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Timeliness of Medicaid Eligibility Determinations Declined Due to Challenges Imposed by NC FAST and Affordable Care Act Implementation (April 2016)

Summary

In North Carolina, county departments of social services (county DSS offices) perform Medicaid eligibility determinations under the supervision of the Department of Health and Human Services (DHHS). County DSS offices failed to meet North Carolina’s timeliness standard for processing Medicaid applications in Fiscal Years 2013–14 and 2014–15. The decrease in timeliness during these years coincided with a workload increase for county DSS offices stemming from conditions created by NC FAST implementation and enactment of the Affordable Care Act. NC FAST offers DHHS the opportunity to proactively manage and monitor county DSS offices, yet the department needs additional resources and authority to hold counties accountable. The General Assembly should authorize DHHS to intervene and take over county administration of Medicaid eligibility determinations when warranted; direct DHHS to report on the timeliness of determinations for Fiscal Years 2015–16 and 2016–17; and appropriate $300,000 to DHHS to support utilization of NC FAST data for performance measurement and evaluation.

Final Report

Executive Summary

Presentation

Handout

Recommendations

Relevant Legislation:

  • Session Law 2017-57, Section 11H.21 directs DHHS to report annually on the timeliness of Medicaid eligibility determinations and on corrective actions conducted and planned for assisting county DSS offices with meeting timeliness standards.
  • Session Law 2016-94, Section 12H.17 requires DHHS to report on the timeliness of Medicaid eligibility determinations for Fiscal Years 2015–16 and 2016–17; sets standards for timely decision and processing of applications; and establishes corrective action measures for county department of social services that fail to meet either average processing time standards, percentage processed timely standards, or both standards.

Agency Actions:

  • DHHS submitted the required report for the 2016–17 fiscal year providing information on the timeliness of Medicaid eligibility determinations by county departments of social services.
  • Effective January 1, 2017, DHHS will monitor the timeliness of Medicaid eligibility determinations by county departments of social services and take corrective actions according to state law if necessary.
  • DHHS is in the process of filling the seven new positions authorized by the General Assembly to support improved utilization of NC FAST data to assist county departments of social services.

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