Pasquotank CountyLocal Government

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, documentation should be present and agree back to the records in the NC FAST system. Any items discovered in the process should be considered resources and explained within the documentation. Condition: There were eleven (11) technical 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. The errors were as follows: Two (2) cases had a failure to complete at least one compliance component or were improperly forced, seven (7) cases lacked substantiating documentation and/or inaccurate resource calculations, and two (2) cases did not have accurate budget calculations. Questioned Costs: There was no affect to eligibility and there were no questioned costs. Context: We examined 60 Medicaid transactions out of 202,882 to re-determine eligibility Medicaid claims from the Medicaid beneficiary report provided by the NC Department of Health and Human Services. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and 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 countable resource and a participant could have been approved for benefits that 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2024-001. 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations.

Criteria: Food and Nutrition Services case files to require proper documentation be contained in the case record to verify eligibility. The case file should contain a completed, signed (telephonic signature is allowable) and dated Food and Nutrition Services application (DSS-8207 or electronically generated ePASS application). The form must be signed by an adult household member (or an authorized representative), and NC FAST captures the user ID which serves as the worker’s electronic signature. Additionally, employment program participation is required for specified applicants. Eligibility criteria further outlined in Food and Nutrition Services Certification Manual, Section 305 through Section 350. Condition: There was one case lacking the required signature. Questioned Costs: There was no affect to eligibility and there were no questioned costs. Context: We examined 60 out of 2,565 Food and Nutrition Services case files active during the fiscal year to ensure verifications used to determine eligibility were properly documented. Effect: For the active cases, there was a chance that information was not adequately documented or were not accessible NC FAST which affect general adherence to prescribed guidelines. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2024-002. 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 supporting documentation used for eligibility verification be reviewed for completeness and reconciled to the information provided in worker dictation. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations.

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. documentation should he present and agree back to the records in the NC FAST system. Any Items discovered In the process should be considered resources and explained within the documentation. Condition: There were eleven (11) technical errors discovered during our procedures that resoum,s ill th• county documentation and those same resources contalned in NC FAST were not the same amounts or files containing resources were not properly documei1ted to be considered countable or non-countable. The errors were as follows: Three (3) rases had a failure to complete at least one compliance component or were improperly forced, two (2) cases lacked substantiating documentation and/or inaccurate resource calculations, four (4) cases did not have accurate budget calculations, and two {2) cases had Inaccurate needs t1nit calculations. Questioned Costs, There was no affect to eligibility and there were no questioned costs. Context: We examined 60 Medkald transactions out of 442,357 to re-determine eligibility Medicaid daims from the Medicaid beneficiary report provided by the NC Department of Health and Human Services. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Servicesand are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: Por those certifications/re•certilications there was a chance that information was not properly documented and reconciled to NC PAST which affect countable resource and a participant could have been approved for benefits that they were not eligible. Cause: Ineffective record keeping and ineffective case review process, Incomplete documentation, and incorrect application ofrutes for purposes of determining eligibility. ldentlficallon ora repeat finding, This is a repeat finding from the Immediate previous audit, 2023-001. Recommendation: Flies should be reviewed internally to ensure proper documentation is in place for eligiblllty. Worlrors should he retrained on what files should contain and the Importance of complete and accurate record keeping. We recommend that all files Include online verifications, dornmented resources of Income and those amounts agree to information in NC FAST. Views ofrespouslble officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support ellglblllty 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.

Criteria: Food and Nutrition Services case files to require proper documentation be contained in the case rernrd to verily eligibility. The case file should contain a completed, signed [telephonic signature Is allowable) and dated Food and Nutrition Services application (DSS-8207 or electronically generated ePASS application). The form must be signed by an adult household member [or an authorized representative), and NC FAST captures the user ID which serves as the worker's electronic signature. Additionally, employment program participation is required for specified applicants. Eligibility critelia further outlined In Pood and Nutrition Services Certification Manual, Section 305 through Section 350. Condition: There were three cases lacking the required signature or date certifying the documentation. Questioned Costs, There was 110 affect to eligibility and there were no questioned costs. Context: We examined 60 out of 3,534 Food and Nutrition Services case files active during the fiscal year to ensure verifications used to determine eligibility were properly documented. Effect, For the active cases, there was • chance that lnfom,ation was not adequately documented or were not accessible NC FAST which affect general adherence to prescribed guide!lnes. Identlficalion of a repeat finding: This is not a repeat finding. cause: Ineffective record keeping and ineffective case review proce<S, incomplete docun1entalion, aud incorrect application of rules for purposes of determining eligibility. Reco111111endatlon: Files should be reviewed internally to ensure proper documentation Is In place for eliglbl!lty. Workers should be retrained on what files should contain and the importance ofcomplete and accurate record keeping. We recommend that all supporting documentation used for eligibility verification be reviewed for completeness and reconciled to the Information provided In worker dictation. Views of responsible officials and planned corredive actions: The County agrees with the finding. Supervisors will perform serond party reviews to ensure proper documentation Is contained in files to support eligibility determinatio11S. Workers will be retrained on what information should be maintained in case files, the Importance of complete and accurate record keeping. and reserve cal cu Jations. The County finance office will also participating In the review process.

