Finding 524602 (2024-006)

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

AI Summary

  • Core Issue: Inaccurate resource entries in Medicaid eligibility documentation, leading to discrepancies between county records and NC FAST system.
  • Impacted Requirements: Compliance with Medicaid Manual MA-2230, which mandates accurate documentation and verification of resources.
  • Recommended Follow-Up: Conduct internal reviews of case files, retrain staff on documentation standards, and ensure all records align with NC FAST data.

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: 2024-006 Inaccurate Resources Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Cause: Identification of a repeat finding: Recommendation: This is a repeat finding from the immediate previous audit, 2023-010. Section III. Federal Award Findings and Questioned Costs (continued) In accordance with Medicaid Manual MA-2230, Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application and these items will agree to reports in the NC FAST system. In this process, the countable resources should be calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the verification process should be considered countable or noncountable resources and explained within the documentation. There were 4 errors discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. 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 NC FAST and a participant 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 of 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. 140

Corrective Action Plan

Corrective Action Plan For the Year Ended June 30, 2024 Finding 2024-005 Name of contact person: Corrective Action: Proposed Completion Date: Finding 2024-006 Name of contact person: Corrective Action: Proposed Completion Date: Finding 2024-007 Name of contact person: Corrective Action: Proposed Completion Date: Review of Verifications needed for Adult cases to determine eligibility correctly will be presented by supervisor to ensure workers know what verifications are needed at time of review or application. Documentation standards will be implemented to ensure workers are applying the correct documentation to the case. For the untimely reviews, Magi and Traditional Recertification Recertification Job Aid will be discussed. Acceptable timeframes and processing times will be discussed. Magi pending recertification details report and traditional recertification details report will be reviewed with staff. 1/31/2025 Section III - Federal Award Findings and Question Costs (continued) 1/31/2025 Ebony Mitchell, Medicaid Program Manager Ebony Mitchell, Medicaid Program Manager Ebony Mitchell, Medicaid Program Manager Review of Adult Policy section 2230 (Financial resources) and acknowledgement required with signature. 1/31/2025 NC Fast Learning gateway (Magi Budgeting: Income Determination) training. Review of family and children’s Medicaid policy section MA – 3300 Income and MA – 3306 Modified adjusted gross income (MAGI). Review of Adult Medicaid income policy section MA – 2250 Income. 145

Categories

Eligibility

Other Findings in this Audit

  • 524600 2024-004
    Significant Deficiency Repeat
  • 524601 2024-005
    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