Yadkin CountyLocal Government

Hyde County, North Carolina Schedule of Findings and Questioned Costs For Year Ended June 30, 2025 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; NONCOMPLIANCE Eligibility Criteria: Condition: Questioned Costs: Context: 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 9 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 1 error where resources were incorrectly calculated or were not properly documented in the case file. In 1 instance, a failure resulted in a recipient being deemed eligible for Medicaid benefits when they were not, due to resources exceeding the eligibility threshold. - There were 2 errors where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. - There were 2 errors where a redetermination of eligibility was not performed in accordance with program requirements. 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. We examined 60 cases from of a total of 25,260 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. 157Hyde County, North Carolina Schedule of Findings and Questioned Costs For Year Ended June 30, 2025 Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: 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 SIGNIFICANT DEFICENCY/NONCOMPLIANCE: Finding 2025-001 also apply to State requirements and State Awards. Section IV - State Award Findings and Questioned Costs Section III. Federal Award Findings and Questioned Costs (continued) 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, 2024-001, 2024-002, 2024- 003 and 2024-004. Note in FY 2025 Medicaid findings were combined into a single finding. 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. 158

Yadkin County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2025 Recommendation: Views of responsible officials and planned corrective actions: 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: 2025-003 SIGNIFICANT DEFICIENCY; NONCOMPLIANCE Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: The County should review financial records periodically to ensure transfers and amendments are made timely for account reconciliations, year-end close and annual financial reporting purposes. The County agrees with this finding. Please refer to the corrective action plan for details. Section II - Financial Statement Findings (continued) Section III - Federal Award Findings and Questioned Costs There were a total of 29 errors found during our testing procedures: - There were 8 errors where income or household size was incorrectly calculated or inaccurate information was entered into the case file. - There was 8 error where resources were incorrectly calculated or were not properly documented in the case file. - There were 7 errors where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. - There were 3 errors where applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. - There were 3 errors where a redetermination of eligibility was not performed in accordance with program requirements. 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. We examined 60 cases from of a total of 200,425 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. 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. This is a repeat finding from the immediate previous audit, 2024-001, 2024-002, 2024-003, and 2024-004. Note in FY 2025 Medicaid findings were combined into a single finding. 128Yadkin County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2025 Cause: Recommendation: Views of responsible officials and planned corrective actions: AL #: 93.778 Section III - Federal Award Findings and Questioned Costs (continued) 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. The County agrees with the finding and is implementing actions to correct these issues, which are further discussed in the corrective action plan. 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. Program Name: Medical Assistance Program SIGNIFICANT DEFICIENCY; NONCOMPLIANCE: Finding 2025-001 also applies to State requirements and State Awards. Section IV - State Award Findings and Questioned Costs 129

Hyde County, North Carolina Schedule of Findings and Questioned Costs For Year Ended June 30, 2025 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; NONCOMPLIANCE Eligibility Criteria: Condition: Questioned Costs: Context: 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 9 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 1 error where resources were incorrectly calculated or were not properly documented in the case file. In 1 instance, a failure resulted in a recipient being deemed eligible for Medicaid benefits when they were not, due to resources exceeding the eligibility threshold. - There were 2 errors where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. - There were 2 errors where a redetermination of eligibility was not performed in accordance with program requirements. 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. We examined 60 cases from of a total of 25,260 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. 157Hyde County, North Carolina Schedule of Findings and Questioned Costs For Year Ended June 30, 2025 Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: 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 SIGNIFICANT DEFICENCY/NONCOMPLIANCE: Finding 2025-001 also apply to State requirements and State Awards. Section IV - State Award Findings and Questioned Costs Section III. Federal Award Findings and Questioned Costs (continued) 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, 2024-001, 2024-002, 2024- 003 and 2024-004. Note in FY 2025 Medicaid findings were combined into a single finding. 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. 158

