PASSAIC COUNTY BOARD OF SOCIAL SERVICESLocal Government

Finding 2023-001 Information on the Federal Program: Medical Assistance Program (Medicaid; Title XIX), ALN # 93.778, Grant Period 1/1/23 – 12/31/23. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only medically needy individuals, or families whose incomes and resources are insufficient to meet the costs of necessary medical services may receive Medicaid to cover the claims supported by medical records. Condition: There were multiple instances where eligibility files selected for review were either incomplete, ineligible for benefits, or unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Compliance Supplement, each individual who receives benefits under the Medicaid program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving Medicaid benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documentation were on file and available for audit review.

Finding 2023-002 Information on the Federal Program: Temporary Assistance for Needy Families (TANF), ALN # 93.558, Grant Period 1/1/23 – 12/31/23. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only a financially needy family that consists of, at a minimum, a minor child living with a parent or other caretaker relative, or a pregnant woman may receive TANF “assistance” or most maintenance-of-effort (MOE)-funded benefits, services, or “assistance” regardless of the TANF purpose that the expenditure is reasonably calculated to accomplish. Condition: There were multiple instances where eligibility files selected for review were either incomplete, ineligible for benefits, or unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Circular Compliance Supplement, each individual who receives benefits under the TANF program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving TANF benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documents were on file and available for audit review.

Finding 2023-003 Information on the Federal Program: Temporary Assistance for Needy Families (TANF), ALN # 93.558, Grant Period 1/1/23 – 12/31/23. Criteria or Specific Requirement: According to N.J.A.C. 10:90-4.1 “General work requirement provisions”, Each WFNJ adult recipient, teen parent, and 16 through 18 year old individual not attending school on a full time basis, unless specifically deferred or unless otherwise specified in this subchapter, shall cooperate with and participate in the WFNJ work requirements in accordance with Federal regulations, the Federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996, the New Jersey State Plan for Temporary Assistance for Needy Families, the Work First New Jersey Act, and the New Jersey SNAP Employment and Training State Plan, for up to 40 hours per week as a condition of eligibility for receipt of cash assistance benefits. Condition: There were multiple instances where eligibility files selected for review revealed the clients were not complying with the “General work requirement provisions”, yet continued to receive benefit payments. Questioned Costs: Unable to be determined. Context: According to N.J.A.C. 10:90-4.13 “Sanctions”, The failure of a recipient to cooperate with the Work First New Jersey program or participate in work activities under the program without good cause shall result in a loss of cash assistance benefits in accordance with the provisions of this section. Effect: By failing to monitor the “General work requirement provisions” of N.J.A.C. 10:90-4.1, instances were noted where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all program participants were adhering to the “General work requirement provisions” of N.J.A.C. 10:90-4.1.

Finding 2022-002 Information on the Federal Program: Medical Assistance Program (Medicaid, Title XIX), ALN # 93.778, Grant Period 1/1/22 – 12/31/22. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only medically needy individuals, or families whose incomes and resources are insufficient to meet the costs of necessary medical services may receive Medicaid to cover the claims supported by medical records. Condition: There were multiple instances where eligibility files selected for review were either incomplete, ineligible for benefits, or unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Compliance Supplement, each individual who receives benefits under the Medicaid program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving Medicaid benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documentation were on file and available for audit review. Management’s Response: Electronic records for all disbursement are created by PCBSS employees on the state Medicaid Portal that records the issuance of benefits and ensure that the information recorded accords with state eligibility regulations. The decision as to whether to maintain paper copies of all pertinent documents is left by regulation to local decision. At 10:90-7.2 the contents of the case file are described in more detail. There is no requirement that hard copies of documents be placed in each case file. Caseworkers are required to note the inspection of case files and in local practice those notes are maintained in the locally operated GUMP system. Medicaid assistance cases are tracked and recorded in the locally operated GUMP system and a permanent record of each is maintained in case files to be Dimmed. Paper records are not required by the Division of Family Development.

