PM 22-09-00: Quality Control (Medicaid, SNAP)

WAG 22-09-00

The Department of Human Services Bureau of SNAP revised textIntegrity (BSNAPI) reviews cases receiving SNAP benefits. The Department of Healthcare and Family Services Bureau of Medicaid Integrity (BMI) conducts reviews of cases receiving Medical Assistance.

The Quality Control (QC) process includes:

  • reviews of the eligibility and payment status of a case at a given point in time;
  • reviews of Medicaid eligibility;
  • reviews of SNAP cases as mandated by federal law;
  • targeted reviews, such as client surveys, provider audits, or database matches.

QC reviews measure how correctly staff apply policy and deliver benefits to eligible persons. The goal of targeted reviews is to improve services for our clients and other customers, while detecting and preventing fraud and abuse.

QC staff conduct reviews of active cases, canceled cases, and denied cases.