Rockingham County

ROCKINGHAM COUNTY, NORTH CAROLINA SCHEDULE OF FINDINGS AND QUESTIONED COSTS FOR THE YEAR ENDED JUNE 30, 2025 Any audit findings disclosed that are required to be reported in accordance with the State Single Audit Implementation Act X yes no Identification of major State programs: Program Name Foster Care and Adoption Cluster Medical Assistance Program State Aid to Airports Program Dollar threshold used to determine a State major program $ 500,000 Auditee qualified as low-risk auditee? yes X no None Reported. 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: Section III. Federal Award Findings and Questioned Costs Section II. Financial Statement Findings Section I. Summary of Auditors' Results 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 crossverification of applicant-provided data against reliable external sources to ensure accuracy and prevent improper payments. 186ROCKINGHAM COUNTY, NORTH CAROLINA SCHEDULE OF FINDINGS AND QUESTIONED COSTS FOR THE YEAR ENDED JUNE 30, 2025 Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: 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 and 2024- 002. 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. There were a total of 10 errors found during our testing procedures: - There were 1 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. - 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 5 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 698,591 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Section III. Federal Award Findings and Questioned Costs (continued) 187ROCKINGHAM 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: 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) 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. 188

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: 2024-001 Inaccurate Information Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: There were 2 errors discovered during our procedures that inaccurate information was entered when determining eligibility. There was no known affect to eligibility and there were no known questioned costs. 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.Context: 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: 2024-002 Untimely Review of SSI Terminations 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 a 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. This is a repeat finding from the immediate previous audit, 2023-001. Section III. Federal Award Findings and Questioned Costs (continued) We examined 60 cases from of a total of 1,127,837 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, and 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. Please refer to the corrective action plan for details.

Context: 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: 2024-002 Untimely Review of SSI Terminations 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 a 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. This is a repeat finding from the immediate previous audit, 2023-001. Section III. Federal Award Findings and Questioned Costs (continued) We examined 60 cases from of a total of 1,127,837 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, and 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. Please refer to the corrective action plan for details.Condition: Questioned Costs: Context: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 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. The County agrees with the finding. Please refer to the corrective action plan for details. Any State communications related to applicants/beneficiaries 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. SIGNIFICANT DEFICENCY: Finding 2024-001 and 2024-002 also apply to State requirements and State Awards. Section IV. State Award Findings and Questioned Costs 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 ex-parte review. This information was not shared with other departments in DSS from which the recipient was also receiving benefits. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 1,127,837 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 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. Section III. Federal Award Findings and Questioned Costs (continued)

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: 2023-001 Inaccurate Information Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: There were 7 errors discovered during our procedures that inaccurate information was entered when determining eligibility. There was no known affect to eligibility and there were no known questioned costs. 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. Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective 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, 2022-002. 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, and 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. We examined 60 cases from of a total of 1,026,673 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 (Medicaid; Title XIX) AL #: 93.778 Finding: 2023-002 Inaccurate Resources Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. 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. There was 2 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. There was no known affect to eligibility and there were no known questioned costs. 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. Section III. Federal Award Findings and Questioned Costs (continued) We examined 60 cases from of a total of 1,026,673 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 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.

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 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. There were 1 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 1,026,673 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 applicants could have been approved for benefits for which they were not eligible. Ineffective record keeping and ineffective case review process, incomplete documentation, and 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 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. 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 (Medicaid; Title XIX) AL #: 93.778 Finding: 2023-004 Non-cooperation with Child Support Procedures SIGNIFICANT DEFICENCY 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 noncustodial 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 5 errors discovered during our procedures that referrals between Department of Social Services (DSS) and Child Support Agencies were not properly made. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 1,026,673 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 applicants could have been approved for benefits for which they were not eligible. Error in reading the ACTS report and/or ineffective case review process. 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. The County agrees with the finding. See Corrective Action Plan in the following section.

