Finding Text
Richmond County
Schedule of Findings and Questioned Costs
For The Year Ended June 30, 2024
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2024-009 Untimely Review of SSI Terminations
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
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
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.
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.
The County agrees with the finding. See Corrective Action Plan in the following section.
Any State communications related to applicants/beneficiaries 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.
Section III - Federal Award Findings and Questioned Costs (continued)
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 3 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid when
their SSI benefits were terminated. Of these 3 errors, one was determined to be an eligibility error with
potential questioned costs.
We examined 60 cases from of a total of 826,901 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.
SIGNIFICANT DEFICENCY: Finding 2024-005, 2024-006, 2024-007, 2024-008, 2024-009 also apply to State requirements and State Awards.
Section IV - State Award Findings and Questioned Costs
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