ANSON COUNTYLocal Government

ANSON COUNTY, NORTH CAROLINA Schedule of Findings and Questioned Costs For the Year Ended June 30, 2025 Identification of major State programs: Program Name Medical Assistance Program Administration Public School Building Capital Fund - Needs Based Lottery Fund Dollar threshold used to determine a State major program $ 500,000 Auditee qualified as State low-risk auditee? yes X no None reported U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid) AL #: 93.778 Finding: 2025-001 SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Section II - Financial Statement Findings Section I - Summary of Auditors' Results Section III - Federal Award Findings and Questioned Costs Federal regulations under 42 CFR § 435.956 require states to verify eligibility factors using electronic data sources where available, and to obtain documentation for unverifiable information. Additionally, the state's Medicaid manual (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual) mandates that all eligibility determinations include cross-verification of applicant-provided data against reliable external sources to ensure accuracy and prevent improper payments. There were a total of 28 errors found during our testing procedures: - There were 4 errors where income or household size was incorrectly calculated or inaccurate information was entered into the case file. - There was 4 error where resources were incorrectly calculated or were not properly documented in the case file. - There were 18 errors where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. In one notable instance, a failure resulted in a recipient being deemed eligible for Medicaid benefits when they were not, due to income exceeding the eligibility threshold. - There were 2 errors where applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. Due to the nature of the populations provided from which the samples were chosen, we are unable to calculate questioned costs for the above mentioned potential eligibility and noncompliance errors. 122ANSON COUNTY, NORTH CAROLINA Schedule of Findings and Questioned Costs For the Year Ended June 30, 2025 Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Section III - Federal Award Findings and Questioned Costs (continued) SIGNIFICANT DEFICENCY: Finding 2025-001 also apply to State requirements and State Awards. The deficiencies and noncompliance reported above are caused from ineffective record keeping and case review processes due to insufficient training of staff, lack of oversight from management, and/or inadequate communication between departments resulting in inconsistencies in data sharing and delayed information exchanges. We recommend that management enhance internal controls by: (1) Providing comprehensive training to staff on the program's eligibility requirements and procedures outlined in the State's Medicaid manuals; (2) Ensuring that there is a formal internal review process and that it is adequately completed to identify and correct errors and monitor compliance; and (3) Communicating all program or policy changes clearly and timely across all departments who oversee eligibility determinations for federal funded programs. The County agrees with the finding and is implementing actions to correct these issues, which are further discussed in the corrective action plan. Section IV. State Award Findings and Questioned Costs We examined 60 cases from of a total of 200,868 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. These control deficiencies and noncompliance increase the risk of improper Medicaid payments, potentially resulting in overpayments to ineligible beneficiaries or underpayments to those who qualify. This is a repeat finding from the immediate previous audit, 2024-002, 2024-004, 2024-005 and 2024- 006. Note in FY 2025 Medicaid findings were combined into a single finding. 123

