Finding 7071 (2023-004)

U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medicaid Assistance Program (Medicaid; Title XIX) AL# 93.778 Finding: 2023-004 IV-D Cooperation with Child Support SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Cost: Context: Effect: There were 5 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. There were no known affects to eligibility and there were no known questioned costs. The County agrees with the finding and is implementing actions to correct these issues, which are further discussed in the corrective action plan. 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. This is a repeat finding from the immediate previous audit, 2022-003. In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. We examined 60 of a total of 1,030,518 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 applicants could have been approved for benefits for which they were not eligible. U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medicaid Assistance Program (Medicaid; Title XIX) AL# 93.778 Finding: 2023-004 IV-D Cooperation with Child Support SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Cost: Context: Effect: There were 5 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. There were no known affects to eligibility and there were no known questioned costs. The County agrees with the finding and is implementing actions to correct these issues, which are further discussed in the corrective action plan. 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. This is a repeat finding from the immediate previous audit, 2022-003. In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. We examined 60 of a total of 1,030,518 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 applicants could have been approved for benefits for which they were not eligible.