EDGECOMBE COUNTYLocal Government

Condition: There were 2 errors discovered during our procedures that referrals between the County's Department of Social Services and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 cases from of a total of 1,005,637 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. Section III. Federal Award Findings (continued) Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details. 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. 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. 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 9 errors discovered during our procedures where income or household size was incorrectly calculated or inaccurate information was entered into the case file. Questioned Costs: There was no known affect to eligibility and there were

Condition: There were 2 errors discovered during our procedures that referrals between the County's Department of Social Services and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 cases from of a total of 1,005,637 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. Section III. Federal Award Findings (continued) Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details. 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. 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. 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 9 errors discovered during our procedures where income or household size was incorrectly calculated or inaccurate information was entered into the case file. Questioned Costs: There was no known affect to eligibility and there were

Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Finding: 2024-005 Inaccurate Resource Calculation SIGNIFICANT DEFICIENCY ELIGIBILITY Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 cases from of a total of 1,005,637 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-005. Section III. Federal Award Findings (continued) Criteria: 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 non-countable resources and explained within the documentation. Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details. Condition: 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. 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.

Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Finding: 2024-006 Inadequate Request for Information SIGNIFICANT DEFICIENCY 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. Please refer to the corrective action plan for details. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. 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. Context: We examined 60 cases from of a total of 1,005,637 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-006. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. 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 12 errors discovered during our procedures where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-007. Section III. Federal Award Findings (continued)