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: 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 applicants could have been approved for benefits for which they were not eligible. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 373,631 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. Program Names: Medical Assistance AL # 93.778 Finding: 2024-002 Inadequate Request for Information In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. Electronic matches are required at applications and redeterminations. There were 6 errors discovered during our procedures where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. Questioned Costs: Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources and income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-005. Section III - Federal Award Findings and Questioned Costs Views of Responsible Officials and Planned Corrective Actions: The county agrees with this finding. See corrective action plan.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2024-003 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Questioned Costs: Identification of a repeat finding: Section III - Federal Award Findings and Questioned Costs (continued) IV-D Non-Cooperation Views of Responsible Officials and Planned Corrective Actions: 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 Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. There was 1 error discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 373,631 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. 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. This is a repeat finding from the immediate previous audit, 2023-006. Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. 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. The County agrees with the finding. See corrective action plan.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2024-004 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Section III - Federal Award Findings and Questioned Costs (continued) There were 7 errors discovered during our procedures where income or household size was incorrectly calculated or inaccurate information was entered into the case file. Of these 7 errors, one was determined to be an eligibility error with known questioned costs. As a result of the lack of a proper eligibility determination, federal funds were distributed to ineligible recipients leading to known questioned costs totaling $663. This may result in disallowed costs that will need to be repaid to the federal awarding agency. Questioned Costs: We examined 60 cases from of a total of 373,631 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. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, a participant could have been approved to receive benefits for which they were not eligible. Inaccurate Information Entry In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific income standards, and documentation must be maintained to support eligibility determinations. In accordance with 2 CFR 200, management should have an adequate system of internal controls procedures in place to ensure an applicant is properly determined or redetermined for benefits. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-007. Views of Responsible Officials and Planned Corrective Actions: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Program Names: Medical Assistance AL # 93.778 Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes that clearly indicates what actions were performed and the results of those actions. The County agrees with the finding. See corrective action plan.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2024-005 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Inaccurate Resource Calculation Views of Responsible Officials and Planned Corrective Actions: The County agrees with the finding. See corrective action plan. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-008. In accordance with Medicaid Manual MA-2230, Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application and these items will agree to reports in the NC FAST system. In this process, the countable resources should be calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the verification process should be considered countable or noncountable resources and explained within the documentation. There were 3 errors discovered during our procedures where resources were imcorrectly calculated or were not properly documented in the case file. Program Names: Medical Assistance AL # 93.778 We examined 60 cases from of a total of 373,631 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. 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. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2024-006 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Untimely Review of SSI Terminations Views of Responsible Officials and Planned Corrective Actions: The County agrees with the finding. See corrective action plan. In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a participant is no longer eligible under Supplemental Security Income (SSI) determination, the County is required to initiate the ex parte review within 5 workdays of the date the termination appears on the SSI Termination Report, and complete the redetermination within 4 months of the month the case appears on the SSI Termination Report and notify the recipient about applicant's ongoing eligibility for Medicaid. There was 1 applicants/beneficiary 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. We examined 60 cases from of a total of 373,631 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. 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-009.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: In accordance with the Single Audit Act of 1984 (amended in 1996), and the Office of Management and Budget (OMB) Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements for Federal Awards (Uniform Guidance), a single audit reporting package and data collection form is required to submitted to the Federal Audit Clearinghouse (FAC) 30 days after receipt of the auditor's report, or 9 months after the end of the fiscal year, whichever comes first. The audit report was not finalized until 10 months after year end. Federal agencies that provide funding and other public associations need current financial information about each unit of local government. The County's audits have been submitted late over the past several years. The County was unable to provide information necessary to complete the audit timely as a result of staffing issues. The County should allocate sufficient resources to ensure that all records are reconciled timely to allow time for the audit to be completed timely. There was no known affect to eligibility and there were no known questioned costs. Section III - Federal Award Findings and Questioned Costs Program Names: Medical Assistance AL # 93.778 Finding: 2023-005 Inadequate Request for Information In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. Electronic matches are required at applications and redeterminations. There were 8 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. Context: Effect: Cause: US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2023-006 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-006. Section III - Federal Award Findings and Questioned Costs (continued) Views of Responsible Officials and Planned Corrective Actions: The county agrees with this finding. See corrective action plan. Program Names: Medical Assistance AL # 93.778 IV-D Non-Cooperation 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 Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. 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 applicants could have been approved for benefits for which they were not eligible. We examined 60 cases from of a total of 331,466 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. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources and income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. There were 2 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. 127

Context: Effect: Cause: US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2023-006 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-006. Section III - Federal Award Findings and Questioned Costs (continued) Views of Responsible Officials and Planned Corrective Actions: The county agrees with this finding. See corrective action plan. Program Names: Medical Assistance AL # 93.778 IV-D Non-Cooperation 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 Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. 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 applicants could have been approved for benefits for which they were not eligible. We examined 60 cases from of a total of 331,466 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. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources and income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. There were 2 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. 127 Context: Effect: Cause: US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2023-007 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: AL # 93.778 Inaccurate Information Entry In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific income standards, and documentation must be maintained to support eligibility determinations. In accordance with 2 CFR 200, management should have an adequate system of internal controls procedures in place to ensure an applicant is properly determined or redetermined for benefits. There were 8 errors discovered during our procedures that inaccurate information was entered when determining eligibility. One applicant received assistance although the family income were above the State provided income Standard. There was no known affect to Questioned Costs: eligibility and there were no known questioned costs. We examined 60 cases from of a total of 331,466 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. 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. Section III - Federal Award Findings and Questioned Costs (continued) We examined 60 cases from of a total of 331,466 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. 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. Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. Program Names: Medical Assistance Views of Responsible Officials and Planned Corrective Actions: The County agrees with the finding. See corrective action plan. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-007.

