Finding 366866 (2023-003)

US Department of Health and Human Services Section III. Federal Award Findings and Questioned Costs (continued) The County agrees with the finding. Program Name: Medical Assistance Program (Medicaid; Title XIX) Section IV. State Award Findings and Questioned Costs AL # 93.778 There were 6 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants could have received assistance for which they were not eligible. We examined 60 from a total of 1,870,417 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. There was no known affect to eligibility and there were no known questioned costs. AL # 93.778 This is a repeat finding from the immediate previous audit, 2022-005. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources and income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. Electronic matches are required at applications and redeterminations.