Questioned Costs: As a result of the lack of a proper eligibility determination, federal funds were distributed to ineligible recipients. Due to the nature of these types of eligibility determinations and the lack of a proper review by the department, the auditor is unable to determine the known or likely questioned costs. Context: We examined 60 cases from of a total of 1,005,637 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. Criteria: 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. Condition: There were 3 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. Of these 3 errors, two were determined to be an eligibility error with potential questioned costs. Effect: 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. Cause: 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. Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details. Section III. Federal Award Findings (continued) Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-008.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Finding: 2023-004 IV-D Non-Cooperation SIGNIFICANT DEFICIENCY ELIGIBILITY US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Finding: 2023-005 Inaccurate Information Entry SIGNIFICANT DEFICIENCY ELIGIBILITY Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determine eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-003. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Cause: Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. Section III. Federal Award Findings Criteria: In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Department of Social Services (DSS) and Child Support Agencies must be met or good cause for not cooperating must be established when determine Medicaid eligibility. Condition: There were 4 errors discovered during our procedures that referrals between the County's Department of Social Services and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 from a total of 911,554 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Finding: 2023-005 Inaccurate Information Entry SIGNIFICANT DEFICIENCY ELIGIBILITY Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determine eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-003. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Cause: Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. Section III. Federal Award Findings Criteria: In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Department of Social Services (DSS) and Child Support Agencies must be met or good cause for not cooperating must be established when determine Medicaid eligibility. Condition: There were 4 errors discovered during our procedures that referrals between the County's Department of Social Services and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 from a total of 911,554 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details. 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. 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 5 errors discovered during our procedures that inaccurate information was entered when determining eligibility. 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. Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details. Condition: There were 6 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. 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. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 from a total of 911,554 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. 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: 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 Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Finding: 2023-006 Inaccurate Resource Calculation SIGNIFICANT DEFICIENCY ELIGIBILITY Section III. Federal Award Findings (continued) Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 from a total of 911,554 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-004. Criteria: 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 non-countable resources and explained within the documentation. Condition: There were 5 errors discovered during our procedures that inaccurate information was entered when determining eligibility. 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. Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details. Condition: There were 6 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-005. 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. Please refer to the corrective action plan for details.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Inadequate Finding: 2023-007 Request for Information SIGNIFICANT DEFICIENCY 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. Please refer to the corrective action plan for details. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. 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. Context: We examined 60 from a total of 911,554 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-006. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-005. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. 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 14 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. 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. Please refer to the corrective action plan for details. Cause: 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 Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Finding: 2023-008 Untimely Review of SSI Termination SIGNIFICANT DEFICIENCY ELIGIBILITY Program Name: Medical Assistance Program (Medicaid; Title XIX) AL# 93.778 SIGNIFICANT DEFICIENCY/ NONCOMPLIANCE: Finding 2023-004, 2023-005, 2023-006, 2023-007, 2023- 008 also apply to State requirements and State Awards. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 from a total of 911,554 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Criteria: 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. Condition: There were 1 applicant/beneficiaries not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. Section IV. State Award Findings Effect: 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. Cause: 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: 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. Please refer to the corrective action plan for details. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-007.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2022-003 IV-D Non-Cooperation SIGNIFICANT DEFICIENCY ELIGIBILITY Criteria: In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child?s non-custodial parent. Cooperation requirement with Department of Social Services (DSS) and Child Support Agencies must be met or good cause for not cooperating must be established when determine Medicaid eligibility. Condition: There were 5 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 957,769 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. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Cause: Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-008. 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. Please refer to the corrective action plan for details.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2022-004 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 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 25 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 from a total of 957,769 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. 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, 2021-009. 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. Please refer to the corrective action plan for details.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2022-005 Inaccurate Resource Calculation SIGNIFICANT DEFICIENCY ELIGIBILITY Criteria: 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 non-countable resources and explained within the documentation. Condition: There were 6 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 957,769 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. 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, 2021-010. 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. Please refer to the corrective action plan for details.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2022-006 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 6 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 957,769 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. 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, 2021-011. 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. Please refer to the corrective action plan for details.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2022-007 Untimely Review of SSI Termination SIGNIFICANT DEFICIENCY ELIGIBILITY Criteria: 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. Condition: There were 2 applicant/beneficiaries 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. Context: We examined 60 from a total of 957,769 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. Effect: 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-012. Cause: 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: 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. Please refer to the corrective action plan for details.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Temporary Assistance for Needy Families (TANF) Cluster CFDA # 93.558 Finding: 2022-008 Inadequate Documentation in case files SIGNIFICANT DEFICIENCY "Criteria: Per Section 200.303 of the Uniform Grant Guidance, a non-federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. The State has provided policies and procedures to ensure that the County is meeting the federal guidance, relevant policies are: Work First Policy 108 (I) and (II) describes the residency requirements and the verifications required by the County. The policy also list out the acceptable documentation to verify address and residency. Work First Policy 104 describes the Mutual Responsibility Agreement and includes the signature requirements and any exceptions. Work First Policy 114 describes the income that is countable and not countable to the household for determining financial eligibility. Additionally, it also provides the types of verifications needed for each type of countable income and procedures related to verifying changes in income (i.e. termination, end of contract, temporary, etc.)." Condition: There were a total of 5 errors found in our testing: 1 instance where state residency evidence was not included in the case file, 1 instance where a signed mutual responsibility agreement was not included the case file, 1 instance where child support income was not updated in NCFAST, and 2 instances where there was no evidence that required income verifications were completed. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 25 of 1,406 TANF recipients from the TANF Eligibility Population Report provided by NC DHHS. The finding is being reported with the financial statement audit as it relates to TANF administrative cost compliance audit. Effect: Due to the errors noted, eligibility cannot be sufficiently substantiated and there is a risk that the County could provide funding and/or benefits to individuals who are not program eligible. Cause: Ineffective documentation/recordkeeping and case review process. Recommendation: The County should provide training of management and staff on the program's eligibility requirements, proper case review process, and required verifications for eligibility. Also, the County should ensure that their formal internal review process is adequately completed to identify and correct errors in case reviews. Views of responsible officials and planned corrective actions: The County agrees with the finding and is implementing actions to correct these issues, which are further discussed in the corrective action plan.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Food and Nutrition Services (FNS) Cluster CFDA # 10.551 and 10.561 Finding: 2022-009 Inadequate Documentation in case files SIGNIFICANT DEFICIENCY "Criteria: Per Section 200.303 of the Uniform Grant Guidance, a non-federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. The State has provided policies and procedures to ensure that the County is meeting the federal guidance, relevant policies are: Food and Nutrition Services Policy 305 describes the verification sources and requirements and the FNS units primary responsibility for providing documentary evidence to support statements on applications and recertifications and procedures required if the statements by applicant/beneficiary are questionable. Food and Nutrition Services Policy 300 describes the sources of income countable and not countable to the household for determining financial eligibility.. Food and Nutrition Services Policy 310 describes the procedures related to verifying changes in income (i.e. termination, end of contract, temporary, etc.)." Condition: There were a total of 7 errors found in our testing: 1 instance where an OVS report was not included in the case file, 1 instance where Unemployment Income Benefits were not included in NCFAST, 1 instance where Social Security Disability Income was not included in NCFAST, 1 instance where child support income was not included in NCFAST, and 3 instances where there was no evidence that required income verifications were completed. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 25 of 7,940 FNS recipients from the a report of all FNS beneficiaries provided by NC DHHS. The finding is being reported with the financial statement audit as it relates to FNS administrative cost compliance audit. Effect: Due to the errors noted, eligibility cannot be sufficiently substantiated and there is a risk that the County could provide funding and/or benefits to individuals who are not program eligible. Cause: Ineffective documentation/recordkeeping and case review process. Recommendation: The County should provide training of management and staff on the program's eligibility requirements, proper case review process, and required verifications for eligibility. Also, the County should ensure that their formal internal review process is adequately completed to identify and correct errors in case reviews. Views of responsible officials and planned corrective actions: The County agrees with the finding and is implementing actions to correct these issues, which are further discussed in the corrective action plan.

