reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 9 - Authorizing a Nursing Facility Per-Diem Payment for a Beneficiary Eligible in a Non-Institutional Category › Rule 23-101-9.1 - Application of Long-Term Care Provisions for Non-Institutional Coverage Groups

Current through June 25, 2024
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 facility or intermediate care facility for the
				individuals with intellectual disabilities (ICF/IID).
B. Any individual requesting long-term care
				services is subject to the transfer of assets provision and the spousal
				impoverishment provision regardless of their source of eligibility or coverage
				group.
1. A five (5) year look-back is
				conducted as well as a review of all subsequent months to determine if a
				transfer of assets has occurred that may disqualify the individual for a per
				diem payment and application of the spousal impoverishment provision that would
				allow possible transfers to a spouse.
2. Beneficiary liability, referred to as
				Medicaid income, is payable for individuals entering long-term care with the
				exception of MAGI-related individuals.
3. Medicaid income is not payable for a
				MAGI-related adult or child.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 9 - Authorizing a Nursing Facility Per-Diem Payment for a Beneficiary Eligible in a Non-Institutional Category › Rule 23-101-9.3 - Adverse Action

Current through June 25, 2024
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 payment.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 9 - Authorizing a Nursing Facility Per-Diem Payment for a Beneficiary Eligible in a Non-Institutional Category › Rule 23-101-9.4 - Exparte Reviews

Current through June 25, 2024
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
				determination of eligibility in another coverage group without requiring the
				individual to come into the office or file a separate application.
1. When to Complete an Exparte Determination.
				For an exparte determination to be made, the specialist must be in the process
				of making a decision on a current application, review or reported change. If
				the specialist is denying or closing for failure to return information or
				failure to complete the interview process, an exparte determination is not
				applicable.
2. Basis for the
				Exparte Review. The decision of whether the recipient is eligible under a
				different coverage group must be based on information contained in the case
				record. This may include income, household or personal information in the
				physical record which indicates the ineligible adult or child has potential
				eligibility in another coverage group. Information received through electronic
				matches with other state/federal agencies such as a disability onset date or
				prior receipt of benefits based on disability are also considered part of the
				case record.
3. Obtaining
				Information to Make the Determination. When potential eligibility under another
				coverage group is indicated, but the specialist does not have sufficient
				information to make an eligibility determination, the recipient must be allowed
				a reasonable opportunity to provide necessary information.
4. Eligibility Decision. If the individual is
				subsequently determined to be eligible in the new category, the approval must
				be coordinated with termination in the current program to ensure there is no
				lapse or duplication in coverage. However, if requested information is not
				provided or if the information clearly shows that the recipient is not eligible
				under another category, eligibility in the current program will be terminated
				with advance notice. During the advance notice period, the recipient is allowed
				time to provide all requested information to determine eligibility in the new
				program, provide information which alters the decision to terminate benefits in
				the current program or request a hearing with continued benefits.
5. Requested Information Provided After
				Closure. If the recipient subsequently provides all of the information needed
				to assess eligibility in the new program within two (2) months of termination,
				the case should be handled in accordance with the redetermination
				procedures.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 10 - Notification › Rule 23-101-10.1 - Notification

Current through June 25, 2024
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.
42 C.F.R. §§
											435.912,
				  435.917.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 10 - Notification › Rule 23-101-10.2 - Advance Notice

Current through June 25, 2024
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 mailing time.
2. The Division
				of Medicaid requires a fifteen (15) day advance notice period for all adverse
				actions other than increasing beneficiary liability which is based on ten (10)
				days advance notice prior to Medicaid payment to the long-term care facility.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 10 - Notification › Rule 23-101-10.3 - Exceptions to Advance Notice

