Division of Medicaid

A. Coverage is mandatory for pregnant woman whose household income is at or below the income standard established by the state, not to exceed one hundred eighty-five percent (185%) of the federal poverty level converted to a Modified Adjusted Gross Income (MAGI)-equivalent standa…

A. Coverage is mandatory for infants born to Medicaid eligible mothers. The infant is deemed eligible for one (1) year from the date of birth. This provision applies in instances where the labor and delivery services were furnished prior to the date of application and covered by …

A. Coverage is mandatory for infants to age one (1) in households whose income is at or below one hundred eighty-five percent (185%) of the federal poverty level converted to a Modified Adjusted Gross Income (MAGI)-equivalent standard. B. Coverage is mandatory for children age on…

A. Coverage is mandatory for children for whom adoption assistance or foster care maintenance payments are made under title IV-E of the Social Security Act, as determined by the Department of Human Services (DHS) who certifies eligibility for this group of children. B. Coverage i…

A. Coverage is mandatory for individuals receiving Supplemental Security Income (SSI). This includes individuals receiving SSI pending a final determination of blindness or disability, those receiving SSI under an agreement to dispose of resources that exceed the SSI resource lim…

A. Qualified Medicare Beneficiaries (QMB) must be entitled to Medicare Part A and have income that does not exceed one hundred percent (100%) of the federal poverty level. Medical assistance is limited to payment of Medicare cost-sharing expenses that includes premiums, co-insura…

The Division of Medicaid provides public notice of any: A. Significant proposed change in methods and standards for setting payment rates for State Plan services, except when a change is: 1. Being made to conform to Medicare methods or levels of reimbursement, 2. Required by a co…

A. The Division of Medicaid defines "public records" as all books, records, papers, accounts, letters, maps, photographs, films, cards, tapes, recordings or reproductions thereof, and any other documentary materials, regardless of physical form or characteristics, having been use…

A. This rule sets forth the Mississippi Division of Medicaid's rules governing the form, content, and filing of requests for declaratory opinions, the procedural rights of persons in relation to the written requests, and the Mississippi Division of Medicaid's procedures regarding…

A. This rule applies to all oral proceedings held for the purpose of providing the public with an opportunity to make oral presentations or written input on proposed new rules, amendments to rules, and proposed repeal of existing rules before the Mississippi Division of Medicaid …

A. This rule applies to all public hearings held for the purpose of providing the public with an opportunity for input on the Division of Medicaid's submissions to the Centers for Medicare and Medicaid Services (CMS). B. The date, time, and place of a public hearing will be publi…

Medicaid eligibility is certified or authorized by the following entities: A. The Social Security Administration (SSA), B. The Mississippi Department of Child Protection Services (DCPS), C. The Mississippi Division of Medicaid, and D. Qualified Hospitals that certify Hospital Pre…

The Division of Medicaid covers the following Medicare cost-sharing groups. A. Qualified Medicare Beneficiaries (QMB) must be entitled to Medicare Part A and have income that does not exceed one hundred percent (100%) of the federal poverty level (FPL). Medical assistance is limi…

A. Coverage is limited to emergency services, including labor and delivery services, for aliens who are in need of treatment of an emergency medical condition who meet all eligibility requirements for Medicaid coverage except for their alien status. 1. Coverage is limited to trea…

A. Qualified hospitals are allowed to determine presumptive eligibility for individuals eligible for Medicaid in certain Medicaid coverage groups, referred to as Hospital Presumptive Eligibility (HPE). 1. Qualified hospitals are to immediately enroll patients in Medicaid who are …

A. Children under age twenty-one (21) who are in foster homes or private institutions and the Mississippi Department of Child Protection Services (DCPS) assumes full or partial financial responsibility are certified for Medicaid coverage by DCPS if the child's income is within st…

A. Individuals who would be eligible for cash assistance if not institutionalized may qualify for Medicaid. 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 o…

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 (FPL) and whose unearned income is at or below one hundred thirty five percent (135%…

A. Section 1115 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 (FPL). B. Coverage under the waiver is subject to an enrollment …

A. Section 1115 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 (FPL) converted to a modified adjusted gross income …

Section 1915 home and community-based services (HCBS) waiver coverage includes the following: A. Elderly and Disabled Waiver [Refer to Part 208, Chapter 1], B. Independent Living Waiver [Refer to Part 208, Chapter 2], C. Assisted Living Waiver [Refer to Part 208, Chapter 3], D. T…

A. The Division of Medicaid covers the following categorically needy individuals as mandated by federal law listed in Miss. Admin. Code Part 101, Rules 1.2 - 1.11. B. The Division of Medicaid covers the following optional categorically needy groups as authorized by state law list…

A. Coverage for children, pregnant women, parents and caretaker relatives are referred to as MAGI-related coverage due to the application of Modified Adjusted Gross Income or MAGI standards to these groups. 1. Income standards for MAGI-related coverage are referred to as MAGI-equ…

A. Coverage is mandatory for parents and other caretaker relatives who have a dependent child or children under the age of eighteen (18) living in the home whose household income is below the applicable limit established by the state for coverage. 1. The limit established by the …

