Finding 7705 (2023-002)

Information on the federal program: Medicaid Cluster (Medicaid), Assistance Listing Number 93.778, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services (NCDHHS), Division of Medical Assistance. Criteria: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX) Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual), case files for individuals or families receiving assistance are required to retain documentation to serve as evidence for the appropriate eligibility determination, including: • accurate computation of countable income and resources; • verification of unearned income; • verification of earned income; and • verification of relationships in the household Information on any non-custodial parent most be obtained for a child support referral within 12 months of the applicant’s eligibility determination. Condition: We noted one instance where the applicant’s relationship with their grandparent, who was included in the household composition, was not established with supporting documentation. We noted two instances where the child support referral was not submitted timely. We noted one instance where the bank information was incorrectly entered by the County for $5. Context/Cause: The County did not retain required documentation in the case files at the time eligibility was determined. We noted the above conditions in 4 out of the 60 case files inspected for applicable payments. Effects: Case files not containing all required documentation results in a risk that the County could provide services to individuals not eligible to receive such services or that such services could be denied to eligible individuals. For all five cases noted, subsequent to being notified that required documentation had not been retained in the case file, the County was able to obtain documentation to substantiate that the applicants tested were eligible to receive benefits. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policies and procedures in place to ensure that all eligibility determination documentation is completed and retained by the County. Auditee’s Response: We concur with the findings and have implemented controls that ensure that eligibility is accurate and continue to complete case reviews to monitor policy compliance.