Finding Text
US Department of Health and Human Services Passed-through the NC Dept. of Health and Human Services Program Name: Low Income Home energy Assistance CFDA #: 93.568 Finding: 2022-6 MATERIAL WEAKNESS/SIGNIFICANT NONCOMPLIANCE Required verifications and documentation for Eligibility Criteria: Per the North Carolina Low-Income Home Energy Assistance Compliance Supplement, the DSS manuals (Energy Programs Manual and others referenced therein), and Administrative Letters from the Division of Health Benefits case files for individuals or families receiving assistance are required to retain documentation to evidence appropriate eligibility determination, including verifications of and support for: ? Household composition ? Citizenship ? Vulnerability ? Income and Deductions ? Energy-related crisis (CIP only) The DSS manuals and Administrative Letters also provide income maintenance amounts for the respective energy program and budget unit size. The computed countable income must be under these limits for the person / family to be eligible for the Medicaid program. Condition: We noted 37 instances of case records not containing the proper verifications or proper computations as required by policy. The files for 5 applications did not calculate income using the gross pay. 13 files for applications did not calculate income using an income averaging method as described in the manual and instead used actual income for the base period. Files for 4 applications did not record or use the correct social security payment in income. 1 additional application did not properly record or use the correct earned income in the income calculation. 10 applications for CIP did not document a life-threatening emergency AND the danger of a household member if the crisis was not alleviated or an illness/medical condition that poses an immediate risk to health or life of any household member. 1 application included a medical condition that posed an immediate risk to health or life, but the person was not included in the household. There were 3 applications that were not approved for the full amount of the crisis because the County was applying an annual maximum benefit for CIP of $600. For the Federal Fiscal Year 2022, the annual maximum for CIP was $1,000. Questioned Costs: There were $3,168 in known errors. The known error rate projects or extrapolates to the entire population of claims paid for the year to an estimated $59,333 in questioned costs for claims paid during the fiscal year. Context: Out of $338,557 claims paid during the year, we tested the eligibility of the application for 40 claims that totaled $18,076. The conditions noted above were noted in 26 of the 40 applications tested. Effect: Case files not containing all required documentation result in a risk that the County could provide benefits to individuals not eligible to receive such benefits or that such individuals could be denied access to eligible benefits. Upon notification of the missing documentation or the errors in calculations in the case files, the County was able to obtain documentation and provide corrected calculations to substantiate that the recipients tested were eligible to receive benefits in all but 11 claims. Those claims totaled $3,168. Identification of a repeat finding: This is a new finding. Cause: The County did not obtain or retain required documentation in case files at the time that eligibility was determined. The review performed by the caseworker was ineffective in determining that all required items were retained, that all calculations were accurate, and that all necessary information was entered into NCFast. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process, specifically those areas noted to have errors above. Files should be reviewed internally to ensure proper documentation is in place for eligibility. Work aids for areas such as income may be helpful for Caseworkers as they document the eligibility process. NCFast should be reviewed to determine that information gathered during the review is properly input into the system and that system driven calculations are utilizing the available information. Views of responsible officials and planned corrective actions: The County agrees with the finding. The Crisis Department will do a monthly review of Crisis and LIEAP policies to stay on top of any changes that may occur between fiscal years and to ensure we are implementing correct procedures. We will also perform self-audits monthly. We will randomly pull two applications from each caseworker to ensure that we are improving on areas we?ve made errors in the past and that we are correctly documenting/processing applications. Based on any findings/questions we have during these self-audits, we will contact our state representative for clarifications.