State audit shows errors in processing of Medicaid applications

PLYMOUTH, N.C. (WNCT) – A recent state audit revealed mistakes being made on Medicaid applications, that could impact where tax dollars are actually going.

The audit took place between July 2015 and June 2016. The audit focused on 10 counties, three urban and the other seven rural.

Among those selected were Jones and Washington Counties.

The audit looked at the total number of Medicaid applications processed by the county’s department of social services to see how many errors were made, and how timely the office was in responding to the applicant.

Jones County was the most inaccurate in processing Medicaid applications of the rural counties audited. The audit found for new applications, Jones County had accuracy errors on 16% of applications. Washington County came in 3rd worst for rural counties audited, making errors on 8% of applications.

Jones County was once again the worst in terms of responding to applications within 45 days, failing to do so on 24.8% of new applications. Washington County was again 3rd worst, failing to respond within 45 days on 22.8% of applications.

Tammy Mixon with Washington County’s DSS released a statement saying:

“Washington County had been working as early as 2015 on a plan for Medicaid timeliness and accuracy performance, as one knows it takes time to fully implement changes and see positive results. We were still in the process of implementing the performance plan when the State Audit occurred in 2016. The period of time that the audit was covering was from July 1, 2015 to through June 30, 2016. The audit findings were not a true reflection of Washington County’s timeliness performance as during the same period of time our agency experienced a 55% staff turnover. However, Washington County takes full responsibility for our performance in timeliness and accuracy regardless if system error, worker error, or staffing turnovers that causes us not to perform at 100%. Washington County is currently performing at 100% with no applications and/or re-certifications going untimely as of April 30, 2017. The only time we may have a case go untimely would be if we were unable to resolve a processing issue at the local level, which may prevent the client from receiving benefits in a timely manner and needs the guidance from the State for a resolution. We feel that the current performance plan, internal trainings, weekly staff meetings, and being fully staffed is what has allowed us to improve our overall performance.  Washington County continues to update the plan when necessary to ensure timeliness and accuracy is met for every deadline.”

Despite numerous calls and emails to the Jones County DSS office, no response was given to WNCT as to how they plan to fix the mistakes.

However, as part of the audit, Jones County DSS Director Jack Jones did provide the state a corrective action plan. In it, he said they would now require all new staff to utilize the Income Maintenance Training offered at Lenoir Community College. Jones also said they would prove better oversight of employees and improve quality of supervision.

He did say, however, that as a small county, they face many barriers in finding specialized individuals who can assist in training.

To read the full audit report, click here.

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