reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.12 - Mandatory Presumptive Eligibility Determined by Qualified Hospitals

Current through June 25, 2024
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 determined eligible for
				Medicaid by authorized hospital staff.
2. HPE provides temporary Medicaid
				eligibility but also allows access to continuing Medicaid coverage provided the
				HPE decision includes filing a full Medicaid application.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.13 - Optional Coverage of Children Elected to be Covered by Mississippi

Current through June 25, 2024
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 state
				established standards, converted to a modified adjusted gross income
				(MAGI)equivalent standard. Children under age twenty-one (21) in adoptions
				subsidized in full or part by DCPS and children in adoption assistance who
				cannot be placed for adoption without medical assistance due to special needs
				of the child are eligible for Medicaid regardless of the child's income, as
				determined by DCPS.
B. Independent
				foster care adolescents who are in foster care under the responsibility of DCPS
				on their eighteenth (18th) birthday have Medicaid coverage continued until age
				twenty-one (21) without regard to any change in circumstances such as income or
				resources.
1. As required by the Affordable
				Care Act (ACA), former foster children receive Medicaid coverage on a mandatory
				basis to age twenty-six (26); however, the optional coverage of former foster
				children to age twenty-one (21) was in place prior to the ACA.
2. The Division of Medicaid, in coordination
				with DCPS, certifies Medicaid coverage for this group.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.14 - Optional Coverage of the Aged, Blind and Disabled (ABD) Considered to be in an Institution Elected to be Covered by Mississippi

Current through June 25, 2024
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
				of Medicaid.
B. Individuals in
				institutions who are eligible under a special income test 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 of Medicaid.
C. Individuals receiving home and
				community-based services who would be Medicaid eligible if institutionalized
				and who are eligible under an approved waiver and receive waiver services may
				qualify for Medicaid. The individual must meet income, resource and other
				non-financial factors of eligibility, as determined by the Division of
				Medicaid.
D. Certain disabled
				children age eighteen (18) or under who are living at home, who would be
				eligible for Medicaid if in a medical institution and for whom the Division of
				Medicaid has made a determination as required under section 1902(e)(3)(B) of
				the Social Security Act may qualify for Medicaid. The cost-effectiveness of
				care at home compared to care provided in a medical institution must be
				considered.
42 U.S.C. §
											1396a; 42 C.F.R. §§ 435.211,
				  435.217, 435.236.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.15 - Optional Coverage of the Aged, Blind and Disabled (ABD) Living At-Home Elected to be Covered by Mississippi

Current through June 25, 2024
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%) of the FPL are eligible for Medicaid.
1. Resource limits and other non-financial
				factors of eligibility are required.
2. Premiums are payable for households with
				countable earnings that exceed one hundred fifty percent (150%) of the FPL.
3. The Division of Medicaid
				certifies eligibility and premiums payable for this group.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.16 - Optional Waiver Coverage of Non-Medicare Aged, Blind and Disabled Individuals

Current through June 25, 2024
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 cap.
C. Resource limits
				and other factors of eligibility apply, as determined by the Division of
				Medicaid.
42 U.S.C. §
											1315; Healthier Mississippi
				  Waiver.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.17 - Optional Waiver Coverage of Family Planning and Family Planning Related Services

Current through June 25, 2024
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 (MAGI) equivalent standard who are not otherwise
				eligible for Medicare, Medicaid, Children's Health Insurance Program (CHIP) or
				other health insurance that includes coverage of family planning services
				[Refer to Miss. Admin. Code Part 221].
B. Effective January 1, 2015, the family
				planning waiver includes the coverage of men.
C. All individuals qualifying for coverage of
				family planning and family planning related services under the waiver must be
				within the age and income limits, as determined by the Division of
				Medicaid.
42 U.S.C. §
											1315; Family Planning
				  Waiver.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.18 - Optional Waiver Coverage of 1915 Home and Community-Based Service (HCBS) Waivers

Current through June 25, 2024
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. Traumatic Brain Injury/Spinal Cord Injury
				Waiver [Refer to Part 208, Chapter 4], and
E. Intellectual Disabilities/Developmental
				Disabilities Waiver [Refer to Part 208, Chapter 5], Source:
				42 U.S.C. §
										1315; Miss. Code Ann. §
									43-13-117.
42 U.S.C. §
											1315; Miss. Code Ann. §
										43-13-117.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 2 - Introduction to Applications and Reviews › Rule 23-101-2.1 - General Information

