General eligibility requirements that apply to all Apple Health programs

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Quality assurance and post eligibility reviews

Revised Date: 
December 1, 2014

Purpose: The Health Care Authority or its designee conducts routine case reviews to determine the accuracy of the Apple Health coverage. Individuals are required to provide all information requested in the course of a quality assurance review. There are three main types of quality assurance reviews.

  1. Quality assurance reviews conducted by the Office of Program Integrity and Quality Assurance: These reviews are conducted according to Federal guidance for the purposes of Medicaid Eligibility Quality Control (MEQC).
  2. Payment Error Rate Measurement (PERM) reviews are conducted every third year by the Office of Program Integrity and Quality Assurance.
  3. Post eligibility reviews are conducted on Apple Health approvals for MAGI-based coverage. These reviews target approvals where electronic verification suggests the applicant was not eligible or electronic verification was not present. Refer to the approved Washington State Verification Plan.