Context: Effect: Cause: US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2023-007 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: AL # 93.778 Inaccurate Information Entry In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific income standards, and documentation must be maintained to support eligibility determinations. In accordance with 2 CFR 200, management should have an adequate system of internal controls procedures in place to ensure an applicant is properly determined or redetermined for benefits. There were 8 errors discovered during our procedures that inaccurate information was entered when determining eligibility. One applicant received assistance although the family income were above the State provided income Standard. There was no known affect to Questioned Costs: eligibility and there were no known questioned costs. We examined 60 cases from of a total of 331,466 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. 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. Section III - Federal Award Findings and Questioned Costs (continued) We examined 60 cases from of a total of 331,466 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. 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. Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. Program Names: Medical Assistance Views of Responsible Officials and Planned Corrective Actions: The County agrees with the finding. See corrective action plan. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-007. Effect: Cause: US Department of Health and Human Service Passed through the NC Dept of Health and Human Services AL # 93.778 Finding: 2023-008 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes that clearly indicates what actions were performed and the results of those actions. The County agrees with the finding. See corrective action plan. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, a participant could have been approved to receive benefits for which they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-008. Program Names: Medical Assistance In accordance with Medicaid Manual MA-2230, Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application and these items will agree to reports in the NC FAST system. In this process, the countable resources should be calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the verification process should be considered countable or noncountable resources and explained within the documentation. There was 1 error discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. Of these, one beneficiary received assistance for which the recipient was not eligible. Views of Responsible Officials and Planned Corrective Actions: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Inaccurate Resource Calculation Questioned Costs: The total questioned costs for the ineligibility error noted above did not meet the minimum threshold for reporting. Section III - Federal Award Findings and Questioned Costs (continued) 129

Effect: Cause: US Department of Health and Human Service Passed through the NC Dept of Health and Human Services AL # 93.778 Finding: 2023-008 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes that clearly indicates what actions were performed and the results of those actions. The County agrees with the finding. See corrective action plan. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, a participant could have been approved to receive benefits for which they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-008. Program Names: Medical Assistance In accordance with Medicaid Manual MA-2230, Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application and these items will agree to reports in the NC FAST system. In this process, the countable resources should be calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the verification process should be considered countable or noncountable resources and explained within the documentation. There was 1 error discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. Of these, one beneficiary received assistance for which the recipient was not eligible. Views of Responsible Officials and Planned Corrective Actions: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Inaccurate Resource Calculation Questioned Costs: The total questioned costs for the ineligibility error noted above did not meet the minimum threshold for reporting. Section III - Federal Award Findings and Questioned Costs (continued) 129 Context: Effect: Cause: US Department of Health and Human Service Passed through the NC Dept of Health and Human Services AL # 93.778 Finding: 2023-009 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Program Names: Medical Assistance We examined 60 cases from of a total of 331,466 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. 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. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Section III - Federal Award Findings and Questioned Costs (continued) In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a participant is no longer eligible under Supplemental Security Income (SSI) determination, the County is required to initiate the ex parte review within 5 workdays of the date the termination appears on the SSI Termination Report, and complete the redetermination within 4 months of the month the case appears on the SSI Termination Report and notify the recipient about applicant's ongoing eligibility for Medicaid. There was 2 applicant/beneficiary not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated, for which the recipient was not eligible. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-009. Untimely Review of SSI Terminations