Current through June 25, 2024
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 full review of all variable eligibility factors, conducted at specific
				intervals not to exceed 12 months for each beneficiary, to determine whether or
				not eligibility continues. Basic information that is not subject to change is
				not re-verified.
C. A special
				review is required to determine the impact a reported change has on eligibility
				during a review.
D. A reinstatement
				reopens eligibility without requiring a new application or renewal form.
				Eligibility may or may not be reopened back to the date of closure, depending
				on the circumstances.
42 C.F.R. §§
											435.902,
				  435.916.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 3 - How to Apply › Rule 23-101-3.1 - Applicants and Application Forms

Current through June 25, 2024
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 certifications, or
3. Who applies for coverage in
				Mississippi through the Federally Facilitated Marketplace (FFM) and has their
				electronic application information transferred to the Division of Medicaid via
				a process referred to as an Account Transfer (AT).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 3 - How to Apply › Rule 23-101-3.2 - Signature Requirements

Current through June 25, 2024
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 apply for Medicaid or CHIP is
				required.
B. If an applicant is
				unable to write his/her name, the form may be signed with an "X" mark; however,
				a witness signature is required. If an applicant is incompetent as adjudged by
				a court or incapacitated due to a physical or mental condition someone must be
				named to officially represent the applicant.
C. Unsigned applications or applications
				signed with an "X" mark that are not witnessed are not valid and are returned
				to the applicant with an explanation of the signature requirements.
D. Applications that are signed but are
				incomplete are accepted as valid applications. The Medicaid Specialist will
				work with the applicant to complete the information needed.
E. Applications signed by an individual other
				than a person who is authorized to apply, as specified in Miss. Admin. Code
				Part 101, Rule
				3.4, are accepted as valid
				applications. The Medicaid Specialist must assist the applicant or head of
				household to obtain an acceptable signature on the submitted application
				form.
42 C.F.R. §
											435.4; 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 3 - How to Apply › Rule 23-101-3.3 - Representatives Authorized to Act for an Applicant

Current through June 25, 2024
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 with no
				separate written authorization required except in cases where the head of
				household has a legal representative who is required to act on his/her behalf.
2. ABD applications require the
				use of a separate authorization form in order for an applicant or recipient to
				appoint an authorized representative.
3. The authorized representative:
a) Has knowledge of the applicant's
				circumstances and is usually a relative or close friend, but may be a designee
				of an organization if the applicant or recipient permits.
b) Must be authorized in writing by the
				applicant to act on his/her behalf and files the application in the name of the
				applicant.
c) Can provide
				eligibility information and sign the application form and receive all
				eligibility notices; however, the applicant or recipient has the right to limit
				the authority of their authorized representative.
4. The appointment of an authorized
				representative does not prevent the Division of Medicaid from communicating
				directly with the applicant or beneficiary as deemed appropriate.
5. When an organization or other individual
				assisted with the completion of an application and their primary need is access
				to case record information rather than function as an authorized
				representative, the "Authorization for the Use and Disclosure of Protected
				Health Information" form must be completed.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 3 - How to Apply › Rule 23-101-3.4 - Who Can File the Application

Current through June 25, 2024
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) Minor living independently, or
d) Minor living with his/her
				parent(s) and applying only for the minor's own children.
3. The parent who has primary physical
				custody of a minor child,
4. Either
				parent of a minor child when custody is equally divided between legal
				parents,
5. The caretaker relative
				with whom a dependent child is living who has primary responsibility for the
				child's care.
a) A caretaker relative is
				defined as a relative by blood, adoption or marriage with whom the child is
				living who assumes primary responsibility for the child's care.
b) A dependent child is defined as a child
				under age eighteen (18) and deprived of parental support by reason of death,
				absence from the home, or physical or mental incapacity.
6. An authorized representative, a
				self-designated representative or a legal representative, as defined in Miss.
				Admin. Code Part 101, Rule
				3.3.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 3 - How to Apply › Rule 23-101-3.5 - Access and Accommodations in Applying