A. Coverage is mandatory for pregnant woman whose household income is at or below the income standard established by the state, not to exceed one hundred eighty-five percent (185%) of the federal poverty level (FPL) converted to a modified adjusted gross income (MAGI) equivalent …

A. Coverage is mandatory for infants born to Medicaid eligible mothers. 1. The infant is deemed eligible for one (1) year from the date of birth. 2. Retroactive eligibility for coverage applies in instances where the labor and delivery services were furnished prior to the date of…

A. Coverage is mandatory for infants to age one (1) in households whose income is at or below one hundred eighty-five percent (185%) of the federal poverty level (FPL) converted to a modified adjusted gross income (MAGI) equivalent standard. B. Coverage is mandatory for children …

A. Coverage is mandatory for children for whom adoption assistance or foster care maintenance payments are made under Title IV-E of the Social Security Act, as determined by the Mississippi Department of Child Protection Services (DCPS) who certifies eligibility for this group of…

A. Coverage is mandatory for individuals receiving Supplemental Security Income (SSI) in Mississippi. 1. This includes individuals: a) Receiving Supplemental Security Income (SSI) pending a final determination of blindness or disability, those receiving SSI under an agreement to …

The beneficiary and, when applicable, the medical facility is notified in writing of the action taken on an application or an active case when eligibility or benefit level is affected by a change. Notes 23 Miss. Code. R. 101-10.1 42 C.F.R. §§ 435.912, 435.917. Amended 4/1/2018…

A. The Division of Medicaid issuances of a notice of adverse action ten (10) days before the effective date of an action to reduce or terminate benefits. 1. For continuation of benefits to apply when an appeal has been filed, the ten (10) day advance notice includes five (5) days…

The Division of Medicaid does not provide advance notice but sends a notice of termination no later than the date of action in the following circumstances when the agency has: A. Factual notification of death. Eligibility is terminated as of the death date. B. Established that a …

A. A child under age nineteen (19), who is approved for Medicaid or the Children's Health Insurance Program (CHIP), is eligible for twelve (12) months consecutively, regardless of changes in family income and other household circumstances. B. Miss. Admin. Code Rule 11.1.A. is app…

A. The twelve (12) month certification for a child in modified adjusted gross income (MAGI) related or aged, blind and disabled (ABD) programs may shorten if the child: 1. Dies, eligibility is terminated. 2. Moves out of the state, eligibility is terminated. 3. Attains the maximu…

A. A deemed eligible infant is defined as a child whose mother was eligible for Medicaid in the child's birth month with no requirement that the child remain with the mother to continue eligibility. B. The deemed eligible child has continuous Medicaid eligibility for a thirteen (…

A. Adults have no protected period of eligibility except for women. Changes in income and other circumstances can impact an adult's eligibility as such changes occur. B. Women have a protected period of eligibility solely due to pregnancy. 1. Pregnant women are provided coverage …

Redetermination or renewal is defined as the process of verifying whether a beneficiary continues to meet the eligibility requirements of a particular program and are classified as either regular or special reviews. A. A regular review is an annual review of eligibility factors t…

A. The Division of Medicaid reviews eligibility of every Medicaid and the Children's Health Insurance Program (CHIP) beneficiary at least every twelve (12) months as required by federal and state law. B. During the regular redetermination process, the beneficiary's circumstances …

A. A renewal of eligibility is processed without requiring information from the beneficiary if the Division of Medicaid is able to do so based on reliable information contained in the beneficiary's case record and other more current information available to the Division of Medica…

A. If the Division of Medicaid cannot renew eligibility based on information available to the agency from electronic data matches, the Division of Medicaid issues a pre-populated renewal form to the recipient displaying the information that is available to the Division of Medicai…

A. Advance notice of an adverse action is required if the eligibility decision results in: 1. Termination of benefits, 2. Conversion to a reduced services coverage group, or 3. Termination of a nursing facility vendor per-diem payment B. During the advance notice period, the bene…

A. Any individual or beneficiary under review who is losing eligibility in one (1) category of eligibility is entitled to have eligibility reviewed and evaluated under all available coverage groups. B. The term "exparte review" is defined as to review information available to the…

A. A special case review is completed when changes occur between regular reviews which may result in adjustments to eligibility or benefit level. B. A special case review is not a full review. 1. The special case or an individual is evaluated to consider the impact of the changed…

A. Beneficiaries must report required changes impacting eligibility within ten (10) days of the date the change becomes known. Changes may be reported in person, by telephone, by mail or fax to the Division of Medicaid. B. A required change is considered reported on the date the …

A. If the reported change has no effect on eligibility or benefits the information will be considered during the next regular redetermination. B. Action on a reportable change is initiated no later than ten (10) working days from the date the change becomes known to the agency to…

A. Certain situations require a reinstatement of services which means eligibility is restored or Medicaid income is corrected for a prior period. Both types of reinstatements are completed without requiring that a new application be filed on behalf of the recipient. B. A reinstat…

A. At the time the Division of Medicaid becomes aware of an error which affects eligibility or level of benefits, action is initiated to correct the error and prevent further error. B. In some instances an error is corrected retroactively to prior months. C. When corrective actio…