{"data":{"id":"us/42-cfr-431.804","jurisdiction":"us","citation":"42 CFR 431.804","heading":"Definitions.","body":"As used in this subpart—\nActive case means an individual determined to be currently authorized as eligible for Medicaid or CHIP by the State.\nCorrective action means action(s) to be taken by the State to reduce major error causes, trends in errors or other vulnerabilities for the purpose of reducing improper payments in Medicaid and CHIP.\nDeficiency means a finding in processing identified through active case review or negative case review that does not meet the definition of an eligibility error.\nEligibility means meeting the State's categorical and financial criteria for receipt of benefits under the Medicaid or CHIP programs.\nEligibility error is an error resulting from the States' improper application of Federal rules and the State's documented policies and procedures that causes a beneficiary to be determined eligible when he or she is ineligible for Medicaid or CHIP, causes a beneficiary to be determined eligible for the incorrect type of assistance, causes applications for Medicaid or CHIP to be improperly denied by the State, or causes existing cases to be improperly terminated from Medicaid or CHIP by the State. An eligibility error may also be caused when a redetermination did not occur timely or a required element of the eligibility determination process (for example income) cannot be verified as being performed/completed by the state.\nMedicaid Eligibility Quality Control (MEQC) means a program designed to reduce erroneous expenditures by monitoring eligibility determinations and work in conjunction with the PERM program established in subpart Q of this part.\nMEQC pilot refers to the process used to implement the MEQC Program.\nMEQC review period is the 12-month timespan from which the State will sample and review cases.\nNegative case means an individual denied or terminated eligibility for Medicaid or CHIP by the State.\nOff-years are the scheduled 2-year period of time between a States' designated PERM years.\nPayment Error Rate Measurement (PERM) Program means the program set forth at subpart Q of this part utilized to calculate a national improper payment rate for Medicaid and CHIP.\nPERM year is the scheduled and designated year for a State to participate in, and be measured by, the PERM Program set forth at subpart Q of this part.","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES","SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS","PART 431—STATE ORGANIZATION AND GENERAL ADMINISTRATION","Subpart P—Quality Control"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-42.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:11Z","sha256":"347e4a6c6026571d6e5a086bf5f15742546ba9cdb108d3dc57ddb0925cd698dc","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-431.800","next":"us/42-cfr-431.806"},"notice":"GroundRules: Original legal text. Not legal advice."}