Finding 559157 (2021-012)

Significant Deficiency
Requirement
E
Questioned Costs
-
Year
2021
Accepted
2025-05-02
Audit: 355385
Organization: Caswell County (NC)

AI Summary

  • Core Issue: Inadequate documentation and record-keeping for Medicaid eligibility led to potential approval of ineligible benefits.
  • Impacted Requirements: Compliance with 42 CFR 435, which mandates proper documentation and electronic verification for eligibility determinations.
  • Recommended Follow-Up: Retrain staff on documentation standards and ensure all files include necessary verifications and accurate case notes.

Finding Text

CASWELL COUNTY, NORTH CAROLINA Schedule of Findings and Questioned Costs For the Year Ended June 30, 2021 US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medicaid Assistance Program (Medicaid; Title XIX) CFDA# 93.778 Finding 2021-012 Inadequate Request for Information SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Cause: Recommendation: Views of Responsible officials and corrective action plans: Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA #: 93.778 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. 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. 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 21 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Section III. Federal Award Findings and Questioned Costs (continued) The county agrees with the finding. Please refer to the corrective action plan for details. SIGNIFICANT DEFICENCY: Finding 2021-009, 2021-010, 2021-011, 2021-012 also apply to State requirements and State Awards. Section IV. State Award Findings and Questioned Costs We examined 60 Medicaid recipients 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. There was no known affect to eligibility and there were no known questioned costs. 121

Corrective Action Plan

CASWELL COUNTY 144 Court Square, Yanceyville, NC 27379 www.caswellcountync.gov 336/694‐4193 Corrective Action Plan For the Year Ended June 30, 2021 Finding: 2021-011 Inaccurate Resource Calculation Name of contact person: Corrective Action: Proposed Completion Date: Finding: 2021-012 Inadequate Request for Information Name of contact person: Corrective Action: Heather Starr Thomas, Medicaid Supervisor Files will be reviewed internally to ensure proper documentation is in place for eligibility. Workers will be retrained on what files should contain and the importance of complete and accurate record keeping. All files will 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. Templates have been put in place to address request for information. All avenues available to caseworker must be exhausted before requesting information from client, unless information provided and information obtained is questionable. We will continue to train on this issue, and it will also be addressed in new worker Trainings. Training in the learning gateway is also available. Section III - Federal Award Findings and Question Costs (continued) 2/28/2022 Heather Starr Thomas, Medicaid Supervisor Files will 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. All files must 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. Resources have been readdressed at Unit Meeting. Templates have been put in place to address programs in which resources are countable. We will continue to train on this issue, and it will also be addressed in new worker Trainings. Training in the learning gateway is also available. 128

Categories

Eligibility Significant Deficiency

Other Findings in this Audit

  • 559154 2021-009
    Significant Deficiency Repeat
  • 559155 2021-010
    Significant Deficiency Repeat
  • 559156 2021-011
    Significant Deficiency
  • 1135596 2021-009
    Significant Deficiency Repeat
  • 1135597 2021-010
    Significant Deficiency Repeat
  • 1135598 2021-011
    Significant Deficiency
  • 1135599 2021-012
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
14.871 Section 8 Housing Choice Vouchers $1.15M
21.019 Coronavirus Relief Fund $834,253
93.778 Medical Assistance Program $623,744
93.558 Temporary Assistance for Needy Families $338,690
93.563 Child Support Services $318,086
93.568 Low-Income Home Energy Assistance $312,590
20.509 Formula Grants for Rural Areas and Tribal Transit Program $296,698
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $238,434
93.045 Special Programs for the Aging, Title Iii, Part C, Nutrition Services $185,952
93.667 Social Services Block Grant $177,648
93.658 Foster Care Title IV-E $149,070
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $130,088
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $116,706
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $80,237
93.268 Immunization Cooperative Agreements $75,769
93.217 Family Planning Services $32,078
16.575 Crime Victim Assistance $31,014
93.069 Public Health Emergency Preparedness $30,720
93.991 Preventive Health and Health Services Block Grant $26,240
93.053 Nutrition Services Incentive Program $24,148
93.994 Maternal and Child Health Services Block Grant to the States $22,637
93.000 Foster Care $17,542
93.052 National Family Caregiver Support, Title Iii, Part E $16,662
93.044 Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers $10,878
93.645 Stephanie Tubbs Jones Child Welfare Services Program $8,582
93.767 Children's Health Insurance Program $8,317
93.556 Marylee Allen Promoting Safe and Stable Families Program $8,232
93.110 Maternal and Child Health Federal Consolidated Programs $7,500
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $4,718
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $4,505
93.659 Adoption Assistance $818
93.977 Sexually Transmitted Diseases (std) Prevention and Control Grants $100
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $50