Mississippi Administrative Code

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…

A. Medicaid income is defined as the amount of income an institutional beneficiary must pay to the nursing facility toward the cost of his or her care. B. Changes in income, marital status or non-covered medical expenses will increase or decrease Medicaid income with the effectiv…

A. Changing from a full service coverage group to a reduced service coverage group requires advance notice before the change can be effective the following month. B. An active full service case is not changed to a reduced service coverage group such as Qualified Medicare Benefici…

A. The application process consists of all activities completed during the timely processing period from the time a signed application form is received by the agency until a notice of approval or denial is mailed to the applicant. B. An annual review or renewal of eligibility is …

A. An applicant is defined as someone: 1. Whose signed application form has been received by the Division of Medicaid and is requesting an eligibility determination, 2. Whose signed application has been received by another agency or entity authorized to make Medicaid certificatio…

A. An application form must be signed to be considered a valid application. The signature does not have to be an original signature since applications are allowed to be submitted via means other than on an original paper form; however, a valid signature by someone authorized to a…

A. An authorized representative is defined as a person or employee of an organization who is acting responsibly for the applicant with his knowledge and written consent. 1. The MAGI-related application form allows the head of household to designate an authorized representative wi…

A. An application can be filed by one (1) of the following individuals, as applicable to the case: 1. Adult applicants, 2. Certain minor applicants including a: a) Pregnant minor of any age requesting coverage solely due to pregnancy, b) Married minor living with a spouse, c) Min…

A. Access to a regional office or out-stationed site should not be a barrier for individuals wishing to apply in person or request assistance with the application process. Each Division of Medicaid regional office where Medicaid Specialists are located is accessible to handicappe…

A. The Division of Medicaid provides assistance to any individual seeking help with the application or renewal process in person, over the telephone, and on-line and includes, but is not limited to, the following: 1. Completion of forms, 2. Securing a representative, if needed, 3…

A. Applications received from persons residing in another state will be denied and notice mailed to explain that the applicants will need to reapply upon arrival in MS with intent to reside. B. Persons who are in MS for a temporary purpose, such as a visit, who intend to return t…

A. If the applicant reports moving to another location within the state during the application process, the application must be completed by the first regional office, and if approved, transferred to the new location. If the application is denied, the record is not transferred un…

A. Applications submitted via any acceptable method for applying should be filed with the regional office that serves the applicants county of residence. However, applications for individuals living in another ROs service area must be accepted by any regional office. The regional…

A. Individuals inquiring about program eligibility requirements are informed of their opportunity to apply and informed about the various means of applying. 1. If a hardcopy application is requested, it will be provided or mailed, as applicable. 2. If another person or agency ref…

A. An application for Medicaid may be filed in any of the following described submission methods. 1. In person at any regional office, official out-stationed location or other location outside the regional office where eligibility staff are on official duty, such as a nursing fac…

A. An applicant who applies for Medicaid on any basis is entitled to have eligibility determined under all available coverage groups. 1. An individual who files a modified adjusted gross income (MAGI)-related application for an insurance affordability program does not also have t…

A. Applications made for Mississippi residents who are temporarily out of the state may be accepted. Generally the applicant must return to the state before the application processing period ends. B. The application of a Mississippi resident who is hospitalized in another state a…

A. Applications received from individuals residing in another state will be denied with a notice mailed to them explaining that the applicants need to reapply upon arrival in Mississippi with the intent to permanently reside. B. Individuals who are in Mississippi for a temporary …

A. If the applicant reports moving to another location within Mississippi during the application process, the application must be completed by the first regional office, and if approved, transferred to the regional office applicable to the new location. If the application is deni…

A. Applications submitted via any acceptable method listed in Miss. Admin. Code Part 101, Rule 4.2 should be filed with the regional office that serves the applicant's county of residence. 1. Applications for individuals living in another regional office's service area will be ac…

A. The Division of Medicaid offers the opportunity to register to vote or update voter registration to applicants, recipients and adults applying for children at the time of application, at the time of review or whenever an address change is reported. B. Voter registration forms …

Certain applications for Medicaid are filed through other agencies or entities as follows: A. Supplemental Security Income (SSI) applications are filed with the Social Security Administration (SSA). No separate application for Medicaid is necessary unless the SSI applicant needs …

The regional offices determine eligibility within the appropriate timeframes for the program type. A. If there is a delay in processing, the reason must be clearly documented in the record. B. Each regional office has controls in place which ensure timely application processing a…

A. The Division of Medicaid determines eligibility within established standards except in unusual circumstances when a decision cannot be reached including, but not limited to: 1. Failure or delay on the part of the applicant, 2. A disability decision has not been returned by the…