Current through June 25, 2024
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 beneficiary
				has moved from Mississippi through information received from the beneficiary or
				because another state reports the beneficiary has been accepted as a resident
				for Medicaid in that state. Eligibility is terminated at the end of the month
				in which action is taken to close the case.
C. Established that the beneficiary has been
				admitted to a public institution, such as a prison or a state hospital in a
				non-Title XIX facility. Eligibility is terminated as of the date of entry into
				the public institution.
D. Been
				unable to locate a beneficiary eligibility. The Division of Medicaid makes
				reasonable efforts to locate the beneficiary but if these efforts are
				unsuccessful, eligibility is terminated. However, if the individual's
				whereabouts subsequently become known during the time the individual is
				eligible for Medicaid services, the case is reinstated.
E. Been notified by the beneficiary or
				his/her designated representative of a request to voluntarily close their case.
				Eligibility is terminated at the end of the month in which action is taken to
				close the case.
F. Established a
				beneficiary has become Medicaid-eligible through Supplemental Security Income
				(SSI) or foster care, eligibility in the current aged, blind and disabled (ABD)
				or modified adjusted gross income (MAGI)related program is
				terminated.
42 C.F.R. §
											431.213; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 11 - Continuous Eligibility for Children › Rule 23-101-11.1 - Continuous Eligibility

Current through June 25, 2024
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 applied when determining and re-determining eligibility for a child under
				age nineteen (19) regardless of category of eligibility.
C. Continuous coverage for children may also
				be referred to as a protected period because the child cannot lose eligibility
				in the assigned category of eligibility unless one (1) of a limited number of
				early termination reasons is met. [Refer to Miss. Admin. Code Part 101, Rule
				11.2 ].
D. The child's program cannot be changed from
				Medicaid to CHIP or vice versa unless the head of household voluntarily
				requests early termination or the child was approved in error in the current
				program.
42 U.S.C. §
											1396a; 42 C.F.R. § 435.926; Miss. Code
				  Ann. §
										43-13-115.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 11 - Continuous Eligibility for Children › Rule 23-101-11.2 - Early Termination Reasons for Children

Current through June 25, 2024
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 maximum
				age for the program and an assessment of continued eligibility indicates the
				child is not eligible in any other MAGI or ABD program, eligibility is
				terminated. [Refer to Miss. Admin. Code Part 101, Rule 12.6 ]
4. Basis of eligibility is long-term care
				placement, eligibility is terminated if the child is discharged from the
				long-term care facility.
5. Becomes
				an inmate in a public institution, eligibility is terminated.
6. Becomes eligible for Medicaid through
				Supplemental Security Income (SSI) or Foster Care, coverage authorized through
				the Medicaid regional office is terminated because the child can have only one
				(1) source of eligibility.
7. Is
				approved in error, eligibility is terminated.
8. Cannot be located after reasonable
				efforts, eligibility is terminated.
9. Has a request for voluntary closure,
				eligibility is terminated.
10.
				Becomes covered by other full health insurance or a CHIP minor's pregnancy is
				discovered which causes the minor to be moved from CHIP to Medicaid for the
				duration of her pregnancy and post-partum period, CHIP eligibility is also
				terminated within the twelve (12) month period.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 11 - Continuous Eligibility for Children › Rule 23-101-11.3 - Deemed Eligible Infants

Current through June 25, 2024
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
				(13) month period from the birth month through the month of the first (1st)
				birthday unless one (1) of the above early termination reasons in Miss. Admin.
				Code Part 101, Rule
				11.2 is applicable.
C. The deemed child's eligibility start date
				is always the birth month regardless of the date the Division of Medicaid
				authorizes eligibility for the child.
D. If the mother is not eligible for Medicaid
				at the time her child is born, she may apply for Medicaid for herself and her
				newborn.
1. The application must be filed by
				the end of the third (3 
				rd) month following the birth month of
				the child in order for the birth to be covered by Medicaid, if determined
				eligible.
2. If the mother and
				newborn are determined eligible, the mother is covered throughout her
				post-partum period and the newborn is eligible for twelve (12) continuous
				months.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 11 - Continuous Eligibility for Children › Rule 23-101-11.4 - Eligibility of Adults

Current through June 25, 2024
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 from their first eligible month through
				the post-partum months regardless of any subsequent changes including, but not
				limited to, income or household composition.
2. Women whose eligibility originated in a
				non-pregnancy related category of eligibility that are determined eligible for
				and transition to pregnancy related Medicaid coverage for the duration of her
				pregnancy and post-partum coverage are covered. Eligibility is reviewed for the
				impact of any changes in circumstances after transitioning back to her original
				category of eligibility.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 12 - The Redetermination or Renewal Process › Rule 23-101-12.1 - General Information