Yadkin County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2025 Recommendation: Views of responsible officials and planned corrective actions: 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: 2025-003 SIGNIFICANT DEFICIENCY; NONCOMPLIANCE Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: The County should review financial records periodically to ensure transfers and amendments are made timely for account reconciliations, year-end close and annual financial reporting purposes. The County agrees with this finding. Please refer to the corrective action plan for details. Section II - Financial Statement Findings (continued) Section III - Federal Award Findings and Questioned Costs There were a total of 29 errors found during our testing procedures: - There were 8 errors where income or household size was incorrectly calculated or inaccurate information was entered into the case file. - There was 8 error where resources were incorrectly calculated or were not properly documented in the case file. - There were 7 errors where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. - There were 3 errors where applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. - There were 3 errors where a redetermination of eligibility was not performed in accordance with program requirements. 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. We examined 60 cases from of a total of 200,425 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. 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. This is a repeat finding from the immediate previous audit, 2024-001, 2024-002, 2024-003, and 2024-004. Note in FY 2025 Medicaid findings were combined into a single finding. 128Yadkin County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2025 Cause: Recommendation: Views of responsible officials and planned corrective actions: AL #: 93.778 Section III - Federal Award Findings and Questioned Costs (continued) 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. The County agrees with the finding and is implementing actions to correct these issues, which are further discussed in the corrective action plan. 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. Program Name: Medical Assistance Program SIGNIFICANT DEFICIENCY; NONCOMPLIANCE: Finding 2025-001 also applies to State requirements and State Awards. Section IV - State Award Findings and Questioned Costs 129

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Section II - Financial Statement Findings Section I - Summary of Auditors' Results (continued) Section III - Federal Award Findings and Questioned Costs Finding: 2024-001 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 3 errors discovered during our procedures where income or household size was incorrectly calculated or inaccurate information was entered into the case file. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from a total of 46,508 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. Questioned Cost: 151Effect: Identification of a repeat finding: Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: We examined 60 cases from a total of 46,508 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. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Views of responsible officials: This is a repeat finding from the immediate previous audit 2023-007. 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. The county agrees with the finding. Please refer to the corrective action plan for details. There was no known affect to eligibility and there were no known questioned costs. Inaccurate Resource Calculation Section III - Federal Award Findings and Questioned Costs (continued) Finding: 2024-002 SIGNIFICANT DEFICIENCY Questioned Costs: There were 1 errors discovered during our procedures where resources were imcorrectly calculated or were not properly documented in the case file. 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. 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.

Effect: Identification of a repeat finding: Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: We examined 60 cases from a total of 46,508 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. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Views of responsible officials: This is a repeat finding from the immediate previous audit 2023-007. 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. The county agrees with the finding. Please refer to the corrective action plan for details. There was no known affect to eligibility and there were no known questioned costs. Inaccurate Resource Calculation Section III - Federal Award Findings and Questioned Costs (continued) Finding: 2024-002 SIGNIFICANT DEFICIENCY Questioned Costs: There were 1 errors discovered during our procedures where resources were imcorrectly calculated or were not properly documented in the case file. 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. 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.Identification of a repeat finding: Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: Section III - Federal Award Findings and Questioned Costs (continued) Recommendation: We examined 60 cases from a total of 46,508 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. 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. Finding: 2024-003 Inadequate Request for Information SIGNIFICANT DEFICIENCY 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 1 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: There was no known affect to eligibility and there were no known questioned costs. Views of responsible officials: 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. The county agrees with the finding. Please refer to the corrective action plan for details. This is a repeat finding from the immediate previous audit, 2023-008. 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: Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: Section III - Federal Award Findings and Questioned Costs (continued) Recommendation: We examined 60 cases from a total of 46,508 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. 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. Finding: 2024-003 Inadequate Request for Information SIGNIFICANT DEFICIENCY 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 1 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: There was no known affect to eligibility and there were no known questioned costs. Views of responsible officials: 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. The county agrees with the finding. Please refer to the corrective action plan for details. This is a repeat finding from the immediate previous audit, 2023-008. 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 Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: 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: The county agrees with the finding. Please refer to the corrective action plan for details. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Finding: 2024-004 Non-Cooperation With Child Support Procedures SIGNIFICANT DEFICIENCY 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 1 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. We examined 60 cases from a total of 46,508 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 Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: 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: The county agrees with the finding. Please refer to the corrective action plan for details. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Finding: 2024-004 Non-Cooperation With Child Support Procedures SIGNIFICANT DEFICIENCY 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 1 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. We examined 60 cases from a total of 46,508 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: Cause: U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Views of responsible officials: The county agrees with the finding. Please refer to the corrective action plan for details. Section III - Federal Award Findings and Questioned Costs (continued) 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 determining eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. SIGNIFICANT DEFICENCY: Finding 2024-001, 2024-002, 2024-003, 2024-004 also apply to State requirements and State Awards. Section IV - State Award Findings and Questioned Costs For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and applicants could have been approved for benefits for which they were not eligible.

