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754 Chapter 3:Processes and procedures • Section 5: Program integrity (07/2026) • If households and/or individuals are eligible for benefits and receiving the correct benefits. • If the decision to deny, terminate or suspend benefits was correct. QC conducts QC reviews on federally matched programs. The programs reviewed include SNAP and Medical. Cases are chosen monthly for review. Other programs (i.e., TANF) may be affected in the course of the QC review. They are from a statistically reliable statewide sample. QC uses specific review methodology to conduct the reviews based on using state policy, approved waivers after implementation, federal regulations and state and federal laws. An important function of QC is to determine the number and kinds of errors in the total caseload. QC analyzes the case findings and shares the results for management decisions. With the knowledge gained, management can determine the cost/benefit of corrective actions. Participant cooperation with Quality Control (QC) Except for medical programs, cooperation with QC is an eligibility requirement for programs receiving a federal match. Therefore, participants must cooperate with the QC review process. Refusal to cooperate will result in the termination of their benefits. The QC reviewer will notify an ODHS|OHA worker when an individual fails to cooperate. When this happens, send a timely notice to end benefits for the entire eligibility group. In the ERDC, REF, REFM, and TANF programs, an individual who refuses to cooperate is ineligible for the program in which the review takes place until the individual cooperates. In the SNAP program, if an individual refuses to cooperate, the filing group is ineligible. If an individual leaves a filing group that has not cooperated with QC and joins another filing group or applies on their own, the ineligibility does not follow the individual to a new filing group. The household may reapply for benefits, but they will not be eligible again until they cooperate with the QC review. This does not apply to medical programs. Worker action on cases selected for QC review A worker must do all the following when notified a case has been selected for review: • Gather all case material from all relevant databases. • Send the material within three working days to the QC reviewer, when requested. • Do not discuss the pending review with the program participant before the QC home visit. The one exception is if the individual has failed to cooperate with the QC reviewer. QC will use the form Quality Control Request for Branch Assistance (MSC 0375) to request branch office assistance. This includes not contacting the individual after receipt of the error decision notice, Quality Control Unit Medicaid Case Review Report (DHS 0372) to discuss statements made to QC. Only discuss restoration of benefits or a repayment plan. • Notify QC immediately if QC selects a case, and the branch transferred the case to a different branch. Inform QC of the date the transfer occurred and the branch receiving the case.