Current through June 25, 2024
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 that are subject to change.
B. A special review is completed when a
				portion of the case must be re-worked or case information must be updated
				because of a change.
42 C.F.R. §
											435.916.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 12 - The Redetermination or Renewal Process › Rule 23-101-12.2 - Regular Redeterminations

Current through June 25, 2024
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 are reviewed and each eligibility
				factor subject to change, such as income and/or resources, is re-evaluated.
				Beneficiaries are not asked to provide information that is not relevant to
				ongoing eligibility or that has already been provided and is not subject to
				change.
C. Each child must be
				provided twelve (12) months of continuous eligibility in his/her eligible
				category. Prior to the end of the twelve (12) month period, a child cannot be:
1. Terminated, unless an early termination
				reason exists [Refer to Miss. Admin. Code Part 101, Rule
				11.2 ], or
2. Changed from one program to another, such
				as Medicaid to CHIP or vice versa, unless the parent or other authorized person
				voluntarily requests early closure in the current program or the original
				determination was in error.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 12 - The Redetermination or Renewal Process › Rule 23-101-12.3 - Administrative Renewals

Current through June 25, 2024
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 Medicaid, such as data secured from data matches
				with other state, federal and commercial databases as required by the
				Affordable Care Act (ACA).
B. If a
				beneficiary's eligibility can be renewed administratively, based on available
				information, the recipient will be notified of the approval and the basis for
				the approval.
C. The beneficiary
				must inform the Division of Medicaid, through any of the modes permitted for
				submission of applications listed in Miss. Admin. Code Part 101, Rule 4.2, if
				any information reported in the renewal process is inaccurate. The individual
				is not required to sign and return the approval notice if all information on
				the notice is accurate.
D.
				Administrative reviews are not processed for age, blind and disabled (ABD)
				cases with an asset test.
E. If an
				administrative review does not result in an approval in the same program,
				Medicaid or the Children's Health Insurance Program (CHIP), then it is not
				possible to complete the administrative review. A pre-populated renewal form is
				issued to allow the beneficiary to provide current information.
42 C.F.R. §
											435.916; Miss. Code Ann. §
										43-13-115.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 12 - The Redetermination or Renewal Process › Rule 23-101-12.4 - Pre-Populated Renewals

Current through June 25, 2024
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 Medicaid.
B. The beneficiary has a minimum of thirty
				(30) days from the date the renewal form is issued to respond and provide any
				necessary information needed to renew eligibility, including returning the
				signed renewal form. The signed renewal form and any paper verifications must
				be returned to the Division of Medicaid through any of the modes permitted for
				submission of applications listed in Miss. Admin Code Part 101, Part 4.2.
C. If a signed renewal form is not
				returned by the due date or if all requested information is not provided a
				telephone contact is attempted prior to taking action to terminate eligibility.
D. If the beneficiary is
				determined no longer eligible at the time of the annual redetermination of
				eligibility, the Division of Medicaid reviews the information in the case
				record for possible eligibility under any other available coverage within
				Medicaid or the Children's Health Insurance Program (CHIP), if appropriate.
1. Terminated individuals are referred for
				health coverage through the Federally Facilitated Marketplace (FFM), as
				appropriate.
2. Eligibility is not
				terminated by the Division of Medicaid until after the pre-populated review
				form is issued and the beneficiary is allowed the opportunity to respond to the
				information.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 12 - The Redetermination or Renewal Process › Rule 23-101-12.5 - Adverse Action

Current through June 25, 2024
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
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 13 - Special Case Reviews › Rule 23-101-13.1 - Conducting a Special Case Review

Current through June 25, 2024
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 information.
2. Factors unrelated to the change are not
				re-verified as part of a special case review.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 13 - Special Case Reviews › Rule 23-101-13.2 - Beneficiary Reporting Requirements

Current through June 25, 2024
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 report of change is received by the Division of Medicaid.
C. If a beneficiary fails to
				report timely or the Division of Medicaid fails to take timely action resulting
				in the beneficiary to receive benefits which he or she is not entitled, the
				Division of Medicaid will report an overpayment.
42 C.F.R. §
											435.916.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 13 - Special Case Reviews › Rule 23-101-13.3 - Taking Action on Reported Changes