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Identification of a repeat finding: 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. Recommendation: The County should allocate sufficient resources to ensure that all records are reconciled timely to allow time for the audit to be completed timely. Views of responsible officials: The County agrees with this finding. Please refer to the corrective action plan for details. Finding: 2023-007 There were 7 errors discovered during our procedures that inaccurate information was entered when determining eligibility. Questioned Cost: 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. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 40,658 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. This is a repeat finding from the immediate previous audit, 2022-007. Inaccurate Information Entry This is a repeat finding from the immediate previous audit, 2022-009. 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. Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: Identification of a repeat finding: 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 no known affect to eligibility and there were no known questioned costs. Inaccurate Resource Calculation Section III - Federal Award Findings and Questioned Costs (continued) Finding: 2023-008 SIGNIFICANT DEFICIENCY Questioned Costs: This is a repeat finding from the immediate previous audit, 2022-010. There were 8 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. We examined 60 cases from of a total of 40,658 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. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Views of responsible officials: 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. The county agrees with the finding. Please refer to the corrective action plan for details.

Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: Identification of a repeat finding: 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 no known affect to eligibility and there were no known questioned costs. Inaccurate Resource Calculation Section III - Federal Award Findings and Questioned Costs (continued) Finding: 2023-008 SIGNIFICANT DEFICIENCY Questioned Costs: This is a repeat finding from the immediate previous audit, 2022-010. There were 8 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. We examined 60 cases from of a total of 40,658 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. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Views of responsible officials: 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. The county agrees with the finding. Please refer to the corrective action plan for details. Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Views of responsible officials: 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. The county agrees with the finding. Please refer to the corrective action plan for details. Section III - Federal Award Findings and Questioned Costs (continued) Recommendation: We examined 60 cases from of a total of 40,658 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. 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. Finding: 2023-009 Inadequate Request for Information SIGNIFICANT DEFICIENCY 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 20 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.

Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Views of responsible officials: 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. The county agrees with the finding. Please refer to the corrective action plan for details. Section III - Federal Award Findings and Questioned Costs (continued) Recommendation: We examined 60 cases from of a total of 40,658 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. 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. Finding: 2023-009 Inadequate Request for Information SIGNIFICANT DEFICIENCY 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 20 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. Identification of a repeat finding: Section III - Federal Award Findings and Questioned Costs (continued) This is a repeat finding from the immediate previous audit, 2022-012. Section IV - State Award Findings and Questioned Costs SIGNIFICANT DEFICENCY: Finding 2023-007, 2023-008, 2023-009 also apply to State requirements and State Awards. 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: The county agrees with the finding. Please refer to the corrective action plan for details. 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 Department of Health and Human Services Program Name: Medical Assistance Program CFDA #: 93.778 Finding: 2022-008 SSI Terminations 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 was 1 error in which a beneficiary 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 of a total of 43,722 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 Effect: The County did not initiate an 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, 2021-008. 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: 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: 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 Department of Health and Human Services Program Name: Medical Assistance Program CFDA #: 93.778 Finding: 2022-009 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 11 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 cases from of a total of 43,722 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 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-009. 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: 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: 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 Department of Health and Human Services Program Name: Medical Assistance Program CFDA #: 93.778 Finding: 2022-010 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 9 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 cases from of a total of 43,722 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 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. 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. Views of responsible officials: 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 Department of Health and Human Services Program Name: Medical Assistance Program CFDA #: 93.778 Finding: 2022-011 IV-D Child Support 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 Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determine Medicaid eligibility. Condition: There was 1 error in which a beneficiary 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 of a total of 43,722 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 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-011. 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 that clearly indicates what actions were performed and the results of those actions. Views of responsible officials: 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 Department of Health and Human Services Program Name: Medical Assistance Program CFDA #: 93.778 Finding: 2022-012 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 7 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 of a total of 43,722 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 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-012. 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: The county agrees with the finding. Please refer to the corrective action plan for details.

US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance ProgramCFDA #: 93.778Finding: 2021-008 SSI TerminationsNONCOMPLIANCE / SIGNIFICANT DEFICIENCYEligibilityCriteria: 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: One applicant was not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated.Questioned Costs: $6,103. This amount was determined by totaling all the aid received by the ineligible beneficiary for all claims during the fiscal year ending 6/30/2021 which had dates of service occurring after the SSI determined the beneficiary ineligible.Context: We examined 60 cases from 1137 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 an 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, 2020-008.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: 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: The county agrees with the finding. Please refer to the corrective action plan for details.

