Division of Medicaid

The duties of the Division of Medicaid Agency are set out by State and Federal legislation and the approved Mississippi State Plan include, but are not limited to: A. Setting regulations and standards for the administration of the Medicaid programs, with approval from the Governo…

A. The duties of the Child Protection Services (CPS) with regard to Medicaid include, but are not limited to: 1. Providing the opportunity for persons to apply for Medicaid benefits through all foster care and refugee programs. 2. Determining eligibility for foster children and a…

Any individual, who requests assistance, including those who are clearly ineligible, must be allowed to apply without delay. The Division of Medicaid must make a reasonable effort to assist the applicant in establishing eligibility. Notes 23 Miss. Code. R. 100-3.1 42 C.F.R. §§ 43…

A. Training on the security standards for data provided by the Internal Revenue Service (IRS) and Social Security Administration (SSA) must be conducted annually for eligibility staff in each regional office. B. During the training employees are instructed in office security proc…

The Division of Medicaid complies with all state and federal policies which prohibit discrimination on the basis of race, age, sex, national origin, handicap or disability as defined through the Americans with Disabilities Act of 1990, the Rehabilitation Act of 1973 and the Civil…

A. The beneficiary or their authorized representative may have access to information in the eligibility case record to either review the file or request copies of information from the file, in certain situations and under specified conditions as required by the Health Insurance P…

All individuals have the right to a confidential relationship with the Division of Medicaid. All information maintained about current and former beneficiaries and current and denied applicants is confidential and must be safeguarded. The Division of Medicaid adheres to state laws…

A. Protected Health Information (PHI) is information created or received by the Division of Medicaid that identifies an individual or for which there is a reasonable basis to believe an individual can be identified, is transmitted or maintained by electronic media or in any other…

The Division of Medicaid releases program information for the purposes of informing the public and conducting necessary business in accordance with all applicable privacy laws. The release of such information includes, but is not limited to: A. The annual report of the Division o…

A. Privacy laws protect electronic records, paper records and oral communication. Employees of the Division of Medicaid are responsible for safeguarding the confidentiality of applicant and beneficiary information in all forms to prevent unauthorized disclosure. B. Failure to abi…

A. The Division of Medicaid ensures that all workforce members receive training regarding the privacy and security requirements of applicable state and federal laws, as well as the privacy and security policies and procedures of the the Division. In addition, all workforce member…

A. The privacy rule protects electronic records, paper records and oral communication. Therefore, employees of the agency are responsible for safeguarding the confidentiality of recipient information in all forms to prevent unauthorized disclosure. B. Failure to abide by the poli…

A. At the time of any action affecting an applicant or recipients claim for assistance, the applicant or recipient must be:1. Informed of his right to a fair hearing; 2. Notified of the method by which he may obtain a hearing, and 3. Informed of his right to represent himself at …

A. If an interview is conducted, the right to appeal must be discussed with the applicant/recipient. In addition, individuals are notified of appeal rights by statements included on the ABD and FCC application forms and on all notices. A hearings pamphlet is included with adverse…

A. A fair hearing is an orderly, but informal meeting in which a client or his representative is afforded an opportunity to address an impartial hearing officer for the purpose of presenting oral testimony and/or evidence of his entitlement to medical assistance and services. B. …

A. The Division of Medicaid must take final administrative action on a hearing, whether state and/or local, within ninety (90) days of the date of the initial request for a hearing. Although regulations allow ninety (90) days, the agency will make every effort to hold hearings pr…

A. If a local hearing is requested the regional office will notify the client or representative in writing of the time and date of the local hearing. If a state hearing is requested, the hearing facilitator assigned to the case will notify the appropriate person in writing of the…

A. A state or local hearing is not open to the public. All persons attending the hearing will attend for the purpose of giving information on behalf of the claimant or rendering him assistance in some other way, or for the purpose of representing the Division of Medicaid. All per…

A. The hearing process is initiated by a written request and can be terminated only by a written statement in which the client or representative withdraws the request for a hearing. B. A state or local hearing request may be withdrawn at any time prior to the scheduled hearing or…

A. The client or his representative has the following rights in connection with a local or state hearing:1. The right to examine at a reasonable time before the date of the hearing and during the hearing the contents of the applicant or recipients case record. the right to have l…

A. A group hearing can be held for a number of clients under the following circumstances: 1. The Division of Medicaid may consolidate the cases and conduct a single group hearing when the only issue involved is one of a single law or agency rule. 2. The clients may request a grou…

A. In Mississippi, persons who are eligible for SSI are automatically eligible for Medicaid. If an SSI applicant or recipient disagrees with the decision to deny or terminate SSI benefits, the individual must contact the Social Security Office which issued the adverse action. B. …

A. If a client or representative requests a hearing within the advance notice period, benefits must be continued or reinstated to the benefit level in effect prior to the planned adverse action.1. Timely Request for Continuation of Benefits. To determine if the request for contin…

A. The regional office is responsible for completing a supervisory review of the action under appeal and for preparing the state hearing record. The office is responsible for all activities involved in the local hearing process and for taking appropriate action on the case at the…

A. The client has the right to appeal a local hearing decision by requesting a state hearing; however, the state hearing request must be made in writing within fifteen (15) days of the mailing date of the local hearing decision. This means the state hearing request must be receiv…

A. The client or his representative may request to present an appeal through a local-level hearing, a state-level hearing, or both. In an attempt to resolve issues at the lowest level possible, offices should encourage clients to request a local hearing first. The only exception …

A. A state hearing is assigned to an impartial hearing officer. Impartial means the hearing officer has not been involved in any way with the action or decision under appeal who 1. Reviews the local offices action; 2. Schedules the hearing; 3. Holds the hearing and provides the f…

A. The Division of Medicaid is responsible for ensuring payment for eligible beneficiaries. Providing timely CHIP benefits is a special concern because, unlike Medicaid, the CHIP effective dates are determined relative to monthly processing deadlines which do not allow the region…

A. An appeal will ordinarily be filed in the regional office responsible for the adverse decision or delay in action. If the client has moved to another regional offices jurisdiction at the time the appeal is made, it is possible for the regional office serving the clients curren…

A. The request for a state or local hearing must be made in writing by the client or his legal representative. B. Legal representative includes the clients authorized representative, an attorney retained to represent the client, a paralegal representative with a legal aid service…

A. An oral request for a hearing must be put in written form. When an oral request is made, the specialist will inform the client that the request must be put in a letter or signed statement and mailed to the regional office or the specialist will mail the appropriate hearing req…

A. A simple statement requesting a hearing that is signed by the client or his legal representative is sufficient; however, if possible, the client should state the reason for the request. B. The written request may be mailed to the regional office or state office. If the letter …

A. The client may come to the regional office or meet with a specialist in person to request a hearing. The specialist must first determine what level of hearing, local or state, is desired. B. If a state level hearing is required because the hearing request is based on a medical…

A. When both members of an eligible couple wish to dispute the action or inaction of the regional office that affects both applications and cases similarly and arose from the same issue, one or both members may file the request for a hearing. The couple will be assured that both …

A. The client has thirty (30) days from the date the appropriate notice is mailed to request either a local or state hearing. This thirty (30) day filing period may be extended if the client can show good cause for not filing within thirty (30) days. B. Good cause includes, but m…

Rule 23-100-6.1 Refer to Part 305. Notes 23 Miss. Code. R. 100-6.1 MS Code Ann. § 43-13-121.1 (Rev. 2001). Transferred 11/11/2016. Refer to Part 305

Rule 23-100-6.2 Refer to Part 305. Notes 23 Miss. Code. R. 100-6.2 MS Code Ann. § 43-13-121.1 (Rev. 2005). Transferred 11/11/2016. Refer to Part 305

Rule 23-100-6.3 Refer to Part 305. Notes 23 Miss. Code. R. 100-6.3 MS Code Ann. § 43-13-317.1 (Rev. 2005). Transferred 11/11/2016. Refer to Part 305

Rule 23-100-7.1 Refer to Part 305. Notes 23 Miss. Code. R. 100-7.1 CFR §431.810 et. seq. (Rev. 1990). Transferred 11/11/2016. Refer to Part 305

A. The federal government, through passage of federal laws, defines and describes categorically needy groups that either must be covered by individual state Medicaid programs or that may be covered by individual state Medicaid programs at their option. B. All individual state Med…

A. Emergency services, including labor and delivery services, must be provided to aliens who meet all eligibility requirements for Medicaid coverage except for their alien status who are in need of treatment of an emergency medical condition. B. Coverage is limited to treatment o…

A. As required by the Affordable Care Act (ACA), qualified hospitals must be allowed to determine presumptive eligibility for individuals eligible for Medicaid in certain Medicaid coverage groups, referred to as Hospital Presumptive Eligibility (HPE). B. HPE affords qualified hos…

A. Children under the age of twenty-one (21) for whom the Department of Human Services (DHS) assumes full or partial financial responsibility who are in foster homes or private institutions are certified for Medicaid coverage by DHS if the child's income is within state establish…

A. Individuals who would be eligible for cash assistance if not institutionalized. The individual must be in a title XIX nursing facility or hospital and meet income, resource and other non-financial factors of eligibility, as determined by the Division of Medicaid. B. Individual…

A. Disabled individuals who work in excess of an established number of hours each month whose net family earned income is at or below two hundred fifty percent (250%) of the federal poverty level and whose unearned income is at or below one hundred thirty-five percent (135%) of t…

Section 1115(a) waiver coverage is granted to certain non-Medicare entitled individuals who are aged, blind or disabled and have income at or below one hundred thirty-five percent (135%) of the federal poverty level. Coverage under the waiver is subject to an enrollment cap. Reso…

Section 1115(a) waiver coverage provides family planning and family planning related services to women of child bearing age who have family incomes at or below one hundred eighty-five percent (185%) of the federal poverty level converted to a Modified Adjusted Gross Income (MAGI)…