Finding 2022-003 Information on the Federal Program: Temporary Assistance for Needy Families (TANF), ALN # 93.558, Grant Period 1/1/22 – 12/31/22. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only a financially needy family that consists of, at a minimum, a minor child living with a parent or other caretaker relative, or a pregnant woman may receive TANF “assistance” or most maintenance-of-effort (MOE)-funded benefits, services, or “assistance” regardless of the TANF purpose that the expenditure is reasonably calculated to accomplish. Condition: There were multiple instances where eligibility files selected for review were either incomplete, ineligible for benefits, or unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Circular Compliance Supplement, each individual who receives benefits under the TANF program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving TANF benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documents were on file and available for audit review. Management’s Response: Electronic records for all disbursement are created by PCBSS employees on the state operated systems commonly referred to as FAMIS and GAAS that record the issuance of benefits and ensure that the information recorded accords with state eligibility regulations. The decision as to whether to maintain paper copies of all pertinent documents is left by regulation to local decision. At 10:90-7.2 the contents of the case file are described in more detail. There is no requirement that hard copies of documents be placed in each case file. Caseworkers are required to note the inspection of case files and in local practice those notes are maintained in the locally operated GUMP system. TANF assistance cases are tracked and recorded in the locally operated GUMP system and a permanent record of each is maintained in case files to be Dimmed. Paper records are not required by the Division of Family Development.

Finding 2021-002 Information on the Federal Program: Medical Assistance Program (Medicaid, Title XIX), CFDA # 93.778, Grant Period 1/1/21 – 12/31/21. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only medically needy individuals, or families whose incomes and resources are insufficient to meet the costs of necessary medical services may receive Medicaid to cover the claims supported by medical records. Condition: There were multiple instances where eligibility files selected for review were either incomplete, or unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Compliance Supplement, each individual who receives benefits under the Medicaid program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving Medicaid benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documentation were on file and available for audit review. Management’s Response: The case record for all Medicaid cases is defined as the electronic or paper record of forms, narratives and documents upon which eligibility decisions are made. It reads: 10:90-7.1 Establishment and maintenance of case records (a) The case record is the official file, whether computerized or hard copy, of forms, chronological narrative, correspondence, and other documents pertinent to the application and determination of eligibility for Medicaid benefits. It constitutes a complete record of the county/municipal agency’s decisions and actions concerning eligibility for assistance in each case. Since it is the record on which decisions to grant, deny or continue assistance in accordance with law and regulations are made, it is mandatory that a case record be established and maintained for every individual who applies for and/or receives Medicaid benefits. Electronic records for all disbursement are created by PCBSS employees on the state operated systems commonly referred to as FAMIS and GAAS that record the issuance of benefits and ensure that the information recorded accords with state eligibility regulations. The decision as to whether to maintain paper copies of all pertinent documents is left by regulation to local decision. At 10:90-7.2 the contents of the case file are described in more detail. There is no requirement that hard copies of documents be placed in each case file. Caseworkers are required to note the inspection of case files and in local practice those notes are maintained in the locally operated GUMP eligibility system. The regulation reads: A record of all pertinent verifications, such as, but not limited to, birth certificates, Social Security numbers, driver’s licenses, and so forth. All TANF, SNAP and Medicaid assistance cases are tracked and recorded in the locally operated GUMP system and a permanent record of each is maintained. Paper records of all documents are not maintained and are not required by the Division of Family Development.

Finding 2021-003 Information on the Federal Program: Temporary Assistance for Needy Families (TANF), CFDA # 93.558, Grant Period 1/1/21 – 12/31/21. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only a financially needy family that consists of, at a minimum, a minor child living with a parent or other caretaker relative, or a pregnant woman may receive TANF “assistance” or most maintenance-of-effort (MOE)-funded benefits, services, or “assistance” regardless of the TANF purpose that the expenditure is reasonably calculated to accomplish. Condition: There were multiple instances where eligibility files selected for review were unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Circular Compliance Supplement, each individual who receives benefits under the TANF program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving TANF benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documents were on file and available for audit review. Management’s Response: The case record for all TANF cases is defined as the electronic or paper record of forms, narratives and documents upon which eligibility decisions are made. It reads: 10:90-7.1 Establishment and maintenance of case records (a) The case record is the official file, whether computerized or hard copy, of forms, chronological narrative, correspondence, and other documents pertinent to the application and determination of eligibility for TANF benefits. It constitutes a complete record of the county/municipal agency’s decisions and actions concerning eligibility for assistance in each case. Since it is the record on which decisions to grant, deny or continue assistance in accordance with law and regulations are made, it is mandatory that a case record be established and maintained for every individual who applies for and/or receives TANF benefits. Electronic records for all disbursement are created by PCBSS employees on the state operated systems commonly referred to as FAMIS and GAAS that record the issuance of benefits and ensure that the information recorded accords with state eligibility regulations. The decision as to whether to maintain paper copies of all pertinent documents is left by regulation to local decision. At 10:90-7.2 the contents of the case file are described in more detail. There is no requirement that hard copies of documents be placed in each case file. Caseworkers are required to note the inspection of case files and in local practice those notes are maintained in the locally operated GUMP eligibility system. The regulation reads: A record of all pertinent verifications, such as, but not limited to, birth certificates, Social Security numbers, driver’s licenses, and so forth. All TANF, SNAP and Medicaid assistance cases are tracked and recorded in the locally operated GUMP system and a permanent record of each is maintained. Paper records of all documents are not maintained and are not required by the Division of Family Development.

