Finding Text
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: 2024-003 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
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: 2024-004 Untimely Review of SSI Terminations
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
For those certifications/re-certifications there was a chance that information was not properly documented and
reconciled to NC FAST and applicants could have been approved for benefits for which they were not eligible.
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
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 and income and those amounts agree to information
in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were
performed and the results of those actions.
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. Electronic matches
are required at applications and redeterminations.
There were 4 errors discovered during our procedures that inadequate information was requested at applications
and/or redeterminations.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 401,179 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.
This is a repeat finding from the immediate previous audit, 2023-004.
The County agrees with the finding. See Corrective Action Plan in the following section.
In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a participant is
no longer eligible under a 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 1 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid when their
SSI benefits were terminated.
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
N.C. Office of State Budget and Management
Program Name: Regional Economic Development Reserve
Finding: 2024-005 Funds Management
SIGNIFICANT DEFICENCY
Cash Management
Criteria:
Condition:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Budget was adopted when the funds were awarded to the County before the grant contracts were signed.
Account each source of fund separately in County accounting system.
The County agrees with the finding. See Corrective Action Plan in the following section.
Grant funds were not properly managed as required.
In accordance with North Carolina General Statute (G.S.) 143C-6-23 and the grant contract with North Carolina
Office of State Budget and Management, the grant funds should be accounted for in a separate fund and accounting
structure within the recipient's central accounting and/or grant management system.
The grant funds were accounted for in County General Fund instead of a separate fund.
SIGNIFICANT DEFICENCY: Finding 2024-001, 2024-002, 2024-003, and 2024-004 also apply to State requirements and State Awards.
Section IV - State Award Findings and Questioned Costs
Section III. Federal Award Findings and Questioned Costs (continued)
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 401,179 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 lead to applicants receiving Medicaid benefits for which they
were not eligible.
The County agrees with the finding. See Corrective Action Plan in the following section.
Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case
review process.
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 ex-parte review. This information was not shared with other departments in DSS from which the
recipient was also receiving benefits.