Current through June 25, 2024
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 handicapped persons. If a site is not accessible,
				alternate accommodations will be made including assistance with an alternate
				method of filing the application.
B. Each application intake site and each
				telephone application is required to provide the following accommodations:
1. A language line to secure the assistance
				of an interpreter capable of communicating in the applicant's language to
				assist in the application process and relate the services offered for
				individuals with limited English proficiency who are unable to communicate
				effectively in any language other than his native language.
a) This service is available free of charge
				and is available to applicants, beneficiaries and those inquiring about
				coverage or services offered through the Division of Medicaid.
b) An applicant is not required to provide
				his/her own interpreter or rely on an accompanying adult or minor child of the
				applicant to provide interpreter services unless it is an emergency situation
				involving imminent threat of safety or welfare of the applicant or beneficiary
				or person inquiring and no qualified interpreter is available.
c) If the applicant, beneficiary or
				individual inquiring about Medicaid eligibility requests an accompanying adult
				to interpret and the accompanying adult agrees and reliance on the accompanying
				adult is appropriate to the circumstances, the Division of Medicaid may allow
				the adult to provide interpreter services.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 3 - How to Apply › Rule 23-101-3.6 - Reasonable Efforts to Assist

Current through June 25, 2024
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. Obtaining necessary information
				from third parties, and
4.
				Providing information to the applicant to assist in making informed decisions
				about Medicaid eligibility.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 3 - How to Apply › Rule 23-101-3.7 - Out of State Applicants

Current through June 25, 2024
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 to
				their home out of state are not eligible for Mississippi Medicaid or
				CHIP.
C. Applicants must always be
				given the right to make an application if they wish to do so and receive a
				decision on their case.
42 CFR §435.403
				  (Rev. 2006).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 3 - How to Apply › Rule 23-101-3.8 - Residence Change During the Application Process

Current through June 25, 2024
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 until the person reapplies in the second
				location.
B. If the applicant
				reports moving out of the state during the application process, the date of the
				move must be determined. If otherwise eligible, the applicant may be approved
				for Medicaid from any requested retroactive months through the month of the
				move. If the applicant will be CHIP eligible, the application will be denied
				when CHIP eligibility is for a future month.
C. If only some members of the applicant
				family are moving from the state, the remaining children and adults who remain
				in MS will be identified and the case will be handled on their ongoing
				eligibility accordingly.
42 CFR §435.403
				  (Rev. 2006).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 3 - How to Apply › Rule 23-101-3.9 - Where to File the Application

Current through June 25, 2024
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 office must review each
				application upon receipt and confirm the accuracy of the address if there is a
				question about the responsible office.
MS Code Ann. §
										43-13-121
				  (Rev. 2012).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 4 - Filing the Application › Rule 23-101-4.1 - Right to Apply

Current through June 25, 2024
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 refers the
				name of an individual in need of medical assistance to the regional office, the
				individual will be contacted, if possible, and the various means of applying
				will be explained. Otherwise, an application will be mailed if an address is
				available.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 4 - Filing the Application › Rule 23-101-4.2 - Submitting an Application and Application File Date

Current through June 25, 2024
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
				facility, hospital or other public facility. The filing date is the date
				received by the office or other location.
2. By mailing to any regional office.
				Applications received by mail which arrive after the end of the month, but
				which are postmarked by the last day of the month, will be considered to have
				been received by the regional office on the last day of the month in which they
				are postmarked.
3. By fax received
				in any regional office. The date of filing is the date received by the Division
				of Medicaid's central or regional offices. An original signature is not
				required.
4. By on-line submission
				to the Federally Facilitated Marketplace (FFM) which is then transferred to the
				Division of Medicaid. The filing date is the date received by the FFM. An
				electronic signature is accepted for applications filed on-line to the
				FFM.
5. By telephone via a
				telephonically recorded application process. The date of filing is the date the
				telephonic signature is recorded. Unless the telephone interview is recorded,
				the completed application must be mailed to the applicant for signature in
				which case the date of filing is the date the Division of Medicaid receives the
				signed application form.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 4 - Filing the Application › Rule 23-101-4.3 - Protected Application Dates for Medicaid Applicants