Finding 2020-002 Information on the Federal Program: Medical Assistance Program (Medicaid, Title XIX), CFDA # 93.778, Grant Period 1/1/20 ? 12/31/20. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only medically needy individuals, or families whose incomes and resources are insufficient to meet the costs of necessary medical services may receive Medicaid to cover the claims supported by medical records. Condition: There were multiple instances where eligibility files selected for review were either incomplete, or unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Compliance Supplement, each individual who receives benefits under the Medicaid program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving Medicaid benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documentation were on file and available for audit review. Management?s Response: The case record for all Medicaid cases is defined as the electronic or paper record of forms, narratives and documents upon which eligibility decisions are made. It reads: 10:90-7.1 Establishment and maintenance of case records (a) The case record is the official file, whether computerized or hard copy, of forms, chronological narrative, correspondence, and other documents pertinent to the application and determination of eligibility for Medicaid benefits. It constitutes a complete record of the county/municipal agency?s decisions and actions concerning eligibility for assistance in each case. Since it is the record on which decisions to grant, deny or continue assistance in accordance with law and regulations are made, it is mandatory that a case record be established and maintained for every individual who applies for and/or receives Medicaid benefits. Electronic records for all disbursement are created by PCBSS employees on the state operated systems commonly referred to as FAMIS and GAAS that record the issuance of benefits and ensure that the information recorded accords with state eligibility regulations. The decision as to whether to maintain paper copies of all pertinent documents is left by regulation to local decision. At 10:90-7.2 the contents of the case file are described in more detail. There is no requirement that hard copies of documents be placed in each case file. Caseworkers are required to note the inspection of case files and in local practice those notes are maintained in the locally operated GUMP eligibility system. The regulation reads: A record of all pertinent verifications, such as, but not limited to, birth certificates, Social Security numbers, driver?s licenses, and so forth. All TANF, SNAP and Medicaid assistance cases are tracked and recorded in the locally operated GUMP system and a permanent record of each is maintained. Paper records of all documents are not maintained and are not required by the Division of Family Development.

Finding 2020-003 Information on the Federal Program: Temporary Assistance for Needy Families (TANF), CFDA # 93.558, Grant Period 1/1/20 ? 12/31/20. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only a financially needy family that consists of, at a minimum, a minor child living with a parent or other caretaker relative, or a pregnant woman may receive TANF ?assistance? or most maintenance-of-effort (MOE)-funded benefits, services, or ?assistance? regardless of the TANF purpose that the expenditure is reasonably calculated to accomplish. Condition: There were multiple instances where eligibility files selected for review were unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Circular Compliance Supplement, each individual who receives benefits under the TANF program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving TANF benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documents were on file and available for audit review. Management?s Response: The case record for all TANF cases is defined as the electronic or paper record of forms, narratives and documents upon which eligibility decisions are made. It reads: 10:90-7.1 Establishment and maintenance of case records (a) The case record is the official file, whether computerized or hard copy, of forms, chronological narrative, correspondence, and other documents pertinent to the application and determination of eligibility for TANF benefits. It constitutes a complete record of the county/municipal agency?s decisions and actions concerning eligibility for assistance in each case. Since it is the record on which decisions to grant, deny or continue assistance in accordance with law and regulations are made, it is mandatory that a case record be established and maintained for every individual who applies for and/or receives TANF benefits. Electronic records for all disbursement are created by PCBSS employees on the state operated systems commonly referred to as FAMIS and GAAS that record the issuance of benefits and ensure that the information recorded accords with state eligibility regulations. The decision as to whether to maintain paper copies of all pertinent documents is left by regulation to local decision. At 10:90-7.2 the contents of the case file are described in more detail. There is no requirement that hard copies of documents be placed in each case file. Caseworkers are required to note the inspection of case files and in local practice those notes are maintained in the locally operated GUMP eligibility system. The regulation reads: A record of all pertinent verifications, such as, but not limited to, birth certificates, Social Security numbers, driver?s licenses, and so forth. All TANF, SNAP and Medicaid assistance cases are tracked and recorded in the locally operated GUMP system and a permanent record of each is maintained. Paper records of all documents are not maintained and are not required by the Division of Family Development.