A. Applications are approved or denied, and the applicant notified, within forty-five (45) days from the date the application was filed. B. The processing timeframe is ninety (90) days when a disability determination is required before the eligibility determination can be complet…

A. Eligibility is determined based on information contained on the application form as well as information secured during the application process. Appropriate Division of Medicaid forms, along with other legal or official documents which support the eligibility decision are filed…

All applications are subject to one (1) of the following actions: A. Approval when all eligibility factors are met, B. Denial when one (1) or more eligibility factors are not met. 1. A Medicaid application cannot be denied due to death. If the applicant dies before a final eligib…

A. The Modified Adjusted Gross Income (MAGI) application asks the following specific questions at the individual level regarding possible aged, blind, disabled (ABD) eligibility if the applying household member: 1. Is disabled, 2. Has a physical, mental or emotional condition tha…

A. The benefit start date for CHIP is generally a future month. Coverage authorized by the 3rd (third) day of the current month is effective the current month. Coverage authorized after the 3rd (third) day of the current is effective on the first (1st) of the following month. B. …

A. Eligibility for a Medicaid or CHIP recipient will end on one (1) of the following days of the month, unless otherwise noted:1. The last of the month in which the recipient was eligible; 2. The death date of the recipient, or 3. The date the recipient entered a public instituti…

A. Retroactive Medicaid eligibility may be available to any Medicaid applicant who received medical care prior to applying for Medicaid. B. Applicants may qualify for coverage for a three (3) month period prior to the month of the application. C. Retroactive eligibility can cover…

A. An application for retroactive Medicaid coverage may be made on behalf of a deceased person. Retroactive eligibility can cover all three (3) months prior to the month of application or any month(s) in the three (3) month period if the deceased person is found to be eligible. N…

Medicaid applicants, including an applicant who dies prior to filing an application or dies prior to completion of the application process, may qualify for Medicaid on one (1) of the following dates: A. The first (1st) day of the month of the application, provided all eligibility…

A. The benefit start date for the Children's Health Insurance Program (CHIP) is the first (1st) day of the month following the month of application, provided all eligibility factors are met. There is no retroactive eligibility for CHIP-eligible children other than newborns. B. Th…

Eligibility for a Medicaid or the Children's Health Insurance Program (CHIP) beneficiary ends on one (1) of the following days of the month, unless otherwise noted: A. The last of the month in which the beneficiary was eligible; B. The death date of the beneficiary, or C. The dat…

A. Retroactive Medicaid eligibility may be available to any Medicaid applicant who received medical care prior to applying for Medicaid. B. Retroactive eligibility may include all three (3) or any of the three (3) months prior to the month of application. In addition: 1. Each App…

An application for retroactive Medicaid coverage may be made on behalf of a deceased person provided the application is filed in a timely manner that allows retroactive Medicaid to cover needed month(s) of eligibility. Retroactive eligibility can cover all three (3) months prior …

A. Individuals whose source of eligibility is Security Income (SSI), Mississippi Department of Child Protection Services (DCPS), modified adjusted gross income (MAGI) or a full service aged, blind, and disabled (ABD) at-home coverage group may enter long-term care in a nursing fa…

A. Federal regulations require that the eligibility of every Medicaid and CHIP recipient be reviewed at least every twelve (12) months. B. Mississippi state law also requires annual reviews. C. During the regular redetermination process, the recipients circumstances are reviewed …

A. Advance notice of an adverse action is generally required, if the eligibility decision results in: 1. Termination of benefits; 2. Conversion to a reduced services coverage group; 3. Increase in the amount of patient liability; and 4. Termination of a nursing facility vendor pa…

A. Any recipient under review who is losing eligibility in one (1) category of assistance is entitled to have eligibility reviewed and evaluated under any/all available coverage groups. B. The term exparte review means to review information available to the agency to make a deter…

A. Medicaid must be available to eligible residents of the state. B. A resident is someone who voluntarily lives in Mississippi with the intention to remain permanently or for an indefinite period of time, or someone living in Mississippi, having entered with a job commitment or …

A. An individual, who is receiving a Title IV-E foster care or adoption assistance payment, is a resident of the state in which the child is currently residing. Notes 23 Miss. Code. R. 102-1.10 42 CFR §435.403 (Rev. 2006).

A. Determine residency for persons under age twenty-one (21) as follows: 1. Not in an Institution or Under Parental Care and Control.a) If a non-institutionalized individual under age twenty-one (21) is emancipated from his/her parents or is married and capable of stating intent,…