Finding 367426 (2023-003)

Significant Deficiency Repeat Finding

Requirement

Questioned Costs

Year

2023

Accepted

2024-02-14

Audit: 290432

Organization: Cleveland County (NC)

Auditor: Thompson Price Scott Adams & CO P A

AI Summary

Core Issue: The County failed to properly document and reconcile Medicaid eligibility, leading to potential approvals for ineligible benefits.
Impacted Requirements: Timely adoption of required policies under federal guidelines was not met, risking the use of funds for unallowable costs.
Recommended Follow-Up: The finance office should closely review grant agreements and compliance requirements to prevent repeat findings.

Finding Text

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance Program (Medicaid; Title XIX) Finding 2023-003 IV-D Cooperation with Child Support SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: The County agrees with the finding. See Corrective Action Plan in the following section. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. We examined 60 from a total of 1,380,866 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. AL No.: 21.027 In accordance with the U.S. Department of Treasury 31 CFR Part 35, Coronavirus State and Local Fiscal Recovery Funds Final Rule and the Uniform Guidance, Eligible Projects Determination & Documentation Policy, Cost Principles/Allowable Costs Policy, Civil Rights Compliance / Nondiscrimination Policy, are required to be adopted as condition of receiving the funds. The County did not adopt required policies timely. The County could use the funds for unallowable costs that were prohibited by the Final Rule. County oversight of the new federal grant requirements to have the stated policies in place. Section III - Federal Award Findings and Questioned Costs 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 1 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. There was no known affect to eligibility and there were no known questioned costs. AL No.: 93.778 The finance office should review the grant agreement and the Uniform Guidance more carefully to ensure all compliance requirements are meet. This is a repeat finding from the immediate previous audit, 2022-002.

Corrective Action Plan

Finding 2023-003 Name of Contact Person: Alice Wilson, Medicaid Program Administrator Corrective Action: Proposed Completion Date: Finding 2023-004 Name of Contact Person: Alice Wilson, Medicaid Program Administrator Corrective Action: Proposed Completion Date: Finding 2023-005 Name of Contact Person: Alice Wilson, Medicaid Program Administrator Corrective Action: Proposed Completion Date: Section III - Federal Award Findings and Questioned Costs Review of Second Party/QA policy and staff training to be completed by 3/31/2024. Specialization of Adult Medicaid group to be completed by 4/30/2024 if fully staffed. Lead staff along with Supervision will condcut refresher training regarding when and how to properly send a IV D referral. The county must also ensure that staff is aware of current guidance in Admin letter 13-23 which states that an applicant/beneficiary is not required to cooperate with Child Support during the CCU period however a parent/caretaker can request assistance with establishing child support at which time the worker would assist by keing the referral. While this is a repeat finding it is important to note the decrease in errors found to one error in 2023 compared to 3 found in 2022. The county feels that the specialization model with in the Family & Childrens team has contributed to this reduction and will continue to reduce as we go forward. Lead Staff along with Supervision will conduct refresher training on how to add evidence and update evidence to the Evidence Dashboard on a case. This area will continue to be a part of the second party checks conducted by lead staff and supervision to ensure accurate entry. Management along with the Econ Services Administrator will review the current second party/ QA Analysis policy and update any areas to ensure that supervisors and lead staff are sampling an ample amount of work in order to identify any error trends. The county is working toward specializing the Adult Medicaid by function within the Adult Program and will consist of one team that consist of a Intake Application team and a Redeterminationteam. The county currently has a targeted completion date of late spring 2024. While this is a repeat finding from 2022 it is important to note the significant decrease in the total number found in 2023 of one error compared to 8 errors found in 2022. Staff training to be completed by 3/31/2024

Other Findings in this Audit

367425 2023-002

Significant Deficiency
367427 2023-004

Significant Deficiency Repeat
367428 2023-005

Significant Deficiency Repeat
367429 2023-006

Significant Deficiency Repeat
943867 2023-002

Significant Deficiency
943868 2023-003

Significant Deficiency Repeat
943869 2023-004

Significant Deficiency Repeat
943870 2023-005

Significant Deficiency Repeat
943871 2023-006

Significant Deficiency Repeat

Programs in Audit

ALN	Program Name	Expenditures
21.027	Coronavirus State and Local Fiscal Recovery Funds	$11.26M
93.778	Medical Assistance Program	$3.74M
93.558	Temporary Assistance for Needy Families	$1.83M
93.563	Child Support Enforcement	$1.81M
93.323	Epidemiology and Laboratory Capacity for Infectious Diseases (elc)	$1.50M
93.658	Foster Care_title IV-E	$1.44M
10.561	State Administrative Matching Grants for the Supplemental Nutrition Assistance Program	$1.33M
93.568	Low-Income Home Energy Assistance	$966,669
10.557	Special Supplemental Nutrition Program for Women, Infants, and Children	$755,230
93.667	Social Services Block Grant	$696,890
93.044	Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers	$302,631
16.710	Public Safety Partnership and Community Policing Grants	$194,309
93.994	Maternal and Child Health Services Block Grant to the States	$169,132
93.596	Child Care Mandatory and Matching Funds of the Child Care and Development Fund	$159,996
93.268	Immunization Cooperative Agreements	$143,235
93.045	Special Programs for the Aging_title Iii, Part C_nutrition Services	$141,107
93.354	Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response	$112,741
93.767	Children's Health Insurance Program	$89,850
16.575	Crime Victim Assistance	$73,428
93.217	Family Planning_services	$71,475
93.391	Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises	$67,980
93.659	Adoption Assistance	$64,803
45.310	Grants to States	$61,801
97.042	Emergency Management Performance Grants	$53,407
93.069	Public Health Emergency Preparedness	$39,642
93.053	Nutrition Services Incentive Program	$32,602
93.898	Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations	$30,860
93.991	Preventive Health and Health Services Block Grant	$30,607
93.674	John H. Chafee Foster Care Program for Successful Transition to Adulthood	$30,300
93.940	Hiv Prevention Activities_health Department Based	$28,000
93.556	Promoting Safe and Stable Families	$27,200
16.738	Edward Byrne Memorial Justice Assistance Grant Program	$23,100
93.436	Well-Integrated Screening and Evaluation for Women Across the Nation (wisewoman)	$13,320
16.607	Bulletproof Vest Partnership Program	$13,298
93.645	Stephanie Tubbs Jones Child Welfare Services Program	$3,433
93.566	Refugee and Entrant Assistance_state Administered Programs	$483
93.977	Preventive Health Services_sexually Transmitted Diseases Control Grants	$100
93.116	Project Grants and Cooperative Agreements for Tuberculosis Control Programs	$50
93.560	Family Support Payments to States_assistance Payments	$-45