US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance ProgramCFDA #: 93.778Finding: 2021-009 Inaccurate Information EntryNONCOMPLIANCE / SIGNIFICANT DEFICIENCYEligibilityCriteria: 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. Of these, one applicant received assistance although the family income was above the State provided income standard.Questioned Cost: $3,859. This amount was determined by totaling all the aid received by the ineligible beneficiaries for all claims during the fiscal year ending 6/30/2021 which had dates of service occurring within the certification period in question.Context: We examined 60 cases from 1137 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.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: The county agrees with the finding. Please refer to the corrective action plan for details.

US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance ProgramCFDA #: 93.778Finding: 2021-010 Inaccurate Resource CalculationSIGNIFICANT DEFICIENCYEligibilityCriteria: 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 7 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 cases from 1137 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.Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2020-010.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: The county agrees with the finding. Please refer to the corrective action plan for details.

US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance ProgramCFDA #: 93.778Finding: 2021-011 IV-D Child Support Non-CooperationSIGNIFICANT DEFICIENCYEligibilityCriteria: 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 6 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 1137 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.Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2020-011.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 that clearly indicates what actions were performed and the results of those actions.Views of responsible officials: The county agrees with the finding. Please refer to the corrective action plan for details.

US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance ProgramCFDA #: 93.778Finding: 2021-012 Inadequate Request for InformationSIGNIFICANT DEFICIENCYEligibilityCriteria: 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 31 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 1137 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: 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: The county agrees with the finding. Please refer to the corrective action plan for details.

US Department of Homeland SecurityPassed through the NC Department of Public SafetyProgram Name: Disaster Grants - Public AssistanceCFDA #: 97.036Finding: 2021-013 Inadequate DocumentationSIGNIFICANT DEFICIENCYAllowable Costs/Cost PrinciplesCriteria: In accordance with 2 CFR section 200.403(g), and the Compliacne Supplement for Disaster Grants - Public Assistance, costs must be adequately documented in order to be allowable under Federal awards.Condition: The County manager has signed an authorization to allow exempt employees to receive overtime pay beginning September 1, 2019 as a result of the Hurricane recovery efforts. However, there were several timesheets from September 2019 through January 2020 that were not adequately documented to show the detailed activites and supervisor's approval.Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.Context: We examined 2 projects from 6 active projects on the FEMA Grant Portal. Documentation that was provided to the Department of Public Safety (DPS) as evidence of the expenditures was reviewed from the FEMA Grant Portal. As it relates to overtime payments, there were timesheets provided for reimbursement. Several timesheets were not signed before it was required to be uploaded to the portal, as the official request for reimbursement did not occur until several months after the information was originally uploadedEffect: The grantor agency does not have accurate and sufficient information to track the projects and the use of the funds.Cause: No effective internal controls were in place to ensure compliance. A supervisory signature would document that the time was reviewed to ensure that it was, in fact, an allowable expenditure.Recommendation: The county should design and implement internal controls over compliance of Federal and State grants to ensure costs are adequately documented and reviewed.Views of responsible officials: The county agrees with this finding. The designated Hyde FEMA Agent uploaded the timesheets into the FEMA portal prior to them being properly reviewed and approved by management because they were actively working in the field managing the hurricane response. When management returned into the office, the timesheets were properly reviewed and approved. Procedures have been put into place to ensure that all timesheets have been reviewed and properly approved prior to being uploaded into the FEMA portal.

US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance ProgramCFDA #: 93.778Finding: 2020-008 SSI TerminationsNONCOMPLIANCE / SIGNIFICANT DEFICIENCYEligibilityCriteria: The State sends notification to the County when a participant is no longer eligible under SSI determination. The County has a certain time period to initiate an ex parte review to determine whether the recipient qualifies for Medicaid under any other coverage group, such as Family and Children's Medicaid, North Carolina Health Choice for Children, Work First Family Assistance, or Medicaid for the Aged, Blind and Disabled.Condition: One applicant was not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated.Questioned Costs: $4,278. 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 occurring after the SSI determined the beneficiary 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 the Medicaid administrative cost compliance audit.Effect: The County did not initiate an 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, 2019-008.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: 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: The County agrees with the finding. Supervisors will review action reports regularly to determine if corrective action plan was taken and that action was correctly closed out. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations.

