Mississippi Administrative Code

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…

A. The following assets and resources of American Indians and Alaska natives are exempt from estate recovery: 1. Interest in and income derived from Tribal land and other resources currently held in trust Status and Judgment funds from the Indian Claims commission and the U. S. c…

A. An individual under the age of eighteen (18) is considered disabled under the SSI program if that child has a medically determinable physical or mental disability, which results in marked and severe functional limitation, and which can be expected to result in death or which h…

A. Statutory blindness is central visual acuity of 20/200 or less in the better eye with the use of a correcting lens. An eye which has a limitation in the field of vision so that the widest diameter of the visual field subtends an angle no greater than 20 degrees is considered t…

A. In Mississippi, an application for SSI is also an application for Medicaid. 1. This does not mean a separate Medicaid application cannot be filed by an SSI applicant; however, the Medicaid agency is not required to obtain a separate Medicaid disability determination for any mo…

A. An independent disability determination when a separate Medicaid application has been filed under one of the following circumstances: 1. The individual has not applied for SSI or has applied and been denied for a reason other than disability; 2. An individual applies separatel…

A. There may be instances when DDS has already determined disability using SSI criteria for the same period of time to be covered by a Medicaid application. If so, a separate Medicaid determination is not needed. B. However, if the disability onset date, as established by SSA, do…

A. In the following situations a separate blindness/disability determination for Medicaid is not needed. The applicant/beneficiary is considered to be blind/disabled: 1. Applicant Receives Title II Disability; a) The Medicaid applicant receives Title II disability benefits on an …

A. If there is no indication that any of the above exceptions apply, a separate disability decision must be obtained from Disability Determination Services when an applicant applies for Medicaid on the basis of disability or blindness. Notes 23 Miss. Code. R. 102-7.8 Miss. Code A…

A. Some cases that are SSI-eligible terminate once per quarter and are reinstated by SSI after one or two (2) months of ineligibility. B. The usual cause of the temporary SSI closure is earned income in a five (5) week month. C. The individual whose SSI is temporarily terminated …

A. Deprivation is an eligibility factor for dependent children under age eighteen (18). Deprivation must exist within the household in order for the parent(s) or caretaker relative to obtain eligibility. The child's eligibility is not tied to deprivation but there must be a depen…

A. The following are legally responsible parents: 1. The child's biological, adoptive or step mother; 2. The child's biological, adoptive or step father; 3. The adoptive parent who has been legally granted a final decree of adoption. Notes 23 Miss. Code. R. 102-8.2 42 CFR §435.60…

A. For the deprivation determination, a child's legal father is one of the following: 1. A man whose name appears on the child's birth certificate unless a court has determined otherwise; 2. A man who has been declared to be the child's father by a court order; 3. A man who has a…

A. Continued absence exists when a parent does not live in the home with the child as the result of divorce, legal separation, desertion, incarceration, long term hospitalization, institutional care, court-ordered removal of the child from the home or because paternity has not be…

A. A child who lives with biological, legal or adoptive parents is deprived of parental support or care if one (1) or both parents receive Social Security Disability or SSI. Notes 23 Miss. Code. R. 102-8.5 42 CFR §435.601(a); 42 CFR §435.601(b) (Rev. 1993).

A. A child who lives with both of his parents is deprived of parental support or care if the combined family income is equal to or below the program gross and net income limits for the appropriate family size. Notes 23 Miss. Code. R. 102-8.6 42 CFR §§435.601(a) and (b) (Rev. 1993…

A. The temporary absence of the parent, other adult caretaker or the child from the home does not affect the eligibility determination, provided the absent member does not establish a home elsewhere and the reasons for the absence is temporary. B. In addition, the adult must reta…

A. The responsible adult may be a relative or a non-relative for children eligible under a federal poverty level and CHIP. B. To meet the requirement of relationship as a parent or caretaker relative, a child must live in the home with a biological, adopted or step parent or one …

A. Residence in an institution can affect an applicant's or recipient's eligibility for any Medicaid program and for CHIP. B. An individual is not eligible when:1. The individual is an inmate; and 2. The facility in which the individual is residing is a public institution. Notes …

A. Children attending these facilities to obtain an education or vocational training may receive Medicaid if they are eligible in their home living arrangement.1. Schools for the deaf or blind are examples of such facilities. Notes 23 Miss. Code. R. 102-9.10 42 CFR 435.1009 (Rev.…

A. The inmate cannot be considered a sole applicant until they have been separated from other household members for thirty (30) days. When determined Medicaid-eligible as a member of the community, the inmate is eligible for full Medicaid services. B. The inmate can be considered…

A. Inmate status is not terminated until the individual is paroled, otherwise unconditionally and permanently released. Inmate status ends when the individual is no longer residing in a penal institution and is released from the penal system due to: 1. End of sentence; 2. Pardon;…