US Department of Treasury Program Name: Coronavirus State and Local Fiscal Recovery Fund CFDA # 21.027 Finding: 2022-010 Lack of General Compliance Policies SIGNIFICANT DEFICIENCY "Criteria: In accordance with the U.S. Department of Treasury 31 CFR Part 35, Coronavirus State and Local Fiscal Recovery Funds Final Rule and the Uniform Guidance, General Financial Management Internal Controls, Eligible Projects Determination & Documentation Policy, Cost Principles/Allowable Costs Policy, Civil Rights Compliance / Nondiscrimination Policy, Records Retention Policy, and Conflict of Interest are required to be adopted as condition of receiving the funds. " Condition: The County did not adopt and implement the following policies for Coronavirus State and Local Fiscal Recovery Fund (CSLFRF) expenditures: Records Retention, Eligible Use, Allowable Costs, Civic Right Compliance, and Conflict of Interest. Effect: The County could have used the funds for activities and costs that were prohibited by the Final Rule. Cause: County oversight of the new federal grant requirements regarding the CSLFRF Revenue Replacement expenditure category to have the stated policies in place. Recommendation: The county management should review the award terms and conditions, and the Uniform Guidance more carefully to ensure all compliance requirements are met. Views of responsible officials and planned corrective actions: The County agrees with the finding and is implementing actions to correct these issues, which are further discussed in the corrective action plan.

US Department of Treasury Passed through the Office of State Budget and Management Program Name: Coronavirus Relief Fund CFDA # 21.019 Finding: 2021-006 Reconciliation of Records and Reporting SIGNIFICANT DEFICENCY REPORTING Criteria: In accordance with Coronavirus Relief Fund grant agreement, N.C. Pandemic Recovery Office (NCPRO) requires that each subrecipient submit the Performance Report (Attachment C-1) and Financial Report (Attachment C-2) monthly to ensure the funds are being used to meet the subrecipient?s goals and deliverables related to recovering from the Coronavirus pandemic and to allow NCPRO to verify that expenditures comply with federal and state requirements. Final Report (Attachment F) is required when the allotment is completed. Coronavirus Relief Fund Compliance Supplement requires that the reports should include all activity of the reporting period, and are supported by applicable accounting or performance records. Condition: Total grant expenditure as of 6/30/2021 reported on all the Attachment C-1 did not agree to total grant expenditure reported on all the Attachment C-2 reports, and did not agree to the County General Ledger. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We reviewed all 12 Attachment C-1 and 12 Attachment C-2 reports submitted to NCPRO for FY 21 expenditures, and determined that the total expenditure reported to NCPRO did not agree to the County General Ledger. Effect: The County could lose track the use of the funds, and NCPRO could report inaccurate information to U.S. Treasury. Cause: Lack of internal control to ensure compliance over federal awards. Recommendation: Employees should be retrained on grant compliance requirements. Internal control procedures should be designed and implemented to ensure reconciliation of records. Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details.

