Finding 529239 (2024-006)

Significant Deficiency Repeat Finding

Requirement

Questioned Costs

Year

2024

Accepted

2025-03-21

Audit: 347266

Organization: Hertford County (NC)

Auditor: Thompson Price Scott Adams & CO

AI Summary

Core Issue: Hertford County failed to conduct timely reviews of Medicaid eligibility after SSI terminations, leading to potential ineligibility for benefits.
Impacted Requirements: The County did not initiate required ex parte reviews within the designated time frame, violating Medicaid compliance standards.
Recommended Follow-Up: Improve communication between DSS departments and retrain staff on the review process to ensure timely eligibility assessments.

Finding Text

Hertford County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2024 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: 2024-006 Untimely Review of SSI Termination SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: There were 1 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. There was no known affect to eligibility and there were no known questioned costs. Any State communications related to applicants’ benefits received by any DSS department 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 The State sends notification to the County when a participant is no longer eligible under 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. We examined 60 cases from of a total of 353,314 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 agrees with the finding. See the response in the corrective action plan. 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 could lead to applicants receiving Medicaid benefits for which they were not eligible. 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. This is a repeat finding from the immediate previous audit, 2023-007. 116

Corrective Action Plan

Corrective Action Plan For the Year Ended June 30, 2024 Finding 2024-006 Untimely Review of SSI Termination Name of contact person: Corrective Action: Proposed completion date: Access and review the SSI Medicaid Termination Report daily in NC FAST. Assign staff or a designated point person to monitor and act on SSI terminations flagged in the system. Set up system alerts or reminders in NC FAST to notify staff of pending SSI terminations requiring immediate review. Develop a log or tracker (manual or digital) to record SSI termination cases, including review dates, actions taken, and deadlines. Use NC FAST or a supplemental tool to track cases through the review process, ensuring no cases fall through the cracks. Retrain staff on Ex Parte Reviews for SSI terminations, including the process for reviewing and evaluating ongoing eligibility. Reinforce the importance of timely action to avoid benefit gaps or unnecessary terminations. Provide clear, step-by-step instructions for handling SSI terminations, including where to find relevant information in NC FAST and how to document actions in case notes. Conduct second-party reviews of SSI termination cases to ensure timely and accurate action is taken. Supervisors should periodically audit a sample of cases to identify delays or errors. Contact clients as soon as an SSI termination is flagged, requesting updated information and notifying them of the potential impact on their benefits. Provide clear instructions on what documents are needed to reassess eligibility. Use NC FAST to track follow-ups with clients, ensuring they respond within required timeframes. Ensure staff are completing Ex Parte Reviews as required, utilizing existing evidence and verifications to determine continued eligibility without unnecessary delays. Develop workflow efficiencies to handle SSI terminations more effectively, such as batching similar cases for quicker review. Run O&M and Medicaid reports to monitor the timeliness of SSI termination reviews. Share progress and findings during staff meetings to promote transparency and improvement. Review reports to identify recurring issues or barriers causing delays and address them promptly. By establishing a system of regular monitoring, staff training, and supervisory oversight, the issue of untimely SSI termination reviews can be effectively addressed and prevented in the future. Management monitor daily to track progress of this issue and modify the controls as needed. Tiffiany Walton, Interim Director Anetre Vaughan, Adult Medicaid Supervisor Melissa Castelow, F&C Medicaid Supervisor Section III - Federal Award Findings and Question Costs BUILD YOUR FUTURE ON OUR FOUNDATION 115 Justice Drive  Suite 1  Winton, North Carolina 27986 Office 252.358.7805  Facsimile 252.358.0198  www.HerfordCountyNC.gov 123

Other Findings in this Audit

529240 2024-007

Significant Deficiency Repeat
529241 2024-008

Significant Deficiency Repeat
529242 2024-009

Significant Deficiency Repeat
1105681 2024-006

Significant Deficiency Repeat
1105682 2024-007

Significant Deficiency Repeat
1105683 2024-008

Significant Deficiency Repeat
1105684 2024-009

Significant Deficiency Repeat

Programs in Audit

ALN	Program Name	Expenditures
93.778	Medical Assistance Program	$1.25M
21.027	Coronavirus State and Local Fiscal Recovery Funds	$724,185
10.561	State Administrative Matching Grants for the Supplemental Nutrition Assistance Program	$461,253
93.563	Child Support Services	$298,902
93.045	Special Programs for the Aging, Title Iii, Part C, Nutrition Services	$157,518
93.667	Social Services Block Grant	$148,471
93.596	Child Care Mandatory and Matching Funds of the Child Care and Development Fund	$83,719
93.658	Foster Care Title IV-E	$81,553
93.568	Low-Income Home Energy Assistance	$80,849
93.044	Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers	$67,799
93.767	Children's Health Insurance Program	$55,519
97.042	Emergency Management Performance Grants	$39,698
93.053	Nutrition Services Incentive Program	$17,001
93.323	Epidemiology and Laboratory Capacity for Infectious Diseases (elc)	$2,924
93.558	Temporary Assistance for Needy Families	$1,960
93.659	Adoption Assistance	$1,066
93.566	Refugee and Entrant Assistance State/replacement Designee Administered Programs	$106