Finding 399870 (2023-001)

Criteria: Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application and these items will agree to reports in the NC FAST system. In this process, the countable resources should be calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the verification process should be considered countable or non-countable resources and explained within the documentation. Condition: These technical errors consisted of forty-eight instances of failure to comply with a policy requirement. Of these, eight (8) failed to run the work number for all individuals with the potential for income. Child support referral was not sent in one (1) case. Errors in social security numbers for household participants resulted in a lack of online verification in two (2) cases. Four (4) cases had improperly forced eligibility. One (1) case of an SSI ex parte review not having been completed. Six (6) cases of incomplete or missing living arrangement documentation. Fifteen (15) instances of inaccurate resource calculations in NC FAST. All errors were the result of evidence entered into NC FAST and used in the eligibility determination not matching the supporting documentation or lacking any supporting documentation. Ten (10) instances of inaccurate budget calculations in NC FAST. All errors were the result of evidence entered into NC FAST and used in the eligibility determination not matching the supporting documentation, a lack of any supporting documentation, or a manual calculation error. One (1) instance of evidence input error resulting in inaccurate needs unit in the eligibility determination. Questioned Costs: There was no affect to eligibility and there were no questioned costs related to those errors. Context: Of the 447,847 claims, we examined 138 Medicaid cases to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which affect countable resource and a participant could have been approved for benefits that they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-002. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: 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 of income and those amounts agree to information in NC FAST. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will complete Monthly Second Party reviews for application approvals/denials and recertifications. These reviews will assist individual workers with noted case errors. Individual counseling will be held with the worker to assure their understanding of the errors.