Criteria: Medicaid for Aged, Blind and Disabled and Medicaid for Family & Children 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, documentation should be present and agree back to the records in the NC FAST system. Any items discovered in the process should be considered resources and explained within the documentation. Condition: There were eleven (11) technical 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. The errors were as follows: Two (2) cases did not have accurate budget calculations, Five (5) cases had a failure to complete at least one compliance component, Three (3) cases contained an inaccurate resource calculation, One (1) cases contained an inaccurate needs unit calculation. Questioned Costs: There was no affect to eligibility and there were no questioned costs. Context: Of the 390,498 cases, we examined 138 Medicaid applicants to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and 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 countable resource and a participant could have been approved for benefits that 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-001. 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations.

US Department of Health and Human ServicesPassed through the NC Dept of Health and Human ServicesProgram Name: Medical Assistance Program (Medicaid; Title XIX)CFDA # 93.778Finding: 2022 - 001Significant DeficiencyNoncompliance EligibilityCriteria: Medicaid for Aged, Blind and Disabled and Medicaid for Family & Children 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, documentation should be present and agree back to the records in the NC FAST system. Any items discovered in the process should be considered resources and explained within the documentation.Condition: There were sixteen (16) technical 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. The errors were as follows: Seven (7) cases did not have accurate budget calculations, Two (2) cases had a failure to complete at least one compliance component, Two (2) cases contained an information input error, Three (3) cases contained an inaccurate needs unit calculation, Two (2) cases contained only one form of residency.Questioned Costs: There was no affect to eligibility and there were no questioned costs.Context: Of the 434,459 cases we examined 120 Medicaid applicants to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance auditEffect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which affect countable resource and a participant could have been approved for benefits that 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.Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-001.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.Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participating in the review process.

Significant Deficiency US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2021 ? 001 Eligibility Criteria: Medicaid for Aged, Blind and Disabled and Medicaid for Family & Children 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, documentation should be present and agree back to the records in the NC FAST system. Any items discovered in the process should be considered resources and explained within the documentation. Condition: There were twelve (12) technical 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. The errors were as follows: Five (5) cases did not have accurate budget calculations, Four (4) cases had a failure to complete at least one compliance component, One (1) case contained an information input error, Two (2) cases contained an inaccurate needs unit calculation. Questioned Costs: There was no affect to eligibility and there were no questioned costs. Context: We examined 60 Medicaid applicants to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and 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 countable resource and a participant could have been approved for benefits that 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participating in the review process.

Significant Deficiency/Noncompliance US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2021 ? 002 Eligibility Criteria: In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. In accordance with 2 CFR 200, management should have an adequate system of internal controls procedures in place to ensure an applicant is properly determined or redetermined for benefits. Condition: There was one error in a case discovered during our procedures that a client was ineligible due to incomplete closure of a denied SSI ex parte review. One applicant/beneficiaries received assistance for which the recipient was not eligible. Questioned Costs: The amount of claims paid on behalf of the above ineligible participants for fiscal year ending 6/30/2021 did not exceed the threshold for a questioned cost determination. Context: We examined 60 Medicaid applicants to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and 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 countable resource or program specific requirements and a participant could have been approved for benefits that 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participate in the review process.

Significant Deficiency US Department of Agriculture Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2020 - 001 Eligibility Criteria: Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application and these items will agree to reports in the NC FAST system. In this process, documentation should be present and agree back to the records in the NC FAST system. Any items discovered in the process should be considered resources and explained within the documentation. Condition: There were twenty three (23) technical 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 flies 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 60 Medicaid applicants to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and 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 countable resource and a participant could have been approved for benefits that 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participating in the review process.

MATERIAL WEAKNESS MATERIAL NONCOMPLIANCE US Department of Agriculture Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2019 ? 001 Eligibility Criteria: Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application and these items will agree to reports in the NC FAST system. In this process, documentation should be present and agree back to the records in the NC FAST system. Any items discovered in the process should be considered resources and explained within the documentation. Condition: There were fourteen (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 60 Medicaid applicants to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and 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 countable resource and a participant could have been approved for benefits that 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participating in the review process.