SCOTLAND COUNTYLocal Government

Scotland County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2024 US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2024-002 Inaccurate Resources Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Identification of a repeat finding: Effect: Cause: Recommendation: Section III. Federal Award Findings and Questioned Costs 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. 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. There were 2 errors discovered during our procedures where resources were imcorrectly calculated or were not properly documented in the case file. Of these 2 errors, one was determined to be an eligibility error with potential questioned costs. There was no known affect to eligibility and there were no known questioned costs. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. Ineffective record keeping and ineffective case review process, incomplete documentation, or incorrect application of rules for purposes of determining eligibility. We examined 60 from a total of 623,126 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, 2023-005. 114

Scotland County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2024 Views of responsible officials and planned corrective actions: Finding: 2024-003 Inadequate Request for Information SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Identification of a repeat finding: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: Ineffective record keeping and ineffective case review process, incomplete documentation, or incorrect application of rules for purposes of determining eligibility. The County agrees with the finding. See Corrective Action Plan in the following section. Section III. Federal Award Findings and Questioned Costs (continued) 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. We examined 60 from a total of 623,126 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. 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. 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 was no known affect to eligibility and there were no known questioned costs.. There were 8 errors discovered during our procedures where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. This is a repeat finding from the immediate previous audit, 2023-007. The County agrees with the finding. See Corrective Action Plan in the following section. 115

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2023-003 IV-D Cooperation with Child Support SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Department of Social Services (DSS) and Child Support Agencies must be met or good cause for not cooperating must be established when determine Medicaid eligibility. We examined 60 from a total of 602,939 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. There were 2 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. There was no known affect to eligibility and there were no known questioned costs Identification of a repeat finding: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2023-004 Inaccurate Information Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Identification of a repeat finding: Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determine eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. The County agrees with the finding. See Corrective Action Plan in the following section. There was no known affect to eligibility and there were no known questioned costs. We examined 60 from a total of 602,939 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. 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. There were 4 errors discovered during our procedures that inaccurate information was entered when determining eligibility. Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. 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. Section III. Federal Award Findings and Questioned Costs (continued) This is a repeat finding from the immediate previous audit, 2022-005.

Identification of a repeat finding: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2023-004 Inaccurate Information Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Identification of a repeat finding: Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determine eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. The County agrees with the finding. See Corrective Action Plan in the following section. There was no known affect to eligibility and there were no known questioned costs. We examined 60 from a total of 602,939 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. 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. There were 4 errors discovered during our procedures that inaccurate information was entered when determining eligibility. Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. 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. Section III. Federal Award Findings and Questioned Costs (continued) This is a repeat finding from the immediate previous audit, 2022-005. Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2023-005 Inaccurate Resources Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: The County agrees with the finding. See Corrective Action Plan in the following section. This is a repeat finding from the immediate previous audit, 2021-002. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. Ineffective record keeping and ineffective case review process, incomplete documentation, or incorrect application of rules for purposes of determining eligibility. Section III. Federal Award Findings and Questioned Costs (continued) 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. There was 6 error discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. There was no known affect to eligibility and there were no known questioned costs. 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.

Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2023-005 Inaccurate Resources Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: The County agrees with the finding. See Corrective Action Plan in the following section. This is a repeat finding from the immediate previous audit, 2021-002. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. Ineffective record keeping and ineffective case review process, incomplete documentation, or incorrect application of rules for purposes of determining eligibility. Section III. Federal Award Findings and Questioned Costs (continued) 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. There was 6 error discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. There was no known affect to eligibility and there were no known questioned costs. 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. Context: Identification of a repeat finding: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2023-006 Untimely Review of SSI Termination SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. We examined 60 from a total of 602,939 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 NC FAST and a participant could have been approved for benefits for which they were not eligible. Ineffective record keeping and ineffective case review process, incomplete documentation, or incorrect application of rules for purposes of determining eligibility. 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. See Corrective Action Plan in the following section. 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. Section III. Federal Award Findings and Questioned Costs (continued) There were 2 errors discovered during our procedures that inaccurate information was entered when determining eligibility.

Context: Identification of a repeat finding: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2023-006 Untimely Review of SSI Termination SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. We examined 60 from a total of 602,939 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 NC FAST and a participant could have been approved for benefits for which they were not eligible. Ineffective record keeping and ineffective case review process, incomplete documentation, or incorrect application of rules for purposes of determining eligibility. 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. See Corrective Action Plan in the following section. 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. Section III. Federal Award Findings and Questioned Costs (continued) There were 2 errors discovered during our procedures that inaccurate information was entered when determining eligibility. Context: Identification of a repeat finding: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2023-007 Inadequate Request for Information SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Section III. Federal Award Findings and Questioned Costs (continued) We examined 60 from a total of 602,939 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. The County did not initiate ex parte review timely, therefore, no eligibility review was completed in the required time period. The lack of follow up and certification lead to applicants receiving Medicaid benefits for which they were not eligible. Ineffective communication between departments within the Department of Social Services. One area within DSS received State communications that applicants would no longer be eligible for SSI benefits and the County needed to conduct an application process. This information was not shared with other departments in DSS from which the recipient was also receiving benefits. 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 was no known affect to eligibility and there were no known questioned costs.. There were 7 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. 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. The County agrees with the finding. See Corrective Action Plan in the following section. This is a repeat finding from the immediate previous audit, 2022-008.