Current through June 25, 2024
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 determine its impact on eligibility and benefit level.
C. A negative change reported during a review
				period that affects eligibility for adult(s) is handled at the time of the
				reported change.
1. Punitive action is not
				taken on children in a case due to action being taken for the adult's
				eligibility.
2. Children are fully
				reviewed at the end of their twelve (12) months of continuous eligibility.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 14 - Reinstatements and Corrective Action › Rule 23-101-14.1 - Situations Requiring a Reinstatement

Current through June 25, 2024
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
				reinstatement is issued r in the following situations, as applicable:
1. Hearing Decision
a) When a decision granting eligibility or
				increased benefits is rendered as part of a state or local hearing, the
				regional office may be required to reinstate and/ or correct Medicaid income.
b) The effective date of the
				reinstatement is retroactive to the date decided by the hearing official.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 14 - Reinstatements and Corrective Action › Rule 23-101-14.2 - Corrective Action

Current through June 25, 2024
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 action to prior months
				adversely affects the beneficiary and the error caused the beneficiary to be
				totally ineligible or eligible for fewer benefits an improper payment has
				occurred.
D. When corrective action
				to prior months favorably affects the beneficiary and the client was eligible
				or eligible for more benefits the corrective action is handled through
				reinstatement.
42 C.F.R. §
											431.246.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 15 - Other Changes - Aged, Blind and Disabled (ABD) Programs › Rule 23-101-15.1 - Changes in Medicaid Income

Current through June 25, 2024
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
				effective dates of such changes determined as follows:
1. A decrease in Medicaid income is effective
				the month in which the change is reported or becomes known to the Division of
				Medicaid.
2. An increase in
				Medicaid income requires advance notice to the beneficiary advising of the
				increase.
a) Advance notice for Medicaid
				income increases is based on issuing notice ten (10) days before the date the
				Division of Medicaid makes its payment to the nursing facility.
b) If a state or local hearing is requested
				within the advance notice period, the increase is not effective until the final
				hearing decision is rendered.
3. A temporary decrease in Medicaid income
				occurs due to the allowance of a deduction including, but not limited to, a
				health insurance premium or other non-covered medical expense.
a) Medicaid income is subsequently returned
				to the amount previously in effect.
b) This action is not considered an increase
				in Medicaid income subject to advance notice.
4. An increase in Medicaid income combined
				with a closure occurs when income is counted in the month received and receipt
				of the income also renders the beneficiary ineligible. The excess income is
				included in the Medicaid income computation provided there are ten (10)
				calendar days left in the month of receipt to allow for advance notice.
5. A temporary increase in
				Medicaid income occurs when excess resources are not an issue, but receipt of
				additional income results in the monthly income total being over the income
				limit for long-term care eligibility.
a) The
				case will remain open if there is not time to allow for advance notice of
				closure.
b) If there are ten (10)
				calendar days left in the month, Medicaid income is increased to the amount of
				that month's income or the Medicaid reimbursement per-diem rate for the
				facility, whichever is less.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 15 - Other Changes - Aged, Blind and Disabled (ABD) Programs › Rule 23-101-15.2 - Changing to a Reduced Service Coverage Group

Current through June 25, 2024
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 Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB),
				or Qualified Individual (QI) for the following month unless there are at least
				fifteen (15) days remaining in the current month.
42 C.F.R. §
											431.211.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 1 - Residency › Rule 23-102-1.1 - State Residency

Current through June 25, 2024
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 for the purpose of seeking employment, whether or not
				the individual is currently employed.
42 CFR §435.403
				  (Rev. 2006).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 1 - Residency › Rule 23-102-1.2 - Residency Requirements

Current through June 25, 2024
A. The individual
				must live in Mississippi and meet all other eligibility requirements in order
				to receive Medicaid benefits.
B. A
				spouse and children living in the same household with the individual are also
				considered Mississippi residents.
42 CFR §435.403
				  (Rev. 2006).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 1 - Residency › Rule 23-102-1.3 - No Permanent Mississippi Address