A. Verification sources for inmate status may include: 1. State Department of Corrections 2. Local prison/mental health authorities; 3. Court documents; 4. Court clerk for court which sentenced the individual; 5. A representative of the prosecutor's or State's Attorney's office; …

A. The Mississippi Department of Corrections forwards the applications of inmates who have had inpatient treatment in a medical facility to the Division of Medicaid. Inmate applications are processed by state office staff. Notes 23 Miss. Code. R. 102-9.14 Miss. Code Ann. §43.13.1…

A. Individuals under age twenty-two (22) may receive Medicaid while in an institution for mental diseases if they are receiving psychiatric services. B. Individual between the ages of twenty-two (22) and sixty-five (65) are not eligible to receive any Medicaid benefits while resi…

A. Inmate status is interrupted when an individual is admitted as an inpatient to a medical institution. B. An inmate may be eligible for Medicaid only while an inpatient in a medical facility (hospital, nursing facility, juvenile psychiatric facility or intermediate care facilit…

A. An institution is an establishment that provides food, shelter and some treatment or services to four or more person unrelated to the proprietor. Notes 23 Miss. Code. R. 102-9.4 42 CFR §435.1010 (Rev. 2006).

A. A public institution is an institution which is the responsibility of a government unit or over which a governmental unit exercises administrative control including: 1. A penal institution or correctional facility is a facility under the control and jurisdiction of the governm…

A. A medical institution is not considered a public institution. Residents may receive Medicaid benefits if otherwise eligible. B. A medical institution is one that: 1. Is organized to provide medical care, including nursing and convalescence care; 2. Has the necessary profession…

A. An individual is an inmate if serving time for a criminal offense or is confined involuntarily in a state or federal prison, jail, detention facility or other penal facility. B. An individual who voluntarily resides in a public institution is not considered an inmate. C. Likew…

A. There are a variety of alternatives to traditional incarceration. An individual is considered an inmate of a penal institution as long a penal authorities remain responsible for providing (or arranging for provision of) food and shelter to the individual. B. An individual is c…

A. Admittance as an inpatient in a hospital, nursing facility, juvenile psychiatric facility or intermediate care facility interrupts inmate status. B. If otherwise eligible, the individual can be approved for Medicaid. This does not include medical facilities on the grounds of o…

A. The Medicare Catastrophic Coverage Act of 1988, ( P.L. 100-360), added provision 1902(r)(2) to the Medicaid statute which allows the state to apply income and resource rules to certain Medicaid coverage groups that are more liberal than the most closely related cash assistance…

A. The following briefly describes the liberalized resource policies currently in effect. The liberalizations are described in greater detail in the discussion of each resource type: 1. Spend down of resources within a month to become eligible in that month, i.e., eligibility may…

A. SSI policy specifies different exclusion limits or different ways to determine countable resources. If the resource policy has not been liberalized, SSI policy is applicable unless a subsequently issued federal statue or Medicaid regulation supersedes SSI policy. B. SSI polici…

A. In the programs using SSI policy, resource determinations are made as of the first moment of a calendar month. B. Any increase or decrease in the value of resources during a month is considered as of the first moment of the month following the month the change occurred.1. Exam…

A. Resources (General Definition): All assets, including real and personal property which an individual or couple:1. Owns; 2. Can apply toward basic needs of food, clothing and shelter, either directly or by conversion to cash, (if not already cash); and 3. Are not legally restri…

A. It is important to distinguish between resources and income to know which counting rules to use for any given month. The same item is not evaluated under two sets of counting rules for the same month; that is, one item cannot be counted as both income and a resource in the sam…

A. If an individual sells, exchanges, or replaces a resource, what he receives in return is not income; rather, it is a different form of resource. B. In order to distinguish resources from income, a determination must be on what has occurred and the monetary gain. C. The monetar…

A. If an individual sells, exchanges or replaces a resource, what he receives in return is a resource that has been converted from one type of resource to another. B. Examples of converted resources are:1. A lot with equity value of $5,000.00 is sold and the money is deposited in…

A. When an individual first receives property (as a gift or inheritance, for instance, and not as a purchase or trade of one resource for another), the new property is subject to evaluation under the income rules for the month of receipt and under resource rules thereafter. Notes…

A. Property of any kind, including cash, is a resource only if it meets all three criteria listed below by resource criteria and description: 1. Ownership Interest. a) An individual must have some form of ownership in property in order for the property to be considered a resource…

A. Unless an individual has been declared legally incompetent, he is assumed capable of managing his own affairs and his resources are considered. Competency does not affect consideration of resources. Notes 23 Miss. Code. R. 103-1.19 Social Security Act §1902 (r)(2); 42 CFR §435…

A. Medicaid uses the value of a person's resources as a factor in determining eligibility. It is generally expected that individuals or couples whose resources exceed the limit will use the excess to meet their needs before becoming eligible for Medicaid. B. As a 1634 state, Miss…