Context: Identification of a repeat finding: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2023-007 Inadequate Request for Information SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Section III. Federal Award Findings and Questioned Costs (continued) We examined 60 from a total of 602,939 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. The County did not initiate ex parte review timely, therefore, no eligibility review was completed in the required time period. The lack of follow up and certification lead to applicants receiving Medicaid benefits for which they were not eligible. Ineffective communication between departments within the Department of Social Services. One area within DSS received State communications that applicants would no longer be eligible for SSI benefits and the County needed to conduct an application process. This information was not shared with other departments in DSS from which the recipient was also receiving benefits. 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 was no known affect to eligibility and there were no known questioned costs.. There were 7 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. 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. The County agrees with the finding. See Corrective Action Plan in the following section. This is a repeat finding from the immediate previous audit, 2022-008. Context: Identification of a repeat finding: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 SIGNIFICANT DEFICENCY/MATERIAL NONCOMPLIANCE: Finding 2023-003, 2023-004, 2023-005, 2023-006 and 2023-007 also apply to State requirements and State Awards. Section IV. State Award Findings and Questioned Costs Ineffective record keeping and ineffective case review process, incomplete documentation, or incorrect application of rules for purposes of determining eligibility. The County agrees with the finding. See Corrective Action Plan in the following section. Section III. Federal Award Findings and Questioned Costs (continued) 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. We examined 60 from a total of 602,939 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. 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. This is a repeat finding from the immediate previous audit, 2022-009.

US Department of Treasury Passed through the NC Department of Health and Human Services Program Name: Coronavirus State and Local Fiscal Recovery Fund AL #: 21.027 Finding: 2022-004 Lack of General Compliance Policies SIGNIFICANT DEFICENCY Internal Control Criteria: In accordance with the U.S. Department of Treasury 31 CFR Part 35, Coronavirus State and Local Fiscal Recovery Funds Final Rule and the Uniform Guidance, General Financial Management Internal Controls, Eligible Projects Determination & Documentation Policy, Cost Principles/Allowable Costs Policy, Civil Rights Compliance / Nondiscrimination Policy, Records Retention Policy, and Conflict of Interest are required to be adopted as condition of receiving the funds. Condition: The County did not adopt and implement the following policies for Coronavirus State and Local Fiscal Recovery Fund (CSLFRF) expenditures: Eligible Use, Allowable Costs, and Civic Right Compliance. Effect: The County could have used the funds for activities and costs that were prohibited by the Final Rule. Cause: County oversight of the new federal grant requirements for the CSLFRF expenditures to have the stated policies in place. Recommendation: The county management should review the award terms and conditions, and the Uniform Guidance more carefully to ensure all compliance requirements are met. Views of responsible officials and planned corrective actions: The County agrees with the finding.

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2022-005 IV-D Cooperation with Child Support SIGNIFICANT DEFICENCY Eligibility Criteria: In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child?s non-custodial parent. Cooperation requirement with Department of Social Services (DSS) and Child Support Agencies must be met or good cause for not cooperating must be established when determine Medicaid eligibility. Condition: There were 7 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 from a total of 683,004 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Cause: Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determine eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Views of responsible officials and planned corrective actions: The County agrees with the finding.

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2022-006 Inaccurate Information Entry SIGNIFICANT DEFICENCY Eligibility Criteria: In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. 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 13 errors discovered during our procedures that inaccurate information was entered when determining eligibility. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 from a total of 683,004 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-002. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, or incorrect application of rules for purposes of determining eligibility. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Views of responsible officials and planned corrective actions: The County agrees with the finding.

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2022-007 Inaccurate Resources Entry SIGNIFICANT DEFICENCY 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 was 1 error discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 from a total of 683,004 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, or incorrect application of rules for purposes of determining eligibility. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Views of responsible officials and planned corrective actions: The County agrees with the finding.

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2022-008 Untimely Review of SSI Termination SIGNIFICANT DEFICENCY Eligibility Criteria: In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a participant is no longer eligible under Supplemental Security Income (SSI) determination, the County is required to initiate the ex parte review within 5 workdays of the date the termination appears on the SSI Termination Report, and complete the redetermination within 4 months of the month the case appears on the SSI Termination Report and notify the recipient about applicant's ongoing eligibility for Medicaid. Condition: There were 2 errors discovered during our procedures that inaccurate information was entered when determining eligibility. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 from a total of 683,004 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: The County did not initiate ex parte review timely, therefore, no eligibility review was completed in the required time period. The lack of follow up and certification lead to applicants receiving Medicaid benefits for which they were not eligible. 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 and planned corrective actions: The County agrees with the finding.

