Finding Text
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Food and Nutrition Services (FNS) Cluster
AL # 10.551 and 10.561
Finding: 2023-007
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria:
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.
The County agrees with the finding.
Section III - Federal Award Findings and Questioned Costs (Continued)
We examined 60 cases from of a total of 552,116 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement audit as
it relates to Medicaid administrative cost compliance audit.
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.
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.
This is a repeat finding from the immediate previous audit, 2022-008.
Per Section 200.303 of the Uniform Grant Guidance, a non-federal entity must
establish and maintain effective internal control over the Federal award that
provides reasonable assurance that the non-federal entity is managing the Federal
award in compliance with Federal statutes, regulations, and the terms and
conditions of the Federal award. The State has provided policies and procedures to
ensure that the County is meeting the federal guidance, relevant policies are:
Food and Nutrition Services Policy 305 describes the verification sources and
requirements and the FNS units primary responsibility for providing documentary
evidence to support statements on applications and recertifications and procedures
required if the statements by applicant/beneficiary are questionable.
Food and Nutrition Services Policy 300 describes the sources of income countable
and not countable to the household for determining financial eligibility.
Food and Nutrition Services Policy 310 describes the procedures related to verifying
changes in income (i.e. termination, end of contract, temporary, etc.).
Due to the errors noted, eligibility cannot be sufficiently substantiated and there is a
risk that the County could provide funding and/or benefits to individuals who are
not program eligible.
The County should provide training of management and staff on the program's
eligibility requirements, proper case review process, and required verifications for
eligibility. Also, the County should ensure that their formal internal review process
is adequately completed to identify and correct errors in case reviews.
The County agrees with the finding and is implementing actions to correct these
issues, which are further discussed in the corrective action plan.
There were a total of 6 errors found in our testing: 3 instances where verification of
an expense used for a deduction of income was not included in the case file and 3
instances where earned income was incorrectly caclculated or verification of
representative income was not completed or entered correctly in NCFAST.
There was no known affect to eligibility and there were no known questioned costs.
We examined 25 of 8,174 FNS recipients from the a report of all active FNS
beneficiaries provided by Nash County's Department of Human Services. The
finding is being reported with the financial statement audit as it relates to FNS
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 a participant could have been
approved for benefits for which they were not eligible.