Current through June 25, 2024
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 to file a separate application to be evaluated for
				potential eligibility in an aged, blind and disabled (ABD) Medicaid program and
				vice versa.
2. Any application
				received by the regional office is evaluated across program lines to determine
				if eligibility exists under any category of Medicaid coverage.
3. Completion of additional forms will be
				necessary to complete the eligibility process.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 4 - Filing the Application › Rule 23-101-4.4 - Applications Received from Mississippi Residents Out-Of-State

Current through June 25, 2024
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 and planning to
				return to Mississippi when discharged may be processed in the usual manner. If
				the application is approved, it must be reviewed every three (3) months to
				determine if the individual's intent is to continue to reside in
				Mississippi.
42 C.F.R. §
											435.403.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 4 - Filing the Application › Rule 23-101-4.5 - Out of State Applicants

Current through June 25, 2024
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 purpose, such as a visit, who intend to return to their home out of
				state are not eligible for Mississippi Medicaid or the Children's Health
				Insurance Program (CHIP).
C.
				Individuals always have the right to make an application if they wish to do so
				and receive a decision on their case.
42 C.F.R. §
											435.403.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 4 - Filing the Application › Rule 23-101-4.6 - Residence Change During the Application Process

Current through June 25, 2024
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 denied, the record is not transferred until
				the applicant reapplies in the second location.
B. If the applicant reports moving out of
				Mississippi during the application process, the date of the move must be
				determined. If otherwise eligible, the applicant may be approved for Medicaid
				for any requested retroactive months through the month of the move. If the
				applicant will be eligible for Children's Health Insurance Program (CHIP),
				eligibility can be established for the month following the month of application
				or any subsequent month(s) when the applicant lived in Mississippi.
C. If only some members of the applicant
				family are moving from Mississippi, the children and adults who remain in
				Mississippi will be identified and the case will be handled on their ongoing
				eligibility accordingly.
42 C.F.R. §
											435.403.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 4 - Filing the Application › Rule 23-101-4.7 - Where to File the Application

Current through June 25, 2024
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 accepted by any
				regional office.
2. Each regional
				office must review each application upon receipt and confirm the accuracy of
				the address if there is a question about the responsible
				office.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 4 - Filing the Application › Rule 23-101-4.8 - Voter Registration

Current through June 25, 2024
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 are available at regional offices and out-stationed sites for those
				applying in person, offered to those applying by phone and available on-line
				for those applying or submitting applications on-line.
C. Completed forms returned to the regional
				office are transmitted to the Circuit Clerk's office in the county of
				residency, according to established timelines.
52 U.S.C §
											20501- 52.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 4 - Filing the Application › Rule 23-101-4.9 - Medicaid Applications Filed Through Another Agency or Entity

Current through June 25, 2024
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 to apply separately for retroactive
				Medicaid or for Medicaid to evaluate coverage for any missing month(s) of SSI
				coverage.
B. Children in the
				custody of the Mississippi Department of Child Protection Services (DCPS) who
				are certified as Medicaid-eligible by DCPS receive Medicaid with no separate
				application required.
C.
				Applications filed with the Federally Facilitated Marketplace (FFM) are
				reviewed for possible Medicaid or the Children's Health Insurance Program
				(CHIP) eligibility before enrolling the applicant in a qualified health plan.
1. If applicants are potentially eligible for
				Medicaid or CHIP, their FFM account is transferred to the Division of Medicaid
				for further development and a decision regarding eligibility.
2. Referrals from the FFM require a Division
				of Medicaid decision to approve or deny eligibility for Medicaid or
				CHIP.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 5 - Standards of Promptness › Rule 23-101-5.1 - Regional Office Responsibilities

Current through June 25, 2024
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 at all staff levels, including
				sufficient time for supervisory review and corrections, as appropriate.
C. Applications are generally
				processed in the order in which they are received, taking into consideration
				promptness and delay in receipt of verifications, and in some cases, urgent
				need.
D. Applications are only
				approved with the proper verifications, received through electronic databases
				and otherwise, that document eligibility for each applicant.
42 C.F.R. §§
											435.911,
				  435.912.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 5 - Standards of Promptness › Rule 23-101-5.2 - Exceptions to Timely Promptness