US Department of Treasury Passed through the Office of State Budget and Management Program Name: Coronavirus Relief Fund CFDA # 21.019 Finding: 2021-007 Subrecipient Monitoring SIGNIFICANT DEFICENCY / NONCOMPLIANCE SUBRECIPIENT MONITORING Criteria: In accordance with 2 CFR sections 200.332(d) through (f), pass-through entity is required to monitor the activities of the subrecipient as necessary to ensure that the subaward is used for authorized purposes, complies with the terms and conditions of the subaward, and achieves performance goals. Condition: County sent the subaward grant agreement to municipalities, but did not follow up on 4 out of 5 subrecipients' activities to ensure the use of funds. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We reviewed all the subaward documentation and determined that the county as a pass-through entity did not have procedures in place to monitor subrecipients activities. Effect: Subrecipient could use the grant fund on unallowed activities. Cause: Lack of internal control to ensure subrecipient monitoring. Recommendation: Employees should be retrained on grant compliance requirements. Internal control procedures should be designed and implemented to ensure subrecipient activities are monitored as required. Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2021-008 IV-D Non-Cooperation SIGNIFICANT DEFICENCY ELIGIBILITY Criteria: In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child?s non-custodial parent. Cooperation requirement with 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 5 errors discovered during our procedures that referrals between Department of Social Services (DSS) and Child Support Agencies were not made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 cases from 20476 Medicaid applicants on 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 North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Cause: Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2020-007. 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. Please refer to the corrective action plan for details.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2021-009 Inaccurate Information Entry SIGNIFICANT DEFICENCY/ NONCOMPLIANCE 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. 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 15 errors discovered during our procedures that inaccurate information was entered when determining eligibility. Of these, one applicant received assistance after moved out of the State. Questioned Costs: $680. This amount was determined by totaling all the aid received by the applicant who was not eligible. Context: We examined 60 cases from 20476 Medicaid applicants on 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2020-008. 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. Please refer to the corrective action plan for details.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2021-0010 Inaccurate Resource Calculation SIGNIFICANT DEFICENCY/ NONCOMPLIANCE ELIGIBILITY Criteria: In accordance with Madicaid 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 non-countable resources and explained within the documentation. Condition: There were 8 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. Of these, one applicant received assistance although the countable resources was above the State provided standard. Questioned Costs: $5,415. This amount was determined by totaling all the aid received by the applicant who was not eligible. Context: We examined 60 cases from 20476 Medicaid applicants on 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2020-009. 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. Please refer to the corrective action plan for details.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2021-011 Inadequate Request for Information SIGNIFICANT DEFICENCY 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 15 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 cases from 20476 Medicaid applicants on 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. Please refer to the corrective action plan for details.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2021-012 SSI Termination SIGNIFICANT DEFICENCY ELIGIBILITY Criteria: 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. Condition: 2 applicant was 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. Context: We examined 60 cases from 20476 Medicaid applicants on 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: 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. Cause: 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: 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. Please refer to the corrective action plan for details.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2020-007 IV-D Non-Cooperation SIGNIFICANT DEFICENCY/ NONCOMPLIANCE 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 eleven errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. Of these, three beneficiaries received assistance for which the recipient was not eligible. Questioned Costs: $1,256. This amount was determined by totaling all the aid received by the ineligible beneficiaries for all claims during the fiscal year ending 6/30/2020 which had dates of service occurring within the certification period in question. 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. Please refer to the corrective action plan for details.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2020-008 Inaccurate Information Entry SIGNIFICANT DEFICENCY/ NONCOMPLIANCE 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. 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 errors discovered during our procedures that inaccurate information was entered when determining eligibility. Of these, one beneficiary received assistance for which the recipient was not eligible. Questioned Costs: $52. This amount was determined by totaling all the aid received by the ineligible beneficiaries for all claims during the fiscal year ending 6/30/2020 which had dates of service occurring within the certification period in question. 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 and a participant 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 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. Please refer to the corrective action plan for details.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2020-009 Inaccurate Resource Calculation SIGNIFICANT DEFICENCY/ NONCOMPLIANCE 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 eleven 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: $9,555. This amount was determined by totaling all the aid received by the ineligible beneficiaries for all claims during the fiscal year ending 6/30/2020 which had dates of service occurring within the certification period in question. 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, 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. Please refer to the corrective action plan for details.

GSA_MIGRATION

GSA_MIGRATION