Cherokee CountyLocal Government

U.S. Department of Health & Human Services Passed-through the N.C. Dept. of Health and Human Services Program Name: Medical Assistance Program ( Medicaid; Title XIX) ALN #: 93.778 Finding: 2021-002 SIGNIFICANT DEFICIENCY Eligibility Criteria: Per the NC Department of Health and Human Services-Division of Health Benefits, the County Department of Social Services Agency is responsible to determine client eligibility in accordance with eligibility requirements defined in the approved State Plan (42 CFR Section 431.10). An applicant/beneficiary (a/b) whose net countable income exceeds the income limit must meet a deductible before he may be authorized for Medicaid. Condition: One case file did not have documentation for determining deductible amount. Cause: The caseworker did not correctly include the proper documentation in the case file. Effect: Case file did not have the proper documentation, which could allow benefits to be provided to individuals who are not eligible. Questioned Costs: There were no known effects to eligibility and there were no known questioned costs. Context: We examined 91 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 the Medicaid administrative cost compliance audit. Identification of a repeat finding: This is not a repeat finding from the immediate previous 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. Views of responsible officials and planned corrective actions: The County agrees with this finding.