Current through June 25, 2024
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 Disability Determination Service (DDS) or
3. Administrative or other
				emergency delay that could not be controlled by the agency.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 5 - Standards of Promptness › Rule 23-101-5.3 - Timely Processing

Current through June 25, 2024
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 completed. However, if a separate disability decision is
				not required, the forty-five (45) day standard applies.
C. The applicable standard of promptness of
				forty-five (45) or ninety (90) days is applied to an aged, blind, or disabled
				(ABD) application from the date an application is filed to the date the notice
				of decision is mailed to the applicant. When there is a delay, the reason is
				documented in the record.
D. The
				applicable standard of promptness for applications filed with the Federally
				Facilitated Marketplace (FFM) begins when the Account Transfer (AT) record is
				received by the Division of Medicaid.
42 C.F.R. §§
											435.911,
				  435.912.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 6 - Processing Applications › Rule 23-101-6.1 - Making an Eligibility Decision

Current through June 25, 2024
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 in the case record.
B. As part of the eligibility process,
				information provided by the applicant and secured from electronic databases is
				evaluated by the Division of Medicaid prior to making the eligibility decision.
C. If information on the modified
				adjusted gross income (MAGI) application or renewal form provided by or on
				behalf of a MAGI applicant or otherwise provided is consistent and reasonably
				compatible with information obtained through electronic databases, eligibility
				must be determined or renewed based on such information.
D. An applicant cannot be required to provide
				additional information or documentation unless information needed cannot be
				obtained electronically or the information obtained electronically is not
				consistent with information declared on the application or otherwise secured
				during the application process.
E.
				The Division of Medicaid is not required to use data available from an
				electronic source if establishing a data match would not be effective
				considering such factors as the administrative costs associated with
				establishing and using the data match as compared to relying on paper
				documentation.
F. Income
				information is obtained from electronic sources such as the Mississippi
				Department of Employment Security, the Social Security Administration (SSA),
				commercial database matches and other available cost-effective databases.
G. The general rule for
				verification is to verify only the information which is material to the
				individual's eligibility. The Division of Medicaid has permission to obtain
				needed verifications based on the signed and dated application form.
42 C.F.R. § 435.
				  940 through § 435.960.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 6 - Processing Applications › Rule 23-101-6.2 - Application Actions

Current through June 25, 2024
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 eligibility determination is
				made, the application process must be continued to completion.
2. If an applicant provides all needed
				information to complete the application before the end of the month following
				the month of the denial, the denied application is used to determine
				eligibility using the original application date and form. The exception is an
				aged, blind, or disabled (ABD) application denied for failure to appear for a
				required interview and there was no request to make alternative arrangements to
				be interviewed.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 7 - Combination Modified Adjusted Gross Income (MAGI) and Aged, Blind, Disabled (ABD) Applications › Rule 23-101-7.1 - MAGI-Related Application Indicates Possible Aged, Blind, Disabled (ABD) Eligibility

Current through June 25, 2024
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 that limits common activities, or
3. Lives in a medical facility or nursing
				facility.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 7 - Combination Modified Adjusted Gross Income (MAGI) and Aged, Blind, Disabled (ABD) Applications › Rule 23-101-7.2 - Beginning Dates of CHIP Eligibility

Current through June 25, 2024
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. There is one exception
				for limited retroactive coverage in CHIP. The start date for a CHIP-eligible
				newborn may be retroactive to the date of birth if the application for the
				newborn is filed within thirty-one (31) days of birth (start the thirty-one
				(31) day count the day following the date of birth).
42 CFR §457.340(f)
				  (Rev. 2012).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 7 - Combination Modified Adjusted Gross Income (MAGI) and Aged, Blind, Disabled (ABD) Applications › Rule 23-101-7.3 - Terminations Dates

Current through June 25, 2024
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 institution.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 7 - Combination Modified Adjusted Gross Income (MAGI) and Aged, Blind, Disabled (ABD) Applications › Rule 23-101-7.4 - Retroactive Medicaid Eligibility

