Finding 9910 (2023-004)

Significant Deficiency Repeat Finding

Requirement

Questioned Costs

Year

2023

Accepted

2024-01-25

Audit: 13548

Organization: Edgecombe County (NC)

Auditor: Thompson Price Scott Adams & CO P A

AI Summary

Core Issue: Significant deficiencies in eligibility processes for the Medical Assistance Program (Medicaid) were identified, including non-cooperation with Child Support Enforcement and inaccurate information entry.
Impacted Requirements: Compliance with Medicaid Manual MA-3365 is critical; all cases must be evaluated for referrals to Child Support Agencies, and proper documentation is essential for eligibility determinations.
Recommended Follow-Up: Conduct internal reviews of files to ensure accurate information and adherence to procedures; improve case review processes to prevent repeat findings.

Finding Text

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Finding: 2023-004 IV-D Non-Cooperation SIGNIFICANT DEFICIENCY ELIGIBILITY US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Finding: 2023-005 Inaccurate Information Entry SIGNIFICANT DEFICIENCY ELIGIBILITY Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determine eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-003. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Cause: Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. Section III. Federal Award Findings Criteria: 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 Department of Social Services (DSS) and Child Support Agencies must be met or good cause for not cooperating must be established when determine Medicaid eligibility. Condition: There were 4 errors discovered during our procedures that referrals between the County's Department of Social Services and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 from a total of 911,554 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.

Corrective Action Plan

Finding: 2023-004 IV-D Non-Cooperation Finding: 2023-005 Inaccurate Information Entry Finding: 2023-006 Inaccurate Resource Calculation Edgecombe County, NC Section III - Federal Award Findings and Question Costs Name of contact person: Veronica Lyons, Tina Radford, Virginia Ewuell, & Angel Joyner/Medicaid Supervisors Corrective Action: The errors that were found were under the policy of having to comply with Child Support. As of August 18, 2023, this policy is no longer in effect while we are under the CCU (Continuous Coverage Unwinding). Medicaid Supervisors will continue to abide by the policy changes as they come into effect to reconvene the compliance with Child Support. Proposed Completion Date: Not applicable.

Other Findings in this Audit

9911 2023-005

Significant Deficiency Repeat
9912 2023-006

Significant Deficiency Repeat
9913 2023-007

Significant Deficiency Repeat
9914 2023-008

Significant Deficiency Repeat
586352 2023-004

Significant Deficiency Repeat
586353 2023-005

Significant Deficiency Repeat
586354 2023-006

Significant Deficiency Repeat
586355 2023-007

Significant Deficiency Repeat
586356 2023-008

Significant Deficiency Repeat

Programs in Audit

ALN	Program Name	Expenditures
21.027	Coronavirus State and Local Fiscal Recovery Funds	$5.99M
93.778	Medical Assistance Program	$1.78M
93.563	Child Support Enforcement	$984,140
93.558	Temporary Assistance for Needy Families	$944,426
10.561	State Administrative Matching Grants for the Supplemental Nutrition Assistance Program	$732,296
93.568	Low-Income Home Energy Assistance	$634,693
10.760	Water and Waste Disposal Systems for Rural Communities	$503,000
93.658	Foster Care_title IV-E	$465,309
93.667	Social Services Block Grant	$415,990
10.557	Special Supplemental Nutrition Program for Women, Infants, and Children	$233,159
93.994	Maternal and Child Health Services Block Grant to the States	$203,961
93.045	Special Programs for the Aging_title Iii, Part C_nutrition Services	$164,484
93.044	Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers	$142,342
93.596	Child Care Mandatory and Matching Funds of the Child Care and Development Fund	$119,410
20.600	State and Community Highway Safety	$72,727
93.268	Immunization Cooperative Agreements	$71,746
93.217	Family Planning_services	$55,168
93.659	Adoption Assistance	$41,632
97.042	Emergency Management Performance Grants	$39,032
93.767	Children's Health Insurance Program	$34,381
93.391	Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises	$32,961
93.069	Public Health Emergency Preparedness	$31,126
93.991	Preventive Health and Health Services Block Grant	$30,651
93.053	Nutrition Services Incentive Program	$28,576
93.323	Epidemiology and Laboratory Capacity for Infectious Diseases (elc)	$24,544
93.116	Project Grants and Cooperative Agreements for Tuberculosis Control Programs	$21,061
16.001	Law Enforcement Assistance_narcotics and Dangerous Drugs_laboratory Analysis	$13,500
93.674	John H. Chafee Foster Care Program for Successful Transition to Adulthood	$9,896
93.645	Stephanie Tubbs Jones Child Welfare Services Program	$6,630
93.556	Promoting Safe and Stable Families	$2,333
93.898	Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations	$1,925