Wake County performed the worst of 10 counties tested for efficiency in handling new Medicaid applications, according to a state audit released Thursday.
The audit examined 250 new applications out of the more than 50,000 processed by Wake in the year ending last June. Wake took too long to determine eligibility for 26 percent of the applicants for enrollment in the government health insurance program that covers poor children, some of their parents, the elderly and the disabled.
The federal government and state law set a deadline of 45 days to determine whether people who apply for Medicaid can enroll. The deadline is 90 days for people seeking disability services.
The audit found great variability in accuracy and timeliness among the counties. Wilkes, a small mountain county, was the most accurate and was the best at meeting deadlines. Guilford County made the most mistakes in determining whether applicants were eligible for Medicaid, with errors on 47 out of 250 applications, or 18.8 percent. Wake’s error rate was relatively low, at 5.6 percent for new applications.
Mistakes mean that some people who aren’t eligible for the insurance program get coverage, while some eligible people are denied. Many wait too long to find out whether or not they qualify. About 1.9 million state residents are enrolled in Medicaid.
State Auditor Beth Wood said she wasn’t surprised by the wide differences in timeliness and quality. Although the state Department of Health and Human Services is responsible for running the Medicaid program, the department has left it up to counties to get people properly enrolled.
“The real takeaway here is that DHHS get their arms around eligibility determination in 100 counties and make sure it’s being consistently done,” Wood said. “DHHS has left it to the counties to do their own thing.”
The audit says DHHS does not provide enough oversight and “has not accepted full responsibility for administration of the program.” It recommends DHHS give counties written guidance on staffing levels, expanded staff training, minimum pay and qualifications for caseworkers, and procedures for properly handling Medicaid applications.
In a statement, DHHS said it is working on the audit’s recommendations.
“Although Medicaid eligibility processing is carried out through counties, DHHS recognizes that we are ultimately accountable,” the statement said.
A 2015 law required an audit of “a representative sample of counties” handling of Medicaid applications. Auditors looked at 250 new applications in each of the three largest counties, six rural counties, and Rowan, which it designated suburban.
The counties use computer software called NC FAST to determine whether applicants are eligible for social services such as Medicaid. Counties make mistakes despite the standardization. The auditors found that caseworker typos and math mistakes accounted for many errors. At other times, applicant files did not include all necessary information, most often lacking verification of income or assets, the audit said.
Caseworkers are trained how to handle applications, but according to Wood, workers said “the training was awful.”
The audit said DHHS did not require county caseworkers determining Medicaid eligibility to learn how to use NC FAST and did not monitor whether counties completed the training.
In a written response included with the audit findings, Wake’s human services director, Regina Petteway, wrote that problems meeting deadlines stemmed from the introduction of NC FAST and the Affordable Care Act increasing applications. The department added jobs to remedy understaffing, she wrote. An effort to get better at making decisions within the time allowed resulted in a 70 percent reduction in broken deadlines between March 31 and Nov. 30, she wrote.