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2022-009 Inadequate Request for Information SIGNIFICANT DEFICENCY Eligibility Criteria: In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. Electronic matches are required at applications and redeterminations. Condition: There were 15 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.. Context: We examined 60 from a total of 683,004 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and applicants could have been approved for benefits for which they were not eligible. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, or incorrect application of rules for purposes of determining eligibility. Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources and income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Views of responsible officials and planned corrective actions: The County agrees with the finding.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services: Division of Social Services Program Name: Medical Assistance Program (Medicaid) CFDA# 93.778 Finding: 2021-002 Significant Deficiency Eligibility/Internal Controls Criteria: Individual case records should maintain proper evidence of the eligibility determination and redeterminations in accordance with the Medicaid Manual and 42 CFR 431.10. Condition: One applicant's information was not properly entered into NC Fast for determination of Medicaid eligibility. An audit of the case file determined the individual qualified for Medicaid. Context: Out of a population of 1,392,617 case files, 98 Medicaid case files were audited for eligibility requirements. One out of the 98 Medicaid case files inadvertently listed one person in the household when there were four people in the household. Effect: Improper information entered into NC Fast could cause an individual to improperly receive Medicaid benefits when they otherwise would not qualify. In addition an individual could be excluded from benefits when they would otherwise qualify. Cause: Human oversight in the eligibility documentation process. Recommendation: Controls could be strengthened to ensure all required steps to determine eligibility have taken place and that all documents are completed. Views of responsible officials and planned corrective actions: This was keying error. The error did not affect eligibility of the case. The department will continue 2nd party reviews of case eligibility for all staff each month. Training for common mistakes will occur - group and/or individual.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services: Division of Social Services Program Name: Low-Income Home Energy Assistance Crisis Intervention Program CFDA# 93.568 Finding: 2021-003 Significant Deficiency Eligibility/Internal Controls Criteria: Individual case records should maintain proper evidence of the eligibility determination and redeterminations in accordance with program requirements for the specific program. Condition: One applicant was an American Indian that should have been referred to the Lumbee Tribe of North Carolina, this applicant received $300 of Low-Income Home Energy Assistance benefits. One applicant file was missing online income verification procedures. Context: Out of a population of 1,637 case files, 40 case files were audited for eligibility requirements. Out of 40 case files sampled and audited, one was not eligible to receive benefits in Scotland County because of American Indian status and one applicant file was missing online verification procedures. Effect: Improper information entered into NC Fast could cause an individual to improperly receive benefits when they otherwise would not qualify. In addition an individual could be excluded from benefits when they would otherwise qualify. Cause: Human oversight in the eligibility documentation process. Recommendation: Controls could be strengthened to ensure all required steps to determine eligibility have taken place and that all documents are completed. Views of responsible officials and planned corrective actions: There is no objection to finding of case that should have been referred to the Lumbee Tribe. One file was missing the process to run OLV - a verification procedure during eligibility. The department will review and retrain on energy program eligibility and complete process to complete eligibility.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services: Division of Social Services Program Name: Medical Assistance Program (Medicaid) CFDA# 93.778 Finding: 2020-004 Significant Deficiency Eligibility/Internal Controls Criteria: Individual case records should maintain proper evidence of the eligibility determination and redeterminations in accordance with the Medicaid Manual and 42 CFR 431.10. Condition: One applicant's information was not properly entered into NC Fast for determination of Medicaid eligibility. An audit of the case file determined the individual qualified for Medicaid. Context: Out of a population of 1,192,195 case files, 98 Medicaid case files were audited for eligibility requirements. One out of the 98 Medicaid case files did not have enough information entered into NC Fast to determine eligibility at recertification. Effect: Lack of evidence entered into NC fast could cause an individual to improperly receive Medicaid benefits when they otherwise would not qualify. In addition an individual could be excluded from benefits when they would otherwise qualify. Cause: Human oversight in the eligibility documentation process. Recommendation: Controls could be strengthened to ensure all required steps to determine eligibility have taken place and that all documents are completed. Views of responsible officials and planned corrective actions: The County agrees with this finding and has strengthened controls in the data entry of client information by continuing monthly second party reviews measuring internal controls and eligibility.

Finding: 2019-002 Significant Deficiency Eligibility Criteria: Individual case records should maintain proper evidence of the eligibility determination and redeterminations in accordance with the Medicaid Manual and 42 CFR 431.10. Condition: One applicant received assistance who did not qualify. Context: Out of a population of 9,407 case files, 101 Medicaid case files were audited for eligibility requirements and one received excess benefits. The known excess amounts paid were $256.81 and did not rise to the level of questioned costs. Effect: One applicant case file out of 101 case files audited received excess benefits. Identification of repeat finding: This is a repeat finding from the immediate previous two audits. See Findings 2018-006 and 2017-003. However, this finding was not a result of control failures by Scotland County. Cause: Improper transfer of case file from another county. Recommendation: Client should continue reviewing transfer cases for errors. Views of responsible officials and planned corrective actions: The case cited was a transfer case from another county. The case was not transferred according to NC FAST policy or Department of Health Benefits policy by the transferring county. As proper procedures were not followed for transfer and no review completed as required prior to transfer, Scotland County had no notification of action to take. Once notification was received in June 2019, Scotland County responded appropriately to review the case and terminate Medicaid. Any costs incurred through Medicaid are the responsibility of the transferring county. If following policy, no Medicaid costs would have occurred.

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