Finding 395878 (2022-006)

Medicaid Cluster (Medicaid), Assistance Listing Number 93.778, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services (NCDHHS), Division of Medical Assistance. Criteria: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX) Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual), case files for individuals or families receiving assistance are required to retain documentation to serve as evidence for the appropriate eligibility determination, including: • verification of date of birth • verification of United States citizenship • verification of Social Security Number (SSN) • accurate record of non‐custodial parent • accurate record of household members and relationships • accurate computation of countable income • verification of unearned income • verification of earned income The Child Support Enforcement Agency (IV-D) can assist families in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirements with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. Condition: We noted one instance where the earned income was not appropriately calculated. We noted three instances where the case worker did not perform the required register of deeds search and one of those same cases the liquid asset verification was not performed. We noted one case where the case worker did not end-date the pregnancy of the mother after birth of the child. We noted one case where the referral between the Department of Social Services and the Child Support Agencies were not properly made. Context/Cause: The County did not retain required documentation in case files at the time eligibility was determined. We noted the above conditions in 6 out of the 60 case files inspected for applicable payments. Effects: Case files not containing all required documentation results in a risk that the County could provide services to individuals not eligible to receive such services or that such services could be denied to eligible individuals. For all 6 cases, subsequent to being notified that required documentation had not been retained in the case file, the County was able to obtain documentation to substantiate that the applicants tested were eligible to receive benefits. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policies and procedures in place to ensure that all eligibility determination documentation is completed and retained by the County. Auditee’s Response: We concur with the findings.