FAC Explorer

Finding 596578 (2022-007)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2022
Accepted
2023-02-19
Audit: 22511
Organization: Edgecombe County (NC)
Auditor: Thompson Price Scott Adams & CO P A

AI Summary

  • Core Issue: The County failed to review Medicaid eligibility on time after SSI terminations, affecting two beneficiaries.
  • Impacted Requirements: Timely ex parte reviews and redeterminations are mandated within specific timeframes according to Medicaid guidelines.
  • Recommended Follow-Up: Conduct internal file reviews, retrain staff on documentation standards, and ensure all eligibility records are complete and accurate.

Finding Text

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) CFDA # 93.778 Finding: 2022-007 Untimely Review of SSI Termination SIGNIFICANT DEFICIENCY ELIGIBILITY Criteria: In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a participant is no longer eligible under Supplemental Security Income (SSI) determination, the County is required to initiate the ex parte review within 5 workdays of the date the termination appears on the SSI Termination Report, and complete the redetermination within 4 months of the month the case appears on the SSI Termination Report and notify the recipient about applicant's ongoing eligibility for Medicaid. Condition: There were 2 applicant/beneficiaries not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 from a total of 957,769 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. Effect: 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-012. Cause: 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. Recommendation: 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. Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details.

Categories

Eligibility Reporting Significant Deficiency

Other Findings in this Audit

  • 20129 2022-009
    Significant Deficiency
  • 20130 2022-010
    Significant Deficiency
  • 20131 2022-008
    Significant Deficiency
  • 20132 2022-003
    Significant Deficiency Repeat
  • 20133 2022-004
    Significant Deficiency Repeat
  • 20134 2022-005
    Significant Deficiency Repeat
  • 20135 2022-006
    Significant Deficiency Repeat
  • 20136 2022-007
    Significant Deficiency Repeat
  • 596571 2022-009
    Significant Deficiency
  • 596572 2022-010
    Significant Deficiency
  • 596573 2022-008
    Significant Deficiency
  • 596574 2022-003
    Significant Deficiency Repeat
  • 596575 2022-004
    Significant Deficiency Repeat
  • 596576 2022-005
    Significant Deficiency Repeat
  • 596577 2022-006
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
21.027 Coronavirus State and Local Fiscal Recovery Funds $3.07M
93.778 Medical Assistance Program $2.08M
93.563 Child Support Enforcement $1.02M
93.658 Foster Care_title IV-E $368,086
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $327,658
93.994 Maternal and Child Health Services Block Grant to the States $191,759
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $157,596
93.568 Low-Income Home Energy Assistance $155,681
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $125,663
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $125,431
21.019 Coronavirus Relief Fund $110,338
93.000 Foster Care $107,485
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $61,173
93.217 Family Planning_services $53,723
10.760 Water and Waste Disposal Systems for Rural Communities $48,196
16.001 Law Enforcement Assistance_narcotics and Dangerous Drugs_laboratory Analysis $40,140
93.991 Preventive Health and Health Services Block Grant $35,560
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $32,003
93.069 Public Health Emergency Preparedness $28,998
93.053 Nutrition Services Incentive Program $22,933
93.767 Children's Health Insurance Program $22,313
93.558 Temporary Assistance for Needy Families $21,187
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $19,187
93.645 Stephanie Tubbs Jones Child Welfare Services Program $16,124
93.556 Promoting Safe and Stable Families $14,931
20.600 State and Community Highway Safety $14,922
97.042 Emergency Management Performance Grants $12,696
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $10,685
93.268 Immunization Cooperative Agreements $10,585
93.667 Social Services Block Grant $9,786
93.659 Adoption Assistance $8,806
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $6,993
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $1,625
93.297 Teenage Pregnancy Prevention Program $1,384
97.067 Homeland Security Grant Program $574
93.000 IV-E Adoption $234
97.039 Hazard Mitigation Grant $142
93.566 Refugee and Entrant Assistance_state Administered Programs $-839