Finding Text
Cause:
Identification of a
repeat finding:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-007 Untimely Review of SSI Termination
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
This is a repeat finding from the immediate previous audit, 2022-008.
The State sends notification to the County when a participant is no longer eligible under SSI
determination. The County has a certain time period to initiate an ex parte review to determine whether
the recipient qualifies for Medicaid under any other coverage group, such as Family and Children's
Medicaid, North Carolina Health Choice for Children, Work First Family Assistance, or Medicaid for
the Aged, Blind and Disabled.
There were 4 beneficiaries not reviewed timely and determined to be eligible for Medicaid when their
SSI benefits were terminated.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.
The County did not initiate ex parte review timely, therefore, no eligibility review was completed in
the required time period. The lack of follow up and certification could lead to applicants receiving
Medicaid benefits for which they were not eligible.
Section III. Federal Award Findings and Questioned Costs (continued)
The finance office should review the grant agreement and the Uniform Guidance more carefully to
ensure all compliance requirements are meet.
The County agrees with the finding. See the response in the corrective action plan.
County oversight of the new federal grant requirement to have the stated policies in place.
This is a repeat finding from the immediate previous audit, 2022-007.
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-008 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
The County agrees with the finding. See the response in the corrective action plan.
There were 4 errors discovered during our procedures that inaccurate information was entered when
determining eligibility.
Ineffective communication between departments within the Department of Social Services. One area
within DSS received State communications that applicants would no longer be eligible for SSI benefits
and the County needed to conduct an application process. This information was not shared with other
departments in DSS from which the recipient was also receiving benefits.
Any State communications related to applicants’ benefits received by any DSS department should be
shared with all areas from which the participant receives benefits. State files should be reviewed
internally to ensure all actions have been properly closed and the corrective action has been taken.
Workers should be retrained on what process needs to be followed when State communications are
received.
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.
In accordance with 2 CFR 200, management should have an adequate system of internal controls
procedures in place to ensure an applicant is properly determined or redetermined for benefits.
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.
This is a repeat finding from the immediate previous audit, 2022-009.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.