reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.7 - Verification of a Marital Relationship - ABD Programs

Current through June 25, 2024
A.
				A marital relationship is presumed for an ABD couple unless the client states
				otherwise and provides the types of evidence listed above which indicate the
				relationship does not exist or has terminated.
42 CFR
				  §435.601(a); 42 CFR §435.601(b) (Rev.
				  1993).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.8 - Changes in Marital Status - ABD Programs

Current through June 25, 2024
A. A man and woman
				are married for a month if they meet any of the criteria for a marital
				relationship within the month.
B.
				When a change occurs and an individual marries, resumes living with a spouse,
				enters a "holding out" relationship, etc., use couple budgeting beginning the
				month of the marriage.
1. An increase in
				benefits can be effective immediately if policy otherwise allows it.
2. Adverse action rules apply when
				ineligibility or a decrease in benefits results for a recipient. Termination of
				marriage is effective the month after the month of a death, divorce, annulment
				or separation.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.9 - Marital Relationships - FCC Programs

Current through June 25, 2024
A. A marital
				relationship is one in which members of the opposite sex are:
1. Married under State law;
2. Married under common law prior to April 1,
				1956 as recognized by MS.
3.
				Couples in "holding out" situations are unrelated individuals for FCC
				purposes.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.10 - Termination of a Martial Relationship - FCC Programs

Current through June 25, 2024
A.
				The marital relationship no longer exists for FCC purposes as of the date that:
1. Either individual dies;
2. A final decree of divorce or annulment is
				issued for the marriage;
a) If a divorced
				couple resumes living together, the adults are unrelated.
3. The married couple begins living in
				separate households.
a) A legally married man
				and woman who resume living together after having lived apart are treated as a
				married couple, regardless of the reason for having resumed living
				together.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.11 - Changes in Marital Relationship Applications, FCC Programs

Current through June 25, 2024
A. Marriage or termination of marriage,
				including separation, is effective the month the event occurs.
B. In application situations, individuals
				must be in the home at least one day of the month to be included in that
				month.
42 CFR § 435. 603
				  (Rev. 2012).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.12 - Changes in Marital Relationship- Active Cases, FCC Programs

Current through June 25, 2024
A. A change in marital staus must reported by
				adult recipients eligible in the Medical Assistance Program.
B. When an adult becomes ineligible due to a
				change in maritable staus, eligibility is terminated after allowing ten (10)
				day (plus two (2) days mailing time) notice of the adverse action.
C. Any changes resulting for the children
				will be handled at review.
42 CFR
				  §435.601(a); 42 CFR §435.601(b) (Rev.
				  1993).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.13 - Definition of a Child - ABD Programs

Current through June 25, 2024
A. In the ABD
				programs, a child is defined as someone who is:
1. Neither married nor head of a household;
				and
2. Either under age eighteen
				(18); or
3. Under age twenty-two
				(22) and a student regularly attending school or college or training that is
				designed to prepare him for a paying job.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.14 - Termination of Child Status - ABD Programs

Current through June 25, 2024
A. Status as a
				child ends:
1. Effective with the month the
				child becomes age eighteen (18) or age twenty-two (22), if a student,
				or
2. The month he last meets the
				definition of a child.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.15 - Student Status as an Eligibility Requirement - ABD Programs

Current through June 25, 2024
A. A child under age eighteen (18) who does
				not expect to earn over $65 in any month meets the definition of a child
				without regard to student status.
B. Student status must be explored whenever
				an applicant or recipient between the ages of eighteen (18) and twenty-two (22)
				alleges being a student.
1. An individual
				meets the definition of a child for purposes of allocation and budgeting if he
				is :
a) Under age twenty-two (22);
				and
b) Regularly attending school,
				college or training designed to prepare him for a paying job.
1) Regular attendance means the individual
				takes one or more courses of study and attends classes:
(a) In a college or university for at least
				eight (8) hours a week under a semester or quarter system;
(b) In grades seven to twelve (712) for at
				least twelve (12) hours a week; or
(c) In a course of training to prepare him
				for a paying job for at least fifteen (15) hours a week if the course involves
				shop practice or twelve (12) hours a week if it does not involve shop
				practice.
(d) This kind of training
				includes antipoverty programs, such as Job Corps and government-supported
				courses in self-improvement.
2) Attendance may be less than the time
				indicated above for reasons beyond the student's control, such as illness, if
				the circumstances justify the reduced credit load or attendance.
(a) Example of school attendance less than
				required hours: A paraplegic is forced to limit vocational school attendance to
				one (1) day a week due to the unavailability of transportation. Although the
				student is enrolled for attendance of less than twelve (12) hours a week, he
				qualifies as regularly attending school because lack of transportation is a
				circumstance beyond his control.
3) Student status is also granted to
				homebound students who have to stay home due to a disability.
4) Student status is granted if the child
				studies courses given by a school (grades seven to twelve (712), college,
				university or government agency and a home visitor or tutor directs the study
				or training.
5) A child remains a
				student when classes end if he attends classes regularly prior to school
				vacation and intends to return when school reopens.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.16 - Definition of a Child - FCC Programs

