Medicaid Eligibility Quality Control (MEQC)

The Medicaid Eligibility Quality Control (MEQC) program is federally mandated by the Centers for Medicare and Medicaid Services (CMS) to oversee and audit the processes for Medicaid eligibility. (CFR) 42 §431.800-431.865

What is MEQC’s role?

  • Oversees the application processes and case management through the execution of regular audits
  • Ensures case processes are accurate and efficient
  • Works to identify methods to reduce errors and avoid incorrect eligibility determinations

What types of audits does MEQC conduct?

  • In Colorado MEQC conducts Pilot Projects
  • Each pilot focuses on a specific eligibility area (ex. HCBS, citizenship, LTC and resources) and requires CMS’ approval
  • Number of cases reviewed is dependent on the specific Pilot 

Some of the objectives we measure:

  • Timely processing of applications (timeliness also applies to each site’s response to MEQC’s requests for cases to be submitted and for errors to be addressed)
  • Data entry
  • Case file documentation

Why is 100% compliance with these audits mandatory?

  • The Centers for Medicare and Medicaid Services (CMS) closely monitors the efficacy of state agencies. Error rates that exceed guidelines may affect federal funding. (CFR) 42 §431.865
  • The Department has made a commitment to ensure every eligible citizen has access to the benefits they qualify for. Regular audits performed by MEQC help ensure this commitment is met.

MEQC Contact:
Kieu Pham