US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance Program (Medicaid; Title XIX)AL #: 93.778Finding: 2022-002 Inaccurate Information EntrySIGNIFICANT DEFICENCYEligibilityCriteria: 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 7 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 of a total 1,085,259 Medicaid claims from the Medicaid Beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit.Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible.Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility.Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions.Views of responsible officials and planned corrective actions: The County agrees with the finding. Please refer to the corrective action plan for details.

US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance Program (Medicaid; Title XIX)AL #: 93.778Finding: 2022-003 Inaccurate Resources EntrySIGNIFICANT DEFICENCYEligibilityCriteria: "In accordance with Medicaid Manual MA-2230, Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were donein 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."Condition: There was 3 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 of a total 1,085,259 Medicaid claims from the Medicaid Beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit.Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible.Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility.Recommendation: Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions.Views of responsible officials and planned corrective actions: The County agrees with the finding. Please refer to the corrective action plan for details.

US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance Program (Medicaid; Title XIX)AL #: 93.778Finding: 2022-004 Untimely Review of SSI TerminationSIGNIFICANT DEFICENCYEligibilityCriteria: 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: 1 applicant was not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated.Questioned Costs: There was no known affect to eligibility and there were no known questioned costs..Context: We examined 60 of a total 1,085,259 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. 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 Program (Medicaid; Title XIX)AL #: 93.778Finding: 2022-005 Inadequate Request for InformationSIGNIFICANT DEFICENCYEligibilityCriteria: 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 1 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 of a total 1,085,259 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, 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 and planned corrective actions: The County agrees with the finding. Please refer to the corrective action plan for details.

U.S. Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: IV-E Foster Care and Adoption Assistance ClusterAL #: 93.658, 93.659Finding: 2022-006 Incorrect Family Assistance Unit DeterminationSIGNIFICANT DEFICENCYReportingCriteria: In accordance with the Child Welfare Manual, Foster Care Funding Appendix 3.5, The composition of the Aid to Families with Dependent Children (AFDC) family assistance unit must be determined first in establishing whether the child is financially needy. The family assistance unit is defined as a group of individuals whose income, resources, and needs are considered as a unit for purposes of determining AFDC eligibility. It consists of the child, natural or adoptive parents and the blood or adoptive siblings living in the same household. If the child lives with a specified relative other than a parent, the family unit will consist of only the child and any siblings that also live with the same specified relative.Condition: There were 10 errors discovered during our procedures that the family assistance unit was determined incorrectly.Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.Context: We examined 12 cases from 113 IV-E Foster Care Assistance applicants to re-determine eligibility. These findings are being reported with the financial statement audit a it relates to IV-E Foster Care administrative costs compliance audit.Effect: For those eligibility determination and re-determination, there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NCFAST) and a participant could have been approved for benefits for which they were not eligible.Cause: Rockingham started to use NC FAST for the Child Welfare as a pilot county, the system was initially not designed intuitively or in a way that was easy to use. There were multiple system issues in the area of FC Financials (including issues with printed forms & documentation) until the Fund Eligibility process was resolved in January of 2020, along with a system update completed in November of 2020 to provide the ability for users to now reassess the CW Fund Eligibility. Due to the system functionality issues, the case workers were not able to enter and document the household relationship properly.Recommendation: Workers should be retrained on NCFAST functions to ensure accurate and complete information is entered into system. Files should be reviewed internally to ensure proper documentation is in place for eligibility.Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details.