Current through June 25, 2024
A. To be
				categorically eligible as a child in the FCC programs, the individual must be
				under the age of nineteen (19).
B.
				Age is verified, primarily through electronic sources.
C. An individual's status as a child ends
				effective the month after he turns age nineteen (19).
42 CFR §435.603
				  (Rev. 2012).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.17 - Emancipated Children - FCC Programs

Current through June 25, 2024
A. Most children
				are dependents of their parents or have another adult caretaker. However, some
				children may be emancipated. An emancipated minor is authorized to act on his
				own behalf. Though not a dependent child, the emancipated minor under age
				nineteen (19) is a categorically eligible child for FCC programs.
B. Emancipation may occur by court-ordered
				emancipation, marriage or living independently; however, how an emancipated
				child under age 19 is treated for Medicaid or CHIP purposes depends on the
				living arrangement of the child, the child's tax dependent or tax filer status
				and/or whether the child must be treated as an exception to tax filer rules or
				under non-filer rules, as described in budgeting rules.
42 CFR § 435. 603
				  (Rev. 2012).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.18 - Minor Parents - FCC Programs

Current through June 25, 2024
A. An unmarried
				parent under age nineteen (19) who resides in the home with his children and
				his parents (the children's grandparents) has his own eligibility determined
				using tax filer or exception rules applies; however, the minor's children are
				included in the household composition with the minor parent as children cannot
				be separated from their parent(s) if living together.
B. The minor's children are dependent
				children of the minor parent for determining their eligibility.
42 CFR § 435. 603
				  (Rev. 2012).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.19 - Minor Heads of Household - FCC Programs

Current through June 25, 2024
A. There are
				instances in which it is permissible for a child to be the head of household.
1. Children living independently, including
				those in group homes, orphanages and other situations in which parents have
				relinquished or abandoned custody, often have individuals filing on their
				behalf, such as a social worker, administrator or foster parent.
2. However, it is also permissible for the
				child to file the application when he is capable of doing so.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.20 - Utilization of Other Benefits- General

Current through June 25, 2024
A. As a condition
				of eligibility, an ABD or FCC applicant or recipient must take all necessary
				steps to obtain all benefits to which they are entitled when the benefit(s) is
				one of the following types:
1.
				Medicare;
2. Unemployment
				Benefits;
3. Worker's Compensation
				Benefit;
4. Social Security
				Retirement, Survivors and Disability Insurance Benefits, Including Early
				Retirement at Age Sixty-Two (62);
5. Retirement or Disability Benefits
				Including Veterans' Pensions And Compensation except VA Aid and Attendance is
				not a required benefit under this provision.
6. Annuity Or Pension Such As Private
				Employer Pensions, Civil Service Pensions, Union Pensions, Railroad Retirement
				Annuities and Pensions, Municipal, County, or State Retirement Benefits.
a) Explore entitlement for private sector
				benefits if the client or former/deceased spouse worked for a private sector
				employer with a pension plan and if not already receiving or has not received a
				pension based on that employment.
a) Explore entitlement for benefits if the
				client or former/deceased spouse (or deceased parent if the client is a child)
				is not already receiving or has not received a pension based on such employment
				and was employed by the one of the following:
1) Federal Civilian Employment for a minimum
				of five (5) years;
2) Federal
				Uniformed Service (Military) for a minimum of twenty (20) years; or
3) State or Local Government
				employment.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.21 - Benefits Exempt from Utilization Provision

Current through June 25, 2024
A. The client
				is not required to apply for the following types of benefits:
1. Temporary Assistance for Needy Families
				(TANF)
2. General Public
				Assistance, including SSI
3. Bureau
				of Indian Affairs General Assistance
4. Victim's Compensation payments
5. Other Federal, state, local or private
				programs with payments based on need
6. Earned Income Tax Credits
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.22 - Individuals Exempt from Utilization Provision

Current through June 25, 2024
A. This
				provision applies only to eligible individuals (applicants or
				recipients).
B. It does not apply
				to non-applicants or ineligibles.
1. This
				includes the ineligible spouse or community spouse in ABD and non-applicant or
				ineligible parents or caretaker relatives of children.
2. However, the responsible adult is required
				to file on behalf of children potentially eligible for other benefits as a
				condition of the child's eligibility.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.23 - Exception to the Utilization Provision

