Finding Text
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 2022-010 Untimely Review of SSI Termination
SIGNIFICANT DEFICIENCY
Eligibility
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.
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: Any State communications related to applicants’ benefits received by any DSS department
should be shared with all areas from which the participant receives benefits. State files should be reviewed
internally to ensure all actions have been properly closed and the corrective action has been taken. Workers should
be retrained on what process needs to be followed when State communications are received.
Views of responsible officials and planned corrective actions: The County agrees with the finding. See
Corrective Action Plan.
NORTHAMPTON COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2022
Section III. Federal Award Findings (continued)
Criteria: The State sends notification to the County when a participant is no longer eligible under SSI
determination. The County has a certain time period to initiate an ex parte review to determine whether the
recipient qualifies for Medicaid under any other coverage group, such as Family and Children's Medicaid, North
Carolina Health Choice for Children, Work First Family Assistance, or Medicaid for the Aged, Blind and Disabled.
Condition: There was 1 applicant 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 cases from of a total of 255,485 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.