Finding 48069 (2022-001)

Material Weakness in Internal Control Over Compliance ? Medicaid Cluster Finding 2022-001 US Department of Health and Human Services Passed through the NC Department of Health and Human Services (NC DHHS) Program Name: Medicaid Cluster ? Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Award Year: 2022 Criteria: Per the NC Department of Health and Human Services-Division of Health Benefits, the County Department of Social Services Agency is responsible to determine client eligibility in accordance with eligibility requirements defined in the approved State Plan (42 CFR Section 431.10). Condition and Context: Of the 60 claims tested we noted the following: 5 instances which included incorrect countable / non-countable income and/or incorrect budget calculations; 2 instances which included incorrect MAGI tax household, member relationship status, or financial unit status which is required under the Modified Adjusted Gross Income (MAGI) for proper eligibility determinations for Family and Children?s Medicaid; 2 instances which included incorrect countable resources and/or incorrect budget calculations; 1 instance in which the local agency failed to prepare a child support referral when there was not absent parent documentation and the parent/caretaker was receiving benefits in the case; 1 instance where agency caseworkers failed to run online verification matches (OVS) and/or (AVS) in NC FAST for all applicable members of the household; 2 instances where a claim recipient's current year eligibility had been automatically Covid-19 extended and therefore the most recent prior year eligibility was tested in lieu and resulted in an incorrect benefit determination of a related member of the claim recipient's household. Identification of a Repeat Finding: This is a repeat finding from the immediate previous audit, 2021-002. Effect: Potential for ineligible applicant to receive benefits. Cause: Administrative oversight. Questioned Costs: None noted. Recommendation: We recommend the County continue to implement training and oversight to ensure that all County staff are properly informed of applicable program requirements. Management?s Response: See corrective action plan