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 23-101-9.2 - Regular Redeterminations

Current through June 25, 2024
A. Federal
				regulations require that the eligibility of every Medicaid and CHIP recipient
				be reviewed at least every twelve (12) months.
B. Mississippi state law also requires annual
				reviews.
C. During the regular
				redetermination process, the recipients circumstances are reviewed and each
				eligibility factor subject to change, such as income and/or resources is
				re-evaluated. Recipients 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. As required by the ACA, a renewal of eligibility must be
				processed without requiring information from the recipient if the agency is
				able to do so based on reliable information contained in the recipients case
				record and other more current information available to the agency, such as data
				secured from data matches with other state, federal and commercial databases.
				If a recipients eligibility can be renewed based on available information, the
				recipient will be notified of the approval and the basis for the approval. It
				is then the recipients responsibility to inform the agency, through any of the
				modes permitted for submission of applications, 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. If the agency cannot
				renew eligibility based on information available to the agency from electronic
				data matches, the agency must issue a pre-populated renewal form to the
				recipient displaying the information that is available to the agency. The
				recipient has 30 (thirty) days from the date the renewal form is issued to
				respond and provide any necessary information that is needed to renew
				eligibility, which includes returning the signed renewal form. The signed form
				and any paper verifications may be returned to the agency through any of the
				modes permitted for submission of applications.
E. If the recipient is determined no longer
				eligible at the time of the annual redetermination of eligibility, it is
				required that the specialist review the information in the case record for
				possible eligibility under any other available coverage within Medicaid, CHIP
				(if appropriate) and potential eligibility for advance payments of premium tax
				credits and cost-sharing reductions through the health insurance marketplace.
				Eligibility will not be terminated by the Division of Medicaid until after the
				prepopulated review form is issued and the recipient is allowed the opportunity
				to respond to the information.
F.
				If a renewal form is not returned within the 30 (thirty) days allowed for
				responding to a renewal but the recipient subsequently submits the renewal form
				and any necessary information needed to renew eligibility within 90 (ninety)
				days after the case is terminated, the case will be reinstated without
				requiring a new application.
42 CFR§435.916
				  (Rev. 1986). Miss. Code Ann. 43-13-115.