Current through June 25, 2024
A. An individual,
				including someone with no permanent address, is a resident of Mississippi if he
				lives in the state and is capable of stating and does state intent to remain
				here permanently or for an indefinite period of time.
1. Indefinite indicates the individual does
				not have a date in mind when he will no longer be a resident of the
				state.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 1 - Residency › Rule 23-102-1.4 - Residing in Another State

Current through June 25, 2024
A. An individual
				who claims to be a resident of Mississippi, but is residing in another state,
				must show an established address or place of residence in Mississippi before he
				can be considered temporarily absent from Mississippi for Medicaid
				purposes.
42 CFR §435.403
				  (Rev. 2006).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 1 - Residency › Rule 23-102-1.5 - Incapable of Stating Intent

Current through June 25, 2024
A. An individual
				who is incapable of stating intent to reside is a resident of the state in
				which he is physically located. No statement of intent is needed.
42 CFR §435.403
				  (Rev. 2006).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 1 - Residency › Rule 23-102-1.6 - Stating Intent to Reside

Current through June 25, 2024
A. A person is
				considered capable of stating intent to reside unless he has an IQ of
				forty-nine (49) or less or has a mental age of seven (7) or less based on tests
				acceptable to the Department of Education; or is judged legally incompetent; or
				is found incapable of indicating intent based on medical documentation obtained
				from a physician, psychologist or other individual licensed by the state in the
				field of mental retardation.
42 CFR §435.403
				  (Rev. 2006).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 1 - Residency › Rule 23-102-1.7 - Specific Residency Prohibitions

Current through June 25, 2024
A. An individual
				cannot be denied Medicaid based on residency for the following reasons:
1. The individual has not resided in MS for a
				specified period of time. There is no durational requirement for
				residency.
2. The individual is
				temporarily absent from MS and intends to return when the purpose of the
				absence has been accomplished. However, if another state has accepted him as a
				resident for Medicaid purposes, the individual cannot be considered a MS
				resident.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 1 - Residency › Rule 23-102-1.8 - Temporary Absence From the State

Current through June 25, 2024
A. The recipient is
				responsible for reporting a temporary absence from Mississippi and for giving
				information on his purpose, plans and dates of departure and return. The
				recipients eligibility must be reviewed every three (3) months to determine the
				recipients continued intent to reside in MS.
B. No limit is place on the length of the
				out-of-state visit; however, if it is determined that an individual has left
				the state with no declared intention to return, the individual will be deemed
				to have given up MS residency and his eligibility will be terminated.
42 CFR §435.403
				  (Rev. 2006).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 1 - Residency › Rule 23-102-1.9 - Individuals Receiving a State Supplementary Payment

Current through June 25, 2024
A.
				An individual receiving a state supplementary payment (optional or mandatory),
				such as state adoption assistance or state foster care payment, is a resident
				of the state making the supplementary payment.
42 CFR §435.403
				  (Rev. 2006).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 1 - Residency › Rule 23-102-1.10 - Individuals Receiving a Title IV-E Payment

Current through June 25, 2024
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.
42 CFR §435.403
				  (Rev. 2006).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 1 - Residency › Rule 23-102-1.11 - Determination of Residency (Under Age 21)

Current through June 25, 2024
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, the state of
				residence is where the individual is living with the intent to remain
				permanently or for an indefinite period.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 1 - Residency › Rule 23-102-1.12 - Determination of Residency (Age 21 and Older)

Current through June 25, 2024
A. Determine
				residency for individuals age twenty-one (21) and older as follows:
1. Not in an Institution.
a) The state of residence is where the
				individual is living with the intent to remain there permanently or for an
				indefinite period, or the state where the individual is living because the
				individual had a job commitment or is seeking employment, either currently
				employed or not. If the individual is incapable of stating intent, the state of
				residence is where the individual is living.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 1 - Residency › Rule 23-102-1.13 - State Placement in an Out-of-State Institution