Information on the federal program: Medicaid Cluster (Medicaid), CFDA 93.778, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services, Division of Medical Assistance. Criteria or specific requirement: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX) Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual), case files for individuals or families receiving assistance are required to retain documentation to evidence appropriate eligibility determination, including: ? accurate record of household members and relationships ? accurate computation of countable income ? verification of earned income ? verification of unearned income Conditions: We noted that in two instances, the case record did not contain an appropriate income conversion and computation in accordance with policy manuals. In four instances, we noted that SOLQ OVS/ OLV, Bendex OVS/OLV, SDX OVS, ESC OVS, and ACTS OVS were not completed to verify the individual?s unearned income. In three instances, we noted that household and relationship information on the image documents was incorrectly entered into NC FAST. In two instances, we noted that the Employment Security Commission (ESC) OVS was not completed to verify the individual?s earned income. In two instances, we noted the total countable income was not recorded accurately into NC FAST based upon documentation in the case record. Context: We sampled 93 participants from a total population of 1,889,126 participants. We noted the above conditions in 8 of the 93 case files inspected. Effect: Case files not containing all required documentation result in a risk that the County could provide services to individuals not eligible to receive such services or that such services could be denied to eligible individuals. Subsequent to being notified that required documentation had not been retained in case files, the County was able obtain documentation to substantiate that the applicants tested were eligible to receive benefits. Cause: The County did not retain required documentation in case files at the time eligibility was determined. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policy and procedures in place to ensure that all eligibility determination documentation is completed and retained by the County.

Information on the federal program: Medicaid Cluster (Medicaid), CFDA 93.778, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services, Division of Medical Assistance. Criteria or specific requirement: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX) Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual), case files for individuals or families receiving assistance are required to retain documentation to evidence appropriate eligibility determination, including: ? verifications of United States citizenship ? verifications of North Carolina State Residency ? accurate record of household members and relationships ? verification of social security number ? verification of real property ownership ? accurate computation of countable income ? verification of earned income ? verification of unearned income ? documentation supporting the use of forced eligibility Conditions: We noted that in one instance the case record did not contain documentation evidencing that tax and Register of Deeds? records were checked to verify whether the individual owns property. In ten instances, the case record did not contain evidence that SOLIQ was completed or manual documentation obtained to verify the individuals citizenship/ alien status. In seven instances, the case record did not contain evidence of household and relationship information to verify household composition. In nine instances, the Employment Security Commission (ESC) OVS was not completed to verify the individual?s earned income. In nine instances, SOLQ OVS/ OLV, Bendex OVS/OLV, SDX OVS, ESC OVS, and ACTS OVS were not completed to verify the individual?s unearned income. In ten instances, the case record did not contain evidence that the State Online Query OVS (SOLQ) was completed to verify the individual?s Social Security Number (SSN). In one instance, the case record did not contain necessary documentation and approvals to determine appropriate use of forced eligibility. In seven instances, the case record did not contain an appropriate income conversion and computation in accordance with policy manuals. In twelve instances, the total countable income was not recorded accurately into NC FAST based upon documentation in the case record. Context: We sampled 93 payments from a total population of 2,026,496 payments made to the participants during the fiscal year. We noted the above condition in 25 of the 93 case files inspected for applicable payments. Effect: Case files not containing all required documentation result in a risk that the County could provide services to individuals not eligible to receive such services or that such services could be denied to eligible individuals. Subsequent to being notified that required documentation had not been retained in case files, the County was able obtain documentation to substantiate that the applicants tested were eligible to receive benefits. Cause: The County did not retain required documentation in case files at the time eligibility was determined. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policy and procedures in place to ensure that all eligibility determination documentation is completed and retained by the County.

Criteria or specific requirement: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX) Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual), to be eligible to receive benefits under this program the individual must have countable resources below the MAGI Medicaid income limits associated with the individual?s household composition. Condition: Four individuals received benefits when their countable income exceeded the MAGI Medicaid income limits. Questioned cost: The known questioned cost was $138. Context: We sampled 93 participants of 23,461 participants. We noted the conditions above were contained in 4 of the 94 case files inspected. Effect: Individuals with countable income over the MAGI Medicaid income limit were incorrectly deemed eligible to receive Medicaid. The known questioned cost was $138. Cause: Incorrect countable income was entered into NCFAST. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policy and procedures to ensure countable income is verified and accurately recorded in NC FAST during the eligibility determination process.