Current through June 25, 2024
A. An individual is
				not required to accept another benefit if the resulting payment would be a
				reduction in current benefits payable to the individual.
B. This does not include a reduction in
				Medicaid benefits.
42 CFR §435.608
				  (Rev. 1993).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.24 - Good Cause for Not Complying with Utilization Provision

Current through June 25, 2024
A.
				The agency must require clients to take all steps necessary to apply for other
				benefits to which they are entitled, unless good cause can be shown for not
				doing so.
B. A denial or dismissal
				of a claim for other benefits due to failure to submit required verification
				does not satisfy this requirement.
C. Good cause for not applying for other
				benefits may be found to exist if the individual does not apply due to:
1. Illness and there is no authorized
				representative to apply on the client's behalf; or
2. The individual previously applied and was
				denied and the reason for thedenial has not changed; or
3. The individual was unaware of the
				availability of a benefit and the agency did not advise him of its
				availability.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.25 - Applying the Utilization Provision

Current through June 25, 2024
A. The utilization
				of other benefits provision is applicable at the time of application and for
				the duration of eligibility.
B. The
				individual potentially eligible for the types of benefits listed above or the
				responsible person, if the client is a child, must take steps to apply for the
				benefits.
C. If eligible, the
				individual must accept the payment regardless of the impact the additional
				income will have on Medicaid eligibility.
42 CFR §435.608
				  (Rev. 1993).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.26 - Notification Requirements for Utilization Provision

Current through June 25, 2024
A.
				The client must be furnished with written request notice explaining the
				responsibility to apply for the potential benefit within thirty (30) days of
				the notice for ABD and within fifteen (15) days of the notice for
				FCC.
B. A Request for Information
				will be used to inform the individual of the following:
1. The type of benefit the client appears to
				be eligible for;
2. The agency or
				organization where an application should be filed;
3. That the client has thirty (30) days (or
				fifteen (15) for FCC) from the date of the notice in which to file an
				application for the potential benefit; and
4. Proof that that application has been filed
				must be provided to the Regional Office within the thirty (30) day (or fifteen
				(15) day) timeframe.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.27 - Agreement to Comply with Utilization Provision

Current through June 25, 2024
A. An agreement
				to comply does not negate any prior action to deny or terminate
				benefits.
B. The effective month of
				eligibility is the month in which the individual takes the steps necessary to
				obtain benefits from the other agency.
42 CFR §435.608
				  (Rev. 1993).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.28 - Other Issues Related to Utilization Provision

Current through June 25, 2024
A. A client may
				be eligible for more than one type of benefit. All potential sources of
				benefits must be identified.
B. The
				election of a lower benefit when the individual has an option between a high
				and low benefit will result in denial or loss of eligibility.
C. When a client has a choice regarding
				payment as a lump sum or an annuity, the annuity must be selected.
1. A one (1) time total withdrawal of pension
				plan funds in this situation does not comply with the statutory requirements
				that mandate application for the annuity or pension, i.e., money payment at
				some regular interval.
2. Recommend
				conversion of lump-sum applications in appropriate situations to focus on
				maximizing the use of the other benefits to provide ongoing support.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.29 - Failure to Comply without Good Cause - ABD Programs

Current through June 25, 2024
A.
				If the ABD individual has failed without good cause to take all steps to obtain
				the other benefits, action to deny or terminate benefits until the requirement
				is fulfilled must be taken.
B. An
				agreement to comply does not negate any prior action to deny or terminate
				benefits.
C. The effective month of
				eligibility is the month in which the individual takes the steps necessary to
				obtain benefits from the other agency or provides proof of ineligibility for
				the benefit.
42 CFR §435.608
				  (Rev. 1993).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.30 - Failure to Comply Without Good Cause - FCC Programs

Current through June 25, 2024
A.
				When the application for other benefits has not been filed and good cause does
				not exist, the FCC adult or child who was potentially eligible for the other
				benefits cannot be approved for Medicaid.
B. However, any other eligible children
				included in the application can be placed in an appropriate program.
42 CFR §435.608
				  (Rev. 1993).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.31 - Assignment of Third Party Rights- FCC Programs

