assistance_state Administered Programs $1