Audit finds errors, delays in Medicaid eligibility system

Posted June 20

State Auditor Beth Wood discusses an audit of the Medicaid program during a Jan. 31, 2013, news conference.

— State auditors say problems with the state's management of a system to deliver Medicaid services has delayed benefits and resulted in eligibility errors for the disabled and low-income children and seniors who use the health insurance program.

The report released Tuesday by State Auditor Beth Wood's office determined the state Department of Health and Human Services failed to create adequate training and staffing levels for the county workers who sign people up for Medicaid, which serves about 1.9 million people across the state. Auditors also found the DHHS was slow to fix technical glitches with its NC FAST program, designed to streamline the deliver of social services.

As a result, Wood's office said lack of training and strained staffing led to errors in the 10 counties auditors examined, either denying benefits to those who qualified or approving them when people were ineligible. In Guilford County, for example, almost one in five applications resulted in errors.

Because DHHS didn't provide counties with any guidelines on how many workers counties would need to process Medicaid applications, auditors said staffing levels varied widely. A staffer in Vance County, for example, would need to process almost three times the number of applications as a worker in Jones County.

"With such a wide range, there are likely inefficiencies and strains in the Medicaid eligibility determination process," auditors wrote.

Serious bugs in the NC FAST system, auditors found, also took DHHS staffers too long to fix, likely delaying benefits to people altogether. Department policy requires staffers to resolve 90 percent of these bugs – called "Tier 3" tickets – within 10 days. But over the course of a year, 80 percent of those tickets took longer than 10 days to solve, and of those, one-third took more than three months to fix.

Auditors attributed the delays to bad communication between the state and counties and the failure of DHHS to monitor the tickets.

In a formal response to the report, DHHS officials said they agreed with the auditors' findings and recommendations, which include the creation of better training programs, monitoring of staffing levels and improved communication about the status of technical glitches.

Tuesday's audit follows a January report from Wood's office that criticized DHHS oversight over counties responsible for determining Medicaid eligibility through the NC FAST system.

State health officials have spent millions and have been working for years to roll out NC FAST in stages to handle a range of social services, from food stamps to Medicaid. Although designed to make it easier for North Carolina residents to access those services, the system has been repeatedly knocked by the Auditor's Office and the state legislature for technical problems and delayed benefits.

Read the audit


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