US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance ProgramCFDA #: 93.778Finding: 2020-009 Inaccurate Information EntryNONCOMPLIANCE / SIGNIFICANT DEFICIENCYEligibilityCriteria: 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 thirty-seven errors discovered during our procedures that inaccurate information was entered when determining eligibility. Of these, two applicant/beneficiaries received assistance for which the recipient was not eligible.Questioned Cost: $7,337. 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 affect income and 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, 2019-009.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: 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.

US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance ProgramCFDA #: 93.778Finding: 2020-010 Inaccurate Resource CalculationSIGNIFICANT DEFICIENCYEligibilityCriteria: 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 eighteen 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 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.Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2019-010.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: The County agrees with the finding. Supervisors will review action reports regularly to determine if corrective action plan was taken and that action was correctly closed out. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations.

US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance ProgramCFDA #: 93.778Finding: 2020-011 IV-D Child Support Non-CooperationSIGNIFICANT DEFICIENCYEligibilityCriteria: 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 two 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 reviewed and reconciled to NC FAST which affect the eligibility, a participant could have been approved for benefits that they were not eligible.Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2019-011.Cause: Error in reading the ACTS report, and 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 that clearly indicates what actions were performed and the results of those actions.Views of responsible officials: The County agrees with the finding. Supervisors will review action reports regularly to determine if correct was taken and that action was correctly closed out. 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 Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program CFDA #: 93.778 Criteria: The State sends notification to the County when a participant is no longer eligible under SSI determination. The County has a certain time period to initiate an ex parte review to determine whether the recipient qualifies for Medicaid under any other coverage group, such as Family and Children's Medicaid, North Carolina Health Choice for Children, Work First Family Assistance, or Medicaid for the Aged, Blind and Disabled. Condition: 2 applicants were not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. Questioned Costs: $263.76. This amount was determined by totaling all the aid received by the two applicants who were not eligible. 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 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: 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: The County agrees with the finding. Supervisors will review action reports regularly to determine if corrective action plan was taken and that action was correctly closed out. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations.

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program 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 were 37 errors discovered during our procedures that inaccurate information was entered when determining eligibility. 4 applicants received assistance for which they were not eligible. Questioned Cost: $30.36. This amount was determined by totaling all the aid received by the four applicants who were not eligible. Context: We examined 91 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 affect income and 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 should clearly indicate what actions were performed and the results of those actions. Views of responsible officials: 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.

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program CFDA #: 93.778 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 14 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 affect to eligibility and there were no 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 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: The County agrees with the finding. Supervisors will review action reports regularly to determine if corrective action plan was taken and that action was correctly closed out. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations.

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program CFDA #: 93.778 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 12 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. Questioned Costs: There was no affect to eligibility and there were no 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 Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly reviewed and reconciled to NC FAST which affect the eligibility, a participant could have been approved for benefits that they were not eligible. Cause: Error in reading the ACTS report, and 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 that clearly indicates what actions were performed and the results of those actions. Views of responsible officials: The County agrees with the finding. Supervisors will review action reports regularly to determine if correct was taken and that action was correctly closed out. 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 Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program CFDA #: 93.778 Criteria: In accordance with 2 CFR 200, management must design, implement, and maintain internal control relevant to the compliance of Federal and State grant requirements. In accordance with the Division of Social Service Fiscal Manual, information reported for reimbursement on the DSS-1571 must agree with the county general ledger. Condition: Information reported on DSS-1571 for reimbursement did not agree with County general leger. Context: Of the12 months DSS-1571 forms reviewed, we examined two months in detail and determined that internal control over DSS-1571 reporting was not effective and efficient. Effect: Information reported on DSS-1571 for reimbursement did not agree with the County general ledger due to the lack of reconciliation and supporting documentation. Cause: Ineffective internal control over DSS-1571 filing procedures. Recommendation: Files should be carefully reviewed internally, reconciliation should be maintained to ensure information reported agrees with the County general ledger. Any discrepancies should be investigated and documented properly. Employees should be retrained on the regulations and the DSS Fiscal Manual that provided by the State. Views of responsible officials: The county agrees with this finding. Management will improve the reporting process to ensure regulations and requirements are properly followed.

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