Finding 524600 (2024-004)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2024
Accepted
2025-02-27
Audit: 344037
Organization: Vance County (NC)

AI Summary

  • Core Issue: Vance County failed to properly refer Medicaid cases to the Child Support Enforcement Agency, leading to potential eligibility concerns.
  • Impacted Requirements: Compliance with Medicaid Manual MA-3365, which mandates cooperation with Child Support Agencies for eligibility determinations.
  • Recommended Follow-Up: Implement a thorough internal review process to ensure accurate documentation and referrals, addressing the repeat finding from the previous audit.

Finding Text

Vance County, North Carolina 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: 2024-004 IV-D Cooperation with Child Support SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Cause: Identification of a repeat finding: Recommendation: Views of responsible officials and planned corrective actions: Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determining eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Section III. Federal Award Findings and Questioned Costs The County agrees with the finding. See Corrective Action Plan in the following section. In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. There were 2 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 830,748 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. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (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, 2023-008. 138

Corrective Action Plan

Finding 2024-004 Name of contact person: Corrective Action: Proposed Completion Date: Section II - Financial Statement Findings (continued) Jul-24 The disbursement of funds will be done via a check or ACH transfer. The wiring of funds will not be a means of paying vendors. If a governmental agency requires a wire transfer, then a wire template will be set up. ALL wire templates will require the approval of the County Manager. The Budget & Finance Director Officer will set up the Wire Template. The County Manager, Budget & Finance Officer, Assistant Finance Officer can initiate a wire, but CANNOT approve their own wire. One of the other designees will need to approve it. All checks now require the signature of the BoCC Chair and the Budget & Finance Director. There will be a shift in staff responsibilities to facilitate dual controls, a segregation of duties, cross-trainings of staff and to maintain internal controls over the assets. FInancial Policies and Procedures will be written and communicated to staff. Additional Training will be given now to staff to ensure they are keying child support referrals timely and adequately once the CCU period is done, since they are currently not required. Caseworkers will be instructed if IV-D referrals are keyed to provide the necessary documentation to support the (child support worker’s request) if keyed during the CCU period. Child support enforcement Job aid will be discussed and distributed with team members. Child support (IV-D) referrals for MA, CA, & MAGI Cases will also be reviewed and discussed with team members. 1/31/2025

Categories

Eligibility

Other Findings in this Audit

  • 524601 2024-005
    Significant Deficiency Repeat
  • 524602 2024-006
    Significant Deficiency Repeat
  • 524603 2024-007
    Significant Deficiency Repeat
  • 524604 2024-008
    Significant Deficiency
  • 1101042 2024-004
    Significant Deficiency Repeat
  • 1101043 2024-005
    Significant Deficiency Repeat
  • 1101044 2024-006
    Significant Deficiency Repeat
  • 1101045 2024-007
    Significant Deficiency Repeat
  • 1101046 2024-008
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $1.48M
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $724,261
93.563 Child Support Services $569,914
93.558 Temporary Assistance for Needy Families $473,585
93.667 Social Services Block Grant $357,980
93.658 Foster Care Title IV-E $223,194
11.307 Economic Adjustment Assistance $216,991
21.027 Coronavirus State and Local Fiscal Recovery Funds $208,560
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $192,849
93.045 Special Programs for the Aging, Title Iii, Part C, Nutrition Services $126,097
93.568 Low-Income Home Energy Assistance $77,948
16.738 Edward Byrne Memorial Justice Assistance Grant Program $47,000
93.044 Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers $42,700
97.042 Emergency Management Performance Grants $30,625
93.767 Children's Health Insurance Program $18,562
93.053 Nutrition Services Incentive Program $15,332
93.645 Stephanie Tubbs Jones Child Welfare Services Program $4,405
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $3,243
93.556 Marylee Allen Promoting Safe and Stable Families Program $2,972
93.052 National Family Caregiver Support, Title Iii, Part E $1,856
93.659 Adoption Assistance $50