Context: Effect: Cause: US Department of Health and Human Service Passed through the NC Dept of Health and Human Services AL # 93.778 Finding: 2023-009 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Program Names: Medical Assistance We examined 60 cases from of a total of 331,466 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. 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. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Section III - Federal Award Findings and Questioned Costs (continued) In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a participant is no longer eligible under Supplemental Security Income (SSI) determination, the County is required to initiate the ex parte review within 5 workdays of the date the termination appears on the SSI Termination Report, and complete the redetermination within 4 months of the month the case appears on the SSI Termination Report and notify the recipient about applicant's ongoing eligibility for Medicaid. There was 2 applicant/beneficiary not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated, for which the recipient was not eligible. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-009. Untimely Review of SSI Terminations Context: Effect: Cause: Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Section III - Federal Award Findings and Questioned Costs (continued) Views of Responsible Officials and Planned Corrective Actions: The County agrees with the finding. See corrective action plan. We examined 60 cases from of a total of 331,466 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. 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-010.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Section III - Federal Award Findings and Questioned Costs (continued) Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-007. Views of Responsible Officials and Planned Corrective Actions: The county agrees with this finding. See corrective action plan. 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 applicants could have been approved for benefits for which they were not eligible. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 402,727 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. Program Names: Medical Assistance AL # 93.778 Finding: 2022-006 Inadequate Request for Information In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. Electronic matches are required at applications and redeterminations. There were 22 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. Questioned Costs: Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources and income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2022-007 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: The County agrees with the finding. See corrective action plan. Program Names: Medical Assistance AL # 93.778 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. Section III - Federal Award Findings and Questioned Costs (continued) We examined 60 cases from of a total of 402,727 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. 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. Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. IV-D Non-Cooperation Views of Responsible Officials and Planned Corrective Actions: 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 Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. There were 3 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-008.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2022-008 NONCOMPLIANCE / SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Section III - Federal Award Findings and Questioned Costs (continued) AL # 93.778 Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes that clearly indicates what actions were performed and the results of those actions. Inaccurate Information Entry In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific income standards, and documentation must be maintained to support eligibility determinations. In accordance with 2 CFR 200, management should have an adequate system of internal controls procedures in place to ensure an applicant is properly determined or redetermined for benefits. There were 9 errors discovered during our procedures that inaccurate information was entered when determining eligibility. One applicant received assistance although the family income were above the State provided income Standard. $569.12. This amount was determined by totaling all the aid received by the applicant who was not eligible. Questioned Costs: The County agrees with the finding. See corrective action plan. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-009. Views of Responsible Officials and Planned Corrective Actions: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Program Names: Medical Assistance We examined 60 cases from of a total of 402,727 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. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, a participant could have been approved to receive benefits for which they were not eligible.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services AL # 93.778 Finding: 2022-009 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Questioned Costs: The total questioned costs for the ineligibility error noted above did not meet the miniumum threshold for reporting. We examined 60 cases from of a total of 402,727 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. 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. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Section III - Federal Award Findings and Questioned Costs (continued) Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-010. Program Names: Medical Assistance In accordance with Medicaid Manual MA-2230, Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application and these items will agree to reports in the NC FAST system. In this process, the countable resources should be calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the verification process should be considered countable or noncountable resources and explained within the documentation. There were 10 errors discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. Of these, one beneficiary received assistance for which the recipient was not eligible. Inaccurate Resource Calculation Views of Responsible Officials and Planned Corrective Actions: The County agrees with the finding. See corrective action plan.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services AL # 93.778 Finding: 2022-010 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 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. In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a participant is no longer eligible under Supplemental Security Income (SSI) determination, the County is required to initiate the ex parte review within 5 workdays of the date the termination appears on the SSI Termination Report, and complete the redetermination within 4 months of the month the case appears on the SSI Termination Report and notify the recipient about applicant's ongoing eligibility for Medicaid. There was 2 applicant/beneficiary not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated, for which the recipient was not eligible. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 402,727 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.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance CFDA #: 93.778 Finding: 2021-007 Inadequate Request for Information SIGNIFICANT DEFICIENCY Eligibility Criteria: In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. Electronic matches are required at applications and redeterminations. Condition: There were 32 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 from a total of 494,624 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. 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 applicants could have been approved for benefits for which they were not eligible. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources and income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. "Views of Responsible Officials and Planned Corrective Actions:" The county agrees with this finding. See corrective action plan.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance CFDA #: 93.778 Finding: 2021-008 IV-D Non-Cooperation SIGNIFICANT DEFICIENCY Eligibility Criteria: 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 Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determine Medicaid eligibility. Condition: There were 3 errors discovered during our procedures that referrals between DSS 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 494,624 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. Effect: 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2020-005. Cause: Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. 