Current through June 25, 2024
A. Federal law
				requires that all Medicaid applicants and recipients must, as a condition of
				eligibility, cooperate with the Medicaid Agency in identifying, to the extent
				they are able, potentially liable insurers and other third parties who may be
				liable to pay for care and services covered by Medicaid.
B. Cooperation includes repaying any monies
				to the Medicaid Agency received from a third party source to the extent that
				Medicaid has paid for the covered service.
C. By accepting Medicaid each
				applicant/recipient is deemed to have made an assignment to the Medicaid
				Program of his rights to medical support or any third party benefits, including
				hospitalization, accident, medical or health benefits owed to the individual,
				as well as rights to such benefits owed by any third party to the children or
				any other person for whom the applicant/recipient has legal authority to
				execute such an assignment.
1. The
				individual's signature on the application form at initial application and each
				redetermination of eligibility acknowledges the automatic assignment of all
				third party rights.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.32 - Failure to Cooperate With Third Party Assignment - FCC Programs

Current through June 25, 2024
A. The Third Party Liability (TPL) Unit has
				the responsibility for determining if an individual has failed, without good
				cause, to cooperate with assignment of third party rights.
B. If the TPL Unit determines there was good
				cause for failure to cooperate, the individual will be exempted from the
				cooperation requirement.
C. A
				determination of failure to assign rights or lack of cooperation in obtaining
				third party payments, without good cause, will result in denial or termination
				of Medicaid benefits after affording the right to appeal.
D. If the TPL Unit determines an individual
				has failed, without good cause, to cooperate with third party assignment,
				action may be taken to deny or terminate eligibility with advance notice and
				state appeal rights.
Miss. Code Ann.
				  43-13-121 (Rev. 2005)
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.33 - CHIP and Other Insurance Coverage - FCC Programs

Current through June 25, 2024
A.
				There is no requirement for assignment of third party rights in the Children's
				Health Insurance Program because the program is for uninsured children
				only.
B. Children who are covered
				by creditable third party insurance at application are not eligible for CHIP.
				This is true regardless of who pay the health insurance premiums.
C. Creditable insurance coverage is full
				health insurance. Children covered only by the following types of insurance may
				qualify for CHIP: accident insurance, disability income insurance, liability
				insurance, supplemental policies for liability insurance, worker's
				compensation, automobile medical payment insurance, credit-only insurance,
				coverage for onsite medical clinics or limited-scope dental or vision or long
				term care insurance.
D. Termination
				of creditable coverage must be verified when the application indicates
				insurance coverage will terminate within the thirty (30) day application
				processing period or terminated within the six months prior to the
				application.
E. As indicated above,
				a child covered by insurance at the time of application is not eligible;
				however, when insurance coverage will terminate within the thirty (30) day
				application processing period, an otherwise CHIP-eligible child is not
				denied.
F. If all other factors of
				eligibility will be met, the the application will be held and action taken to
				approve the child after the insurance coverage has ended.
45 CFR.
				  §457.310(a) (Rev. 2006). Miss. Code Ann. §
										43-13-121
				  (rev. 2005).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.34 - Child Support Requirements in General

Current through June 25, 2024
A. State child
				support (IV-D) agencies are required to provide all appropriate child support
				services available under IV-D of the Social Security Act to families with an
				absent parent who receive Medicaid benefits and who have assigned rights for
				medical support to the State.
B.
				State IV-D agencies are required to petition for medical support when health
				insurance is available to the absent parent at a reasonable cost. In order for
				the IV-D agency to provide the services required by law, the Division of
				Medicaid must refer the following children to the Mississippi Department of
				Human Services (MDHS), Child Support Enforcement Office:
1. Disabled children in an ABD program with
				an absent parent; and
2. Children
				in the Medical Assistance Program (85) with an absent parent.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.35 - Child Support Requirements for Medical Assistance Program

Current through June 25, 2024
A.
				Referral to and cooperation with child support is required as a condition of
				the adult's eligibility if the deprivation reason for at least one child is
				continued absence.
B. The parent or
				caretaker relative must cooperate with child support requirements and assist
				the state by cooperating with enforcement of existing court orders or in
				obtaining at least medical support from the absent parent.
C. A referral to the IV-D agency is made
				whether or not there is an existing court order and regardless of whether child
				support is being paid by the absent parent.
History: Revised to correspond with the ACA (eff. 01/01/2014)
				  eff. 04/01/2014.
45 CFR. §233.90
				  (Rev. 1994). Miss. Code Ann. §
										43-13-121
				  (Rev. 2005).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 6 - General Eligibility Requirements › Rule 23-102-6.36 - Non-Cooperation and Good Cause Determinations - FCC Programs

Current through June 25, 2024
A.
				At time of application, if the 85 parent or caretaker relative refuses to
				cooperate with child support, the adult's Medicaid eligibility will be
				denied.
B. After a referral to the
				IV-D agency, