Division of Medicaid

A. When the applicant provides a document with the SSN or provides the number verbally, the number must be validated through SVES.1. If the number originally submitted to SVES is not verified, the correct information must be obtained and re-submitted for the SVES inquiry. 2. If d…

A. Eligibility for the Medicaid program is limited to certain groups of individuals authorized by Congress. B. When authorizing a group, Congress also establishes specific requirements which must be met to qualify as a member of that group.1. Each designated group is assigned a c…

A. An individual categorically eligible as aged must be sixty (65) years of age or older. B. According to the SSI program, a given age is attained on the first moment of the day preceding the anniversary of the individual's birth.1. Example: A person born on January 1, 1943, is c…

A. To be categorically eligible for Medicaid as blind or disabled, the individual must, at a minimum, meet the Supplemental Security Income (SSI) definition of blindness or disability.1. The Disability Determination Service (DDS) makes all decisions relating to disability and bli…

A. The Families. Children and CHIP (FCC) programs serve children in specific age groups. B. Children have continuous eligibility for a twelve (12) month certification period unless an "early-out" termination reason is met. Notes 23 Miss. Code. R. 102-5.4 42 CFR §435.116 (Rev. 199…

A. A pregnant woman of any age is categorically eligible. B. A pregnant woman's eligibility includes a two (2) month post-partum period following the month of delivery, miscarriage or other termination of pregnancy. Notes 23 Miss. Code. R. 102-5.5 42 CFR §435.116 (Rev. 2012). Del…

A. Low-income parent(s) or caretaker relatives with children under age eighteen (18) are categorically eligible for Medicaid. B. This group includes intact two (2) parent families and families in which the children are deprived of one or both parents. C. A caretaker relative is r…

A. An eligible individual must:1. Be in one of the categories of assistance; 2. Be a citizen of the United States or a qualified alien; 3. Be a resident of Mississippi; and in addition, 4. Have income and resources, when applicable, within specified program limits; and 5. File an…

A. The marital relationship no longer exists for FCC purposes as of the date that: 1. Either individual dies; 2. A final decree of divorce or annulment is issued for the marriage; a) If a divorced couple resumes living together, the adults are unrelated. 3. The married couple beg…

A. Marriage or termination of marriage, including separation, is effective the month the event occurs. B. In application situations, individuals must be in the home at least one day of the month to be included in that month. Notes 23 Miss. Code. R. 102-6.11 42 CFR § 435. 603 (Rev…

A. A change in marital staus must reported by adult recipients eligible in the Medical Assistance Program. B. When an adult becomes ineligible due to a change in maritable staus, eligibility is terminated after allowing ten (10) day (plus two (2) days mailing time) notice of the …

A. In the ABD programs, a child is defined as someone who is: 1. Neither married nor head of a household; and 2. Either under age eighteen (18); or 3. Under age twenty-two (22) and a student regularly attending school or college or training that is designed to prepare him for a p…

A. Status as a child ends: 1. Effective with the month the child becomes age eighteen (18) or age twenty-two (22), if a student, or 2. The month he last meets the definition of a child. Notes 23 Miss. Code. R. 102-6.14 42 CFR §435.601(a); 42 CFR §435.601(b) (Rev. 1993)

A. A child under age eighteen (18) who does not expect to earn over $65 in any month meets the definition of a child without regard to student status. B. Student status must be explored whenever an applicant or recipient between the ages of eighteen (18) and twenty-two (22) alleg…

A. To be categorically eligible as a child in the FCC programs, the individual must be under the age of nineteen (19). B. Age is verified, primarily through electronic sources. C. An individual's status as a child ends effective the month after he turns age nineteen (19). Notes 2…

A. Most children are dependents of their parents or have another adult caretaker. However, some children may be emancipated. An emancipated minor is authorized to act on his own behalf. Though not a dependent child, the emancipated minor under age nineteen (19) is a categorically…

A. An unmarried parent under age nineteen (19) who resides in the home with his children and his parents (the children's grandparents) has his own eligibility determined using tax filer or exception rules applies; however, the minor's children are included in the household compos…

A. There are instances in which it is permissible for a child to be the head of household. 1. Children living independently, including those in group homes, orphanages and other situations in which parents have relinquished or abandoned custody, often have individuals filing on t…

A. The eligible ABD adult or child is one who meets all basic program requirements. B. An eligible spouse is a person who: 1. Meets all of the basic program requirements, 2. Is the husband or wife of an eligible individual; and 3. Lives with the eligible individual. 4. This inclu…

A. As a condition of eligibility, an ABD or FCC applicant or recipient must take all necessary steps to obtain all benefits to which they are entitled when the benefit(s) is one of the following types:1. Medicare; 2. Unemployment Benefits; 3. Worker's Compensation Benefit; 4. Soc…

A. The client is not required to apply for the following types of benefits: 1. Temporary Assistance for Needy Families (TANF) 2. General Public Assistance, including SSI 3. Bureau of Indian Affairs General Assistance 4. Victim's Compensation payments 5. Other Federal, state, loca…

A. This provision applies only to eligible individuals (applicants or recipients). B. It does not apply to non-applicants or ineligibles.1. This includes the ineligible spouse or community spouse in ABD and non-applicant or ineligible parents or caretaker relatives of children. 2…

A. An individual is not required to accept another benefit if the resulting payment would be a reduction in current benefits payable to the individual. B. This does not include a reduction in Medicaid benefits. Notes 23 Miss. Code. R. 102-6.23 42 CFR §435.608 (Rev. 1993).

A. The agency must require clients to take all steps necessary to apply for other benefits to which they are entitled, unless good cause can be shown for not doing so. B. A denial or dismissal of a claim for other benefits due to failure to submit required verification does not s…

A. The utilization of other benefits provision is applicable at the time of application and for the duration of eligibility. B. The individual potentially eligible for the types of benefits listed above or the responsible person, if the client is a child, must take steps to apply…

A. The client must be furnished with written request notice explaining the responsibility to apply for the potential benefit within thirty (30) days of the notice for ABD and within fifteen (15) days of the notice for FCC. B. A Request for Information will be used to inform the i…

A. An agreement to comply does not negate any prior action to deny or terminate benefits. B. The effective month of eligibility is the month in which the individual takes the steps necessary to obtain benefits from the other agency. Notes 23 Miss. Code. R. 102-6.27 42 CFR §435.60…

A. A client may be eligible for more than one type of benefit. All potential sources of benefits must be identified. B. The election of a lower benefit when the individual has an option between a high and low benefit will result in denial or loss of eligibility. C. When a client …

A. If the ABD individual has failed without good cause to take all steps to obtain the other benefits, action to deny or terminate benefits until the requirement is fulfilled must be taken. B. An agreement to comply does not negate any prior action to deny or terminate benefits. …

A. Children under age nineteen (19), pregnant women of any age and parents or needy caretakers, within the specified degree of relationship, are eligible individuals for the FCC programs if they apply and meet program requirements. B. For family coverage, parents must live togeth…

A. When the application for other benefits has not been filed and good cause does not exist, the FCC adult or child who was potentially eligible for the other benefits cannot be approved for Medicaid. B. However, any other eligible children included in the application can be plac…

A. Federal law requires that all Medicaid applicants and recipients must, as a condition of eligibility, cooperate with the Medicaid Agency in identifying, to the extent they are able, potentially liable insurers and other third parties who may be liable to pay for care and servi…

A. The Third Party Liability (TPL) Unit has the responsibility for determining if an individual has failed, without good cause, to cooperate with assignment of third party rights. B. If the TPL Unit determines there was good cause for failure to cooperate, the individual will be …

A. There is no requirement for assignment of third party rights in the Children's Health Insurance Program because the program is for uninsured children only. B. Children who are covered by creditable third party insurance at application are not eligible for CHIP. This is true re…

A. State child support (IV-D) agencies are required to provide all appropriate child support services available under IV-D of the Social Security Act to families with an absent parent who receive Medicaid benefits and who have assigned rights for medical support to the State. B. …

A. Referral to and cooperation with child support is required as a condition of the adult's eligibility if the deprivation reason for at least one child is continued absence. B. The parent or caretaker relative must cooperate with child support requirements and assist the state b…

A. At time of application, if the 85 parent or caretaker relative refuses to cooperate with child support, the adult's Medicaid eligibility will be denied. B. After a referral to the IV-D agency, satisfactory cooperation, good cause for failure to cooperate and satisfactory coope…

A. The age of an individual must be verified in the following situations: 1. The applicant is an adult or child applying for benefits which are based on age; 2. There are ineligible children in an ABD deeming household; 3. A disabled or blind applicant under age twenty-one (21) a…

A. A marital relationship is one in which members of the opposite sex are: 1. Married under State law; 2. Married under common law provided the couple began holding out prior to April 1, 1956; 3. Married for Title II purposes, meaning one member of the couple is entitled to spous…

A. For ABD programs, the marital relationship no longer exists as of the date that: 1. Either individual dies; 2. A final decree of divorce or annulment is issued for the marriage; (If a divorced couple resumes living together, the specialist must develop whether they have a hold…

A. A marital relationship is presumed for an ABD couple unless the client states otherwise and provides the types of evidence listed above which indicate the relationship does not exist or has terminated. Notes 23 Miss. Code. R. 102-6.7 42 CFR §435.601(a); 42 CFR §435.601(b) (Rev…

A. A man and woman are married for a month if they meet any of the criteria for a marital relationship within the month. B. When a change occurs and an individual marries, resumes living with a spouse, enters a "holding out" relationship, etc., use couple budgeting beginning the …

A. A marital relationship is one in which members of the opposite sex are: 1. Married under State law; 2. Married under common law prior to April 1, 1956 as recognized by MS. 3. Couples in "holding out" situations are unrelated individuals for FCC purposes. Notes 23 Miss. Code. R…

A. The law defines disability as the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less …

A. The Division of Medicaid is required to seek recovery of payments for nursing facility services and Home and Community-Based Services (HCBS) as well as related hospital and prescription drug services from the estates of deceased Medicaid recipients who were fifty-five (55) or …

A. Estate property includes any real or personal property owned by the recipient in its entirety or by shared ownership.1. Ownership of life estate interests or ownership of property that has been transferred into a trust is not subject to estate recovery. B. Real property includ…

A. Estate recovery rules to not apply to a deceased recipient if at the time of death the recipient has: 1. A legal surviving spouse, or 2. A surviving dependent child under the age of twenty-one (21); or 3. A dependent blind or disabled child of any age. a) The blind or disabled…