Current through June 25, 2024
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 all
				three (3) months of the prior period or any month(s) in the three (3) month
				period. In addition:
1. Each Applicant must be
				informed of the availability of retroactive Medicaid coverage.
2. The applicants statement is accepted
				regarding medical expenses incurred in the retroactive period.
3. Retroactive Medicaid may also be available
				to an individual who is added to a case. (e.g. child returns home).
4. The applicant does not have to be eligible
				in the month of the application (or current month) to be eligible for one or
				months of retroactive Medicaid.
5.
				The applicant or recipient may ask for retroactive Medicaid coverage at any
				time.
6. The date of application,
				rather than the date of the eligibility determination, establishes the
				beginning of the three-month retroactive period.
7. There is no provision for retroactive
				coverage in the Qualified Medicare beneficiary (QMB) program. QMB eligibility
				begins the month following the month of authorization. It is not appropriate to
				place a QMB-only approval into an SLMB or Ql-1 category of eligibility to
				provide retroactive payment of Part B premiums for the retro period.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 7 - Combination Modified Adjusted Gross Income (MAGI) and Aged, Blind, Disabled (ABD) Applications › Rule 23-101-7.5 - Deceased Applicants

Current through June 25, 2024
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.
42 CFR §435.914(a)
				  (Rev. 1986).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 8 - Eligibility Dates › Rule 23-101-8.1 - Beginning Dates of Medicaid Eligibility

Current through June 25, 2024
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 factors are met.
B. The first (1st) day of the month after the
				month of application in which all eligibility factors are met.
C. The first (1st) day of the first (1 
				st), second (2 
				nd) or third (3 
				rd) month prior to the month of
				application when conditions are met for retroactive Medicaid.
D. The first (1st) day of the month following
				the month of approval for a Qualified Medicare Beneficiary (QMB).
E. The Hospital Presumptive Eligibility (HPE)
				beginning date of eligibility defined as the date the HPE application is
				approved by authorized hospital staff.
42 C.F.R. §§
											435.914,
				  435.915,
				  435.1110.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 8 - Eligibility Dates › Rule 23-101-8.2 - Beginning Dates of the Children's Health Insurance Program (CHIP) Eligibility

Current through June 25, 2024
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. The start date for a CHIP-eligible newborn
				is the date of birth of the newborn if the application for the newborn is filed
				within thirty-one (31) days of birth with the thirty-one (31) day count
				beginning the day following the date of birth.
42 C.F.R. §
											457.340(g).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 8 - Eligibility Dates › Rule 23-101-8.3 - Terminations Dates

Current through June 25, 2024
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 date the beneficiary
				entered a public institution.
D.
				The last day of the month of the Hospital Presumptive Eligibility (HPE) period
				or the day of the month that the full application for Medicaid is
				denied.
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 8 - Eligibility Dates › Rule 23-101-8.4 - Retroactive Medicaid Eligibility

Current through June 25, 2024
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 Applicant is informed of
				the availability of retroactive Medicaid coverage.
2. The applicant's statement is accepted
				regarding medical expenses incurred in the retroactive period.
3. Retroactive Medicaid may also be available
				to an individual who is added to a case such as a child who returns home.
4. The applicant does not have to
				be eligible in the month of the application or even the current month to be
				eligible for one (1) or more months of retroactive Medicaid.
5. The applicant or beneficiary may ask for
				retroactive Medicaid coverage at any time.
6. The date of application, rather than the
				date of the eligibility determination, establishes the beginning of the three
				(3) month retroactive period.
7.
				There is no provision for retroactive coverage in the Qualified Medicare
				Beneficiary (QMB) program. QMB eligibility begins the month following the month
				of authorization. QMBs cannot be placed into a Specified Low-Income Medicare
				Beneficiary (SLMB) or Qualified Individual (QI)-1 category of eligibility to
				provide retroactive payment of Medicare Part B premiums for the retro period.
8. Hospital Presumptive
				Eligibility (HPE) has no retroactive coverage.
a) If a full application for Medicaid is
				filed and approved, retroactive Medicaid is available for up to three (3)
				months prior to the month the full Medicaid application is filed.
b) Any partial month of eligibility granted
				under HPE is changed to a full month of eligibility, provided the full
				application is timely filed.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 8 - Eligibility Dates › Rule 23-101-8.5 - Deceased Applicants

Current through June 25, 2024
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 to
				  the month of application or any month(s) in the three (3) month period if the
				  deceased person is found to be eligible.
42 C.F.R. § 435.
				  915.