Information on the federal program: Temporary Assistance for Needy Families (TANF), CFDA 93.558, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services, Division of Social Services. Criteria or specific requirement: Per the North Carolina TANF Program (Work First Program) Compliance Supplement and the DSS manuals, the family?s net earned and unearned income are deducted from the Need Standard for the number of assistance unit members. The payment is one-half the difference. Conditions: We noted that in one instance a families monthly benefit check was larger than the calculated standard payment amount they should have been received. Questioned cost: The known questioned cost was $1,204. Context: We sampled 93 payments from a total population of 5,355 payments made to the participants during the fiscal year. We noted the above condition in 1 of the 93 case files inspected for applicable payments. Effect: Individuals received larger monthly benefit payments than allowed. The known questioned cost was $1,204. Cause: Countable income was incorrectly recorded in NCFAST resulting in an inaccurate needs calculation. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process to understand how the benefits are calculated and determined and that the appropriate amounts are used to pay benefits.

Information on the federal program: Temporary Assistance for Needy Families (TANF), CFDA 93.558, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services, Division of Social Services. Criteria or specific requirement: Per the North Carolina TANF Program (Work First Program) Compliance Supplement and the DSS manuals, to be eligible a family cap is applied when a child is born 10 months after a month in which a parent received cash assistance which does not allow the family?s TANF Family Assistance payment to increase. Conditions: We noted that in one instance a families monthly benefit check increased. Questioned cost: The known questioned cost was $660. Context: We sampled 93 payments from a total population of 5,355 payments made to the participants during the fiscal year. We noted the above condition in 1 of the 93 case files inspected for applicable payments. Effect: Individuals received larger monthly benefit payments than allowed. The known questioned cost was $660. Cause: Proper internal controls are not in place to ensure a DSS caseworker assess the family cap conditions. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policy and procedures in place to ensure that the family cap is assessed when determining TANF eligibility.

Information on the federal program: Temporary Assistance for Needy Families (TANF), CFDA 93.558, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services, Division of Social Services. Criteria or specific requirement: Per the North Carolina TANF Program (Work First Program) Compliance Supplement and the DSS manuals, the County must implement the required Income Eligibility and Verification System through the Online Verification System (OVS). Conditions: We noted that in one instance the casefile did not contain a completed OVS. Context: We sampled 93 payments from a total population of 5,355 payments made to the participants during the fiscal year. We noted the above condition in 1 of the 93 case files inspected for applicable payments. Effect: Case files not containing all required documentation result in a risk that the County could provide services to individuals not eligible to receive such services or that such services could be denied to eligible individuals. Subsequent to being notified that required documentation had not been retained in case files, the County was able obtain documentation to substantiate that the applicants tested were eligible to receive benefits. Cause: The County did not retain required documentation in case files at the time eligibility was determined. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policy and procedures in place to ensure that all eligibility determination documentation is completed and retained by the County.

Information on the federal program: Low Income Home Energy Assistance, CFDA 93.568, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services, Division of Social Services. Criteria or specific requirement: Per the North Carolina Low-Income Home Energy Assistance Compliance Supplement and Energy Programs Manual published by the Division of Social Services, households denied assistance or not receiving reasonably prompt assistance must have an opportunity for a hearing. Condition: We noted that in one instance the Approval/ Denial Notice form DSS-8107 was not marked sent in NC Fast resulting in the client not having an opportunity for a hearing. Context: We sampled 25 of 137 total denied applications. We noted the above condition in one of the 25 inspected files. Effect: Case files containing an Approval/ Denial Notice form 8107 that is not sent to applicants results in a risk that the denied or approved applicants are not receiving timely communication or an opportunity for a hearing. Cause: Internal controls were not in place to ensure the Approval/ Denial Notice for DSS 8107 is sent in NC FAST. Recommendation: We recommend that the County continue to train and monitor employees on the eligibility/denial application process to ensure eligibility worksheets are completed appropriately, reviewed by the DSS caseworker and retained by the County.

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