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. "Views of Responsible Officials and Planned Corrective Actions:" The County agrees with the finding. See corrective action plan.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance CFDA #: 93.778 Finding: 2021-009 Inaccurate Information Entry NONCOMPLIANCE / SIGNIFICANT DEFICIENCY Eligibility Criteria: In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific income standards, and documentation must be maintained to support eligibility determinations. In accordance with 2 CFR 200, management should have an adequate system of internal controls procedures in place to ensure an applicant is properly determined or redetermined for benefits. Condition: There were 11 errors discovered during our procedures that inaccurate information was entered when determining eligibility. One applicant received assistance although the family income were above the State provided income Standard. Questioned Costs: $569.12. This amount was determined by totaling all the aid received by the applicant who was not eligible. Context: We examined 60 from a total of 494,624 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. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, a participant could have been approved to receive benefits for which they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2020-006. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes that clearly indicates what actions were performed and the results of those actions. "Views of Responsible Officials and Planned Corrective Actions:" The County agrees with the finding. See corrective action plan.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance CFDA #: 93.778 Finding: 2021-010 Inaccurate Resource Calculation SIGNIFICANT DEFICIENCY Eligibility Criteria: Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application and these items will agree to reports in the NC FAST system. In this process, the countable resources should be calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the verification process should be considered countable or non-countable resources and explained within the documentation. Condition: There were 5 errors discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 from a total of 494,624 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. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants could have received assistance for which they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2020-007. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. "Views of Responsible Officials and Planned Corrective Actions:" The County agrees with the finding. See corrective action plan.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Low Income Energy Assistance CFDA #: 93.568 Finding: 2020-004 Income Verification NONCOMPLIANCE / SIGNIFICANT DEFICIENCY Eligibility Criteria: The County is required to verify applicant's countable income to determine whether the applicant is eligible for the program and document the verifications performed and appropriate amounts used for verifications in the eligibility determination process. Condition: There were twelve errors in which the County failed to appropriately document the correct countable income, of these, there was one instance where this failure resulted in an incorrect eligibility determination. Questioned Costs: The questioned costs were immaterial and below the threshold for reporting. Context: We examined 40 Low Income Energy Assistance and Crisis Intervention Program cases from a listing of approved energy assistance applicants for the months of October and March of fiscal year 2020. These findings are being reported with the financial statement audit as it relates to the Social Services administrative cost compliance audit. Effect: For those determinations resulting in an internal control error, there was a chance that an applicant could have been approved for benefits for which they were not eligible. For the error in which an incorrect eligibility determination was found, program funds were paid on behalf of an applicant who was not eligible for benefits and, potentially, a future potential eligible individual may have been denied benefits because of limitations on program funding. Cause: Lack of proper internal controls over eligibility determinations. Recommendation: The County should ensure that applicant intake information is clear and concise, verification procedures are performed correctly and accurately documented in the case files. Eligibility determinations should be made carefully using all available information within requirements of policy. Additionally, management should perform routine reviews to ensure staff is following policy and to provide feedback on performance improvement. The auditor recommends that management update their internal procedures and clearly communicate the updates, as well as expectations, to all staff. Views of Responsible Officials and Planned Corrective Actions: The county agrees with this finding. See corrective action plan.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance CFDA #: 93.778 Finding: 2020-005 IV-D Non-Cooperation SIGNIFICANT DEFICIENCY Eligibility Criteria: 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 Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determine Medicaid eligibility. Condition: There were four errors discovered during our procedures that referrals between DSS 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 Medicaid applicants 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. Effect: 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. Cause: Error in reading the ACTS report and/or ineffective case review process. 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. Views of Responsible Officials and Planned Corrective Actions: The County agrees with the finding. See corrective action plan.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance CFDA #: 93.778 Finding: 2020-006 Inaccurate Information Entry SIGNIFICANT DEFICIENCY Eligibility Criteria: In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific income standards, and documentation must be maintained to support eligibility determinations. In accordance with 2 CFR 200, management should have an adequate system of internal controls procedures in place to ensure an applicant is properly determined or redetermined for benefits. Condition: There were twenty-two errors discovered during our procedures that inaccurate information was entered when determining eligibility. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 Medicaid recipients 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. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, a participant could have been approved to receive benefits for which they were not eligible. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes that clearly indicates what actions were performed and the results of those actions. Views of Responsible Officials and Planned Corrective Actions: The County agrees with the finding. See corrective action plan.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance CFDA #: 93.778 Finding: 2020-007 Inaccurate Resource Calculation NONCOMPLIANCE / SIGNIFICANT DEFICIENCY Eligibility Criteria: Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application and these items will agree to reports in the NC FAST system. In this process, the countable resources should be calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the verification process should be considered countable or non-countable resources and explained within the documentation. Condition: There were sixteen errors discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. Of these, one beneficiary received assistance for which the recipient was not eligible. Questioned Costs: $7,894. This amount was determined by totaling all the aid received by the ineligible beneficiary for all claims during the fiscal year ending 6/30/2020 which had dates of service during the certification period for which the were determined ineligible. Context: We examined 60 Medicaid applicants 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. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants could have received assistance for which they were not eligible. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Views of Responsible Officials and Planned Corrective Actions: The County agrees with the finding. See corrective action plan.

