Finding 516067 (2024-007)

Significant Deficiency Repeat Finding

Requirement

Questioned Costs

Year

2024

Accepted

2024-12-19

Audit: 333850

Organization: Edgecombe County (NC)

Auditor: Thompson Price Scott Adams & CO

AI Summary

Core Issue: Federal funds were given to ineligible recipients due to improper eligibility determinations.
Impacted Requirements: Timely ex parte reviews and notifications as per Medicaid Manual MA-3120 were not followed.
Recommended Follow-Up: Improve communication within the Department of Social Services and implement corrective actions to prevent future eligibility errors.

Finding Text

Questioned Costs: As a result of the lack of a proper eligibility determination, federal funds were distributed to ineligible recipients. Due to the nature of these types of eligibility determinations and the lack of a proper review by the department, the auditor is unable to determine the known or likely questioned costs. Context: We examined 60 cases from of a total of 1,005,637 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. Criteria: In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a participant is no longer eligible under Supplemental Security Income (SSI) determination, the County is required to initiate the ex parte review within 5 workdays of the date the termination appears on the SSI Termination Report, and complete the redetermination within 4 months of the month the case appears on the SSI Termination Report and notify the recipient about applicant's ongoing eligibility for Medicaid. Condition: There were 3 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. Of these 3 errors, two were determined to be an eligibility error with potential questioned costs. Effect: 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 lead to applicants receiving Medicaid benefits for which they were not eligible. Cause: 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. Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details. Section III. Federal Award Findings (continued) Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-008.

Corrective Action Plan

Corrective Action: Application checklist updated to include a line items to ask if the client owns their home; does the client have to pay rent or any other living expenses; and was the case evaluated for 1/3 reduction if applicable. These additions to the checklist will serve as a reminder to the worker that all of these areas are covered when working the case. Training will be conducted with all workers on MA-2261 1/3 Reduction, and MA-2230 Financial Resources. Medicaid Supervisors and Quality Control workers will review files internally to ensure policy is applied to all cases and that the evidence entered into NCFAST matches the information in determinations. Proposed Completion Date: Training and implementation of additional reviews and procedures will be implemented by January 15, 2025. Proposed Completion Date: Training and implementation of additional reviews and procedures will be implemented by January 15, 2025. Name of contact person: Virginia Ewuell and Angel Joyner, Medicaid Supervisors. Denise McKnight, Social Services Program Administrator Corrective Action: SSI termination reports are being worked and monitored to ensure that SSI terminated recepients are reviewed and acted on timely. Application checklist has been updated with the line item to check to see if SSI has been terminated. Medicaid Supervisors and Quality Control workers will review files internally to ensure policy is applied to all cases and that the evidence entered into NCFAST matches the information in determinations.

Other Findings in this Audit

516063 2024-003

Significant Deficiency Repeat
516064 2024-004

Significant Deficiency Repeat
516065 2024-005

Significant Deficiency Repeat
516066 2024-006

Significant Deficiency Repeat
1092505 2024-003

Significant Deficiency Repeat
1092506 2024-004

Significant Deficiency Repeat
1092507 2024-005

Significant Deficiency Repeat
1092508 2024-006

Significant Deficiency Repeat
1092509 2024-007

Significant Deficiency Repeat

Programs in Audit

ALN	Program Name	Expenditures
10.760	Water and Waste Disposal Systems for Rural Communities	$6.73M
93.778	Medical Assistance Program	$2.14M
93.563	Child Support Services	$1.12M
93.558	Temporary Assistance for Needy Families	$953,270
10.561	State Administrative Matching Grants for the Supplemental Nutrition Assistance Program	$890,693
93.667	Social Services Block Grant	$456,861
93.658	Foster Care Title IV-E	$405,585
21.027	Coronavirus State and Local Fiscal Recovery Funds	$227,381
10.557	Wic Special Supplemental Nutrition Program for Women, Infants, and Children	$218,798
93.994	Maternal and Child Health Services Block Grant to the States	$200,103
93.045	Special Programs for the Aging, Title Iii, Part C, Nutrition Services	$185,005
93.596	Child Care Mandatory and Matching Funds of the Child Care and Development Fund	$155,560
93.323	Epidemiology and Laboratory Capacity for Infectious Diseases (elc)	$144,892
93.767	Children's Health Insurance Program	$96,928
93.967	Centers for Disease Control and Prevention Collaboration with Academia to Strengthen Public Health	$95,528
93.568	Low-Income Home Energy Assistance	$88,095
93.917	Hiv Care Formula Grants	$65,613
93.217	Family Planning Services	$56,864
97.067	Homeland Security Grant Program	$54,000
93.268	Immunization Cooperative Agreements	$49,668
93.044	Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers	$45,793
16.001	Law Enforcement Assistance Narcotics and Dangerous Drugs Laboratory Analysis	$42,330
97.042	Emergency Management Performance Grants	$39,698
93.069	Public Health Emergency Preparedness	$34,935
93.053	Nutrition Services Incentive Program	$30,703
93.991	Preventive Health and Health Services Block Grant	$29,265
20.600	State and Community Highway Safety	$28,249
16.738	Edward Byrne Memorial Justice Assistance Grant Program	$24,856
93.116	Project Grants and Cooperative Agreements for Tuberculosis Control Programs	$21,327
16.607	Bulletproof Vest Partnership Program	$21,060
93.674	John H. Chafee Foster Care Program for Successful Transition to Adulthood	$11,948
93.659	Adoption Assistance	$6,874
93.645	Stephanie Tubbs Jones Child Welfare Services Program	$5,546
93.556	Marylee Allen Promoting Safe and Stable Families Program	$3,842
93.898	Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations	$380
93.977	Sexually Transmitted Diseases (std) Prevention and Control Grants	$58