Finding 2019-002 Information on the Federal Program: Medical Assistance Program (Medicaid, Title XIX), CFDA # 93.778, Grant Period 1/1/19 ? 12/31/19. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only medically needy individuals, or families whose incomes and resources are insufficient to meet the costs of necessary medical services may receive Medicaid to cover the claims supported by medical records. Condition: There were multiple instances where eligibility files selected for review were either incomplete, or unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Compliance Supplement, each individual who receives benefits under the Medicaid program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving Medicaid benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documentation were on file and available for audit review. Management?s Response: The case record for all Medicaid cases is defined as the electronic or paper record of forms, narratives and documents upon which eligibility decisions are made. It reads: 10:90-7.1 Establishment and maintenance of case records (a) The case record is the official file, whether computerized or hard copy, of forms, chronological narrative, correspondence, and other documents pertinent to the application and determination of eligibility for Medicaid benefits. It constitutes a complete record of the county/municipal agency?s decisions and actions concerning eligibility for assistance in each case. Since it is the record on which decisions to grant, deny or continue assistance in accordance with law and regulations are made, it is mandatory that a case record be established and maintained for every individual who applies for and/or receives Medicaid benefits. Electronic records for all disbursement are created by PCBSS employees on the state operated systems commonly referred to as FAMIS and GAAS that record the issuance of benefits and ensure that the information recorded accords with state eligibility regulations. The decision as to whether to maintain paper copies of all pertinent documents is left by regulation to local decision. At 10:90-7.2 the contents of the case file are described in more detail. There is no requirement that hard copies of documents be placed in each case file. Caseworkers are required to note the inspection of case files and in local practice those notes are maintained in the locally operated GUMP eligibility system. The regulation reads: A record of all pertinent verifications, such as, but not limited to, birth certificates, Social Security numbers, driver?s licenses, and so forth. All TANF, SNAP and Medicaid assistance cases are tracked and recorded in the locally operated GUMP system and a permanent record of each is maintained. Paper records of all documents are not maintained and are not required by the Division of Family Development.

Finding 2019-003 Information on the Federal Program: Temporary Assistance for Needy Families (TANF), CFDA # 93.558, Grant Period 1/1/19 ? 12/31/19. Criteria or Specific Requirement: According to the OMB Uniform Guidance Compliance Supplement, only a financially needy family that consists of, at a minimum, a minor child living with a parent or other caretaker relative, or a pregnant woman may receive TANF ?assistance? or most maintenance-of-effort (MOE)-funded benefits, services, or ?assistance? regardless of the TANF purpose that the expenditure is reasonably calculated to accomplish. Condition: There were multiple instances where eligibility files selected for review were either incomplete, or unable to be presented for audit review. Questioned Costs: Unable to be determined. Context: Per the Federal OMB Uniform Guidance Circular Compliance Supplement, each individual who receives benefits under the TANF program should have a completed eligibility determination on file which is available for audit review. Effect: By failing to provide documentation that each individual receiving TANF benefits was eligible for the program, there could be instances where ineligible program participants are receiving assistance. Cause: Controls were not in place to ensure that all required eligibility determinations and supporting documents were on file and available for audit review. Management?s Response: The case record for all TANF cases is defined as the electronic or paper record of forms, narratives and documents upon which eligibility decisions are made. It reads: 10:90-7.1 Establishment and maintenance of case records (a) The case record is the official file, whether computerized or hard copy, of forms, chronological narrative, correspondence, and other documents pertinent to the application and determination of eligibility for TANF benefits. It constitutes a complete record of the county/municipal agency?s decisions and actions concerning eligibility for assistance in each case. Since it is the record on which decisions to grant, deny or continue assistance in accordance with law and regulations are made, it is mandatory that a case record be established and maintained for every individual who applies for and/or receives TANF benefits. Electronic records for all disbursement are created by PCBSS employees on the state operated systems commonly referred to as FAMIS and GAAS that record the issuance of benefits and ensure that the information recorded accords with state eligibility regulations. The decision as to whether to maintain paper copies of all pertinent documents is left by regulation to local decision. At 10:90-7.2 the contents of the case file are described in more detail. There is no requirement that hard copies of documents be placed in each case file. Caseworkers are required to note the inspection of case files and in local practice those notes are maintained in the locally operated GUMP eligibility system. The regulation reads: A record of all pertinent verifications, such as, but not limited to, birth certificates, Social Security numbers, driver?s licenses, and so forth. All TANF, SNAP and Medicaid assistance cases are tracked and recorded in the locally operated GUMP system and a permanent record of each is maintained. Paper records of all documents are not maintained and are not required by the Division of Family Development.