RANDOLPH COUNTY, NORTH CAROLINALocal Government

U.S. Department of Health and Human Services Passed through N.C. Department of Health and Human Services, Division of Social Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA#: 93.778 Finding 2020-001 Nonmaterial Noncompliance ? Eligibility Criteria: The County should have adequate monitoring controls to ensure that all information is updated appropriately in recipient?s files and in the NCFast system, and to ensure that all required physical documentation is located in the file to properly document eligibility with program requirements. Condition: There were six out of 60 participants tested with errors noted below. All were determined to have properly been eligible. Context: The following are the details of the errors noted on the participants selected for testing: ? There was one instance where the DMV in OVS/OLV did not agree to the information entered into NCFAST. ? There were two instances where income determination (earned or unearned income) was incorrectly calculating the client?s income, but was still within the proper Medicaid class. ? There was one instance where the household count improperly included an additional member of the household that should not have been during the period tested. ? There was one instance in which the IV-D referral was never sent by the County in order to properly determine if the participant was in cooperation with child support. Upon reexamination of each of the files listed above, the County was able to substantiate that all of the recipients were eligible to receive Medicaid benefits. This was accomplished by such means as re-computation of the budget by retrieving the online verification form (OLV) which matched the Medicaid Coverage period to ensure all appropriate income sources were included in the computation. Known Questioned costs: There are no questioned costs as the individuals were eligible for Medicaid services being provided and there were no improper payments. Effect: By not having the required documentation in the files or information being incorrectly documented, eligibility cannot be readily substantiated and there is a risk that the County could provide funding to individuals who are not eligible. Cause: Workers attention to detail and insuring that all OVS/OLV/AVS results are run and that staff are aware and able to troubleshoot the results that are inconclusive. Workers attention to certification period based on type of Medicaid being approved. Recommendation: Although these issues will occur from time to time considering the volume of case files that the County processes and maintains, we recommend that procedures be reinforced in order to ensure that all proper documentation is kept and maintained in the case file in an attempt to prevent loose filings resulting in missing documentation. Views of responsible officials: Management agrees with the finding.

U.S. Department of Health and Human Services Passed through N.C. Department of Health and Human Services, Division of Social Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA#: 93.778 Finding: 2019-002 Significant Deficiency ? Eligibility (Federal and State) Criteria or Specific Requirement: In accordance with Section 200.303 of the Uniform Grant Guidance, each non-federal entity must establish and maintain effective internal controls over the federal award that provides assurance that the non-federal entity is managing the federal awards in compliance with federal statutes, regulations, and the terms and conditions of the federal award. Condition: We noted two instances in which corrective action on eligibility cases selected by the County?s Quality Assurance Department were not remediated during the fiscal year. Context: Out of 60 cases tested for eligibility, two cases had case files that did not meet the County?s documentation and process standards. Corrections to these cases were made approximately 12 months after the date of review. Known Questioned Costs: There are no questioned costs as the individuals were eligible for services being provided and there were no improper payments. Effect: Case files were incomplete or did not adhere to the County?s policies or procedures. Cause: The County did not follow their policy on when remediation must occur. Recommendation: We recommend that the County implement a policy to ensure cases selected for quality review are remediated in a timely manner. Best practices in this regard are within 30 days. Views of responsible officials: Management agrees with the finding.

U.S. Department of Health and Human Services Passed through N.C. Department of Health and Human Services, Division of Social Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA#: 93.778 Finding 2019-003 Nonmaterial Noncompliance ? Eligibility Criteria: The County should have adequate monitoring controls to ensure that all information is updated appropriately in recipient?s files and in the NCFast system, and to ensure that all required physical documentation is located in the file to properly document eligibility with program requirements. Condition: We noted one instance in which income was incorrectly documented with the NCFast system. Context: Out of the 60 cases tested, we noted one of the files had incorrect income documented in NCFast. The income support provided by the applicant showed income of $1,447.87 per month but the income entered into NCFast was $751.10 per month. Based on this error, the applicant received MAFCN and should have received MPW. Known Questioned costs: There are no questioned costs as the individual was eligible for Medicaid services being provided and there were no improper payments. Effect: By information being incorrectly documented, eligibility cannot be readily substantiated and there is a risk that the County could provide funding to individuals who are not eligible. Cause: Caseworker oversite. Recommendation: Although these issues will occur from time to time considering the volume of case files that the County processes and maintains, we recommend that procedures be reinforced in order to ensure that all proper documentation is kept and maintained in the case file. Views of responsible officials: Management agrees with the finding.

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