US Department of Transportation Passed through the NC Dept of Transportation Program Names: Airport Improvement CFDA #: 20.106 Finding: 2020-008 Grant Cash Management NONCOMPLIANCE / SIGNIFICANT DEFICIENCY Cash Management Criteria: The County as a grantee/subgrantee of NCDOT and funded on an advance basis are required to pay their vendors within three business days of receipt of the NCDOT payment. Condition: There were two errors in which the County remitted payments greater than three business days from receipt of the NCDOT payments. Questioned Costs: $251,906. The total of advance payments to vendors that were untimely remitted. Context: We examined four of fifteen payments received for the Airport Improvement Program and determined that two of these were not in compliance with the three business day requirement. Effect: NCDOT advance payments for program expenditures were held in the County's bank account more than the allowable time. Noncompliance can put the County at risk of losing future state and federal funding for Airport programs. Cause: Lack of proper internal controls over cash management requirements. Recommendation: The County should accurately track and review accounts payable related to its federal and state grant programs. Additionally, the County should ensure that advance payments from the state are remitted to the vendors within the allowable time frame. Views of responsible of officials and planned corrective actions: The county agrees with the finding. See corrective action plan.

US Department of Agriculture Passed through the NC Dept of Health and Human Services Program Names: Supplemental Nutrition Assistance Program CFDA #: 10.561 Criteria: The County is required to contained proper documentation in the case record to verify eligibility, which including a completed , signed and dated Food and Nutrition Services application. Condition: One case file does not contain completed and signed application. Questioned Costs: There were no questioned costs. Context: We examined 60 cases and determined one case does not have proper documentation on file. Effect: Applicant's eligibility would not be verified. Cause: Ineffective internal control over case filing procedures. Recommendation: Files should be reviewed internally to ensure proper documentation as program required. Views of Responsible Officials and Planned Corrective Actions: The county agrees with this finding. Management will review files more frequently and carefully to ensure regulations and requirements are properly followed.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Low Income Energy Assistance CFDA #: 93.568 Criteria: The County is required to verify applicant's countable income to determine whether the applicant is eligible for the program. Condition: One case file does not any verification of applicant's income. Questioned Costs: There were no questioned costs. Context: We examined 20 cases from Low-Income Energy Assistance and 20 cases from Crisis Intervention Program, total 40 cases and determined one case does not have proper documentation on file. Effect: Applicant could receive benefits for which he is not eligible. Cause: Ineffective internal control over eligibility determination procedures. Recommendation: Case workers should be reminded for the eligibility requirements and procedures listed on the NC Integrated Eligibility Manual. Files should be reviewed internally to ensure proper documentation as program required. Views of Responsible Officials and Planned Corrective Actions: The county agrees with this finding. Case workers will be retrained and management will review files more frequently and carefully to ensure regulations and requirements are properly followed.

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Program Names: Medical Assistance CFDA #: 93.778 Criteria: In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific income standards, and documentation must be maintained to support eligibility determinations. In accordance with 2 CFR 200, management should have an adequate system of internal controls procedures in place to ensure an applicant is properly determined or redetermined for benefits. Condition: There was 1 error discovered during our procedures that inaccurate information was entered when determining eligibility, resulting in applicant received benefits for which who was not eligible. Questioned Costs: $0. This amount was the aid received by the one applicant who were not eligible. Context: We examined 60 Medicaid recipients 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. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, a participant could have been approved to receive benefits for which they were not eligible. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes that clearly indicates what actions were performed and the results of those actions. Views of Responsible Officials and Planned Corrective Actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participating in the review process.

US Department of Transportation Passed through the NC Dept of Transportation Program Names: Airport Improvement CFDA #: 20.106 Criteria: Grantees of NCDOT are funded on either an advance or reimbursement basis. Grantees that receive advance funding should pay vendors within 3 business days of receipt of the NCDOT payment. Condition: 1 out of 8 transactions reviewed that payment were made to vendors over 3 business days of receipt of the NCDOT payment. Questioned Costs: There were no questioned costs. Context: Examined 8 payments that were over $5,000 each, and determined that 1 payment was not in compliance with the 3-day requirement. Effect: NCDOT reimbursement was held in the County's account more than the allowed time. Cause: Ineffective internal control and review process. Recommendation: We recommend that management to review accounts payable and deposit documentation more frequently to make the payment on a timely basis. Views of responsible of officials and planned corrective actions: The county agrees with the finding. Management will review documentation more frequently and carefully to ensure payments are being made on a timely basis.

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