Current through June 25, 2024
A.
				If a state agency arranges for an individual to be placed in an institution in
				another state, the state arranging or making the placement is the individual's
				state of residence.
B. For purposes
				of state placement, the term institution also includes licensed foster care
				homes that provide food, shelter, and supportive services for one or more
				individuals unrelated to the proprietor. The following actions are not
				considered state placement:
1. Providing
				basic information to individuals about another states Medicaid program and
				information about healthcare services and facilities in another state
				or
2. Providing information
				regarding institutions in another state if the individual is capable of
				indicating intent and decides to move.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 1 - Residency › Rule 23-102-1.14 - Out-of-State Placements

Current through June 25, 2024
A. There are two
				circumstances under which Mississippi will pay for placement in an out-of-state
				nursing facility.
1. If the agency has a part
				in the placement or otherwise approves or authorizes an out-of-state placement,
				regional offices will be notified on an individual case basis.
2. When a MS resident moves to a nursing
				facility in another state, only the partial month of the move can be paid if
				the facility enrolls as a Mississippi provider. The individual is considered a
				resident of the new state effective with the first full month of residence and
				has to qualify for Medicaid eligibility and vendor payment in the new
				state.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 1 - Residency › Rule 23-102-1.15 - Recipients Moving to Mississippi From Another State

Current through June 25, 2024
A.
				Termination of Benefits in the Former State of Residence.
1. An individual coming to MS from another
				state may be considered a resident of Mississippi in the month of the move,
				provided the individual intends to reside in Mississippi.
2. Individuals are not entitled to
				duplication of Medicaid services from both the former state and Mississippi.
				When a Medicaid recipient moves from one state to another, the former state
				initiates the change effective the first month in which it can administratively
				terminate the case in accordance with timely and adequate notice
				regulations.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 2 - United States Citizens › Rule 23-102-2.1 - Eligible Individuals

Current through June 25, 2024
A. An eligible
				individual must either be a citizen of the United States or a qualified alien.
1. Most United States citizens are
				natural-born citizens, meaning they were born in the United States or were born
				to United States citizens overseas. Individuals born in the United States,
				which includes the fifty (50) states, the District of Columbia, Puerto Rico,
				Guam, the U. S. Virgin Islands, the Northern Marinara Islands and the Panama
				Canal Zone before it was returned to Panama, are U. S. citizens at birth
				(unless born to foreign diplomatic staff), regardless of the citizenship or
				nationality of the parents.
2.
				Nationals from American Samoa or Swains Island are citizens for Medicaid
				purposes.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 2 - United States Citizens › Rule 23-102-2.2 - Child Citizenship Act of 2000

Current through June 25, 2024
A. The Child
				Citizenship Act of 2000, enacted February 21, 2001, amended the Immigration and
				Naturalization Act to provide automatic acquisition of U. S. citizenship by
				operation of law to certain foreign born children, including orphans with a
				full and final adoption by U. S. citizens, either abroad or in the U. S., and
				the biological or legitimated children of U. S. citizens. Prior to the
				implementation of this act, these children had to go through the naturalization
				process to become citizens.
42 CFR §435.407(a)
				  (Rev. 2007).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 2 - United States Citizens › Rule 23-102-2.3 - Establishing Citizenship and Identity

Current through June 25, 2024
A. The citizenship
				and identity of applicants and recipients declaring to be U. S. citizens will
				be established in accordance with provisions of the Deficit Reduction Act (DRA)
				of 2005, which was effective with applications and reviews on and after July 1,
				2006. Documentary verification of citizenship is required.
B. The evidences of citizenship are divided
				into a hierarchy of primary, secondary, third level and fourth level documents.
				Primary evidence has the highest reliability and conclusively establishes both
				a persons citizenship and identity. When the individual has secondary, third or
				fourth level documentation of citizenship, additional verification must be
				provided to establish identity. The evidences of identity are not
				prioritized.
C. The highest level
				of verification must be used if it is available. Available means the document
				exists and can be obtained within the time period allowed for providing
				information, i.e., thirty (30), forty-five (45) and ninety (90) days based on
				application type. Therefore, when a higher level document is not available, it
				is permissible to use a lower level document.
D. Applicants must be provided a reasonable
				opportunity to provide verification of citizenship and identity. An application
				cannot be approved if required citizenship and identity verification has not
				been provided.
E. It is generally
				the individuals responsibility to provide required documents and pay associated
				fees to obtain them. However, when individuals are economically disadvantaged
				and unable to pay fees associated with obtaining necessary documents, lower
				level evidences of citizenship and identity will be accepted.
F. Assistance must be provided when an
				applicant or beneficiary, who is homeless, an amnesia victim, mentally impaired
				or physically incapacitated and lacks someone to act for them, does not have
				the required verifications. Contact must be attempted and assistance provided
				to any applicant or recipient who is known to be deaf, hard of hearing, blind,
				mentally or visually impaired, physically incapacitated or otherwise disabled,
				illiterate, limited English proficient, homeless and/or requires communication
				assistance with reading agency notices and other written correspondence prior
				to denying or terminating their case.
1.
				Eligibility will not be denied or terminated until all avenues of verification
				have been exhausted. However, when the individual has been given a reasonable
				opportunity to provide the information and all avenues of assistance have been
				exhausted and documented, eligibility must be denied or terminated if needed
				information is not provided.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 2 - United States Citizens › Rule 23-102-2.4 - Exemptions from Citzenship/Identity Requirements

Current through June 25, 2024
A.
				Individuals declaring to be U. S. citizens are exempt from citizenship and
				identity documentation requirements if they are in one of the following
				categories:
1. Medicare recipients entitled
				to, or enrolled in, Medicare Part A or B under any claim number are exempt from
				the verification requirements.
2.
				Individuals receiving Social Security benefits under A claim number based on
				their own disability are exempt from the verification requirements. The
				individual must be a current recipient of Social Security Disability. Prior
				receipt of disability does not qualify an individual for this exemption. In
				addition, this exemption does not apply to individuals receiving early
				retirement or to dependants drawing off the disabled individuals
				record.
3. Individuals receiving
				SSI benefits are exempt. The individual must be a current SSI recipient. Prior
				receipt if SSI does not qualify a person for this exemption. Former SSI
				recipients applying for Medicaid must provide evidence of citizenship and
				identity. However, current SSI recipients applying only for retroactive
				coverage are exempt.
4. Children in
				receipt of Title IV-B services or Title IV-E Adoption Assistance or foster care
				payments are exempt.
5. Deemed
				eligible children are exempt from citizenship and identity verification
				requirements until the end of the deemed year. All eligibility factors,
				including documentation of citizenship and identity, must be met for
				eligibility to continue beyond the first year.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 2 - United States Citizens › Rule 23-102-2.5 - Evidences of U.S. Citizenship

Current through June 25, 2024
A. Primary Evidence
				has the highest reliability. If provided, no further verification is needed. If
				any other level of evidence is used to verify U. S. citizenship, a second
				document verifying identity must be obtained.
1. The following documents may be accepted as
				primary proof of an individuals citizenship and identity.
a) U.S. Passport. A U.S. Passport does not
				have to be currently valid to be accepted as evidence of U.S. citizenship as
				long as it was originally issued without limitation. On an emergency basis, the
				passport office will issue a U.S. passport without proof of citizenship. In
				this instance, the passport is issued with the limitation that is valid for one
				(1) year rather than the usual five (5) or ten (10) years. When the holder of a
				passport with limitation returns to the country, he has to provide proof of
				citizenship to have the passport reissued without limitation. To determine if a
				passport was issued with limitation, compare the issuance date, with the
				expiration date. If the expiration date is less than five (5) years from the
				issuance date, the passport was issued with limitation and cannot be used as
				proof of citizenship. Each passport must be examined closely to determine
				whether or not the passport was issued with limitation. Spouses and children
				were sometimes included on one passport through 1980. U.S. passports issued
				after 1980 show only one person. Consequently, the citizenship when it was
				issued with a limitation. However, such a passport may be used as proof of
				identity. NOTE: Do not accept any passport as evidence of U.S. citizenship when
				it was issued with a limitation. However, such a passport may be used as proof
				of identity.
b) Certificate of
				Naturalization (N-550 or N-570). Issued by Department of Homeland Security
				(DHS) for Naturalization.
c)
				Certificate of Citizenship (N-560 or N-561). Issued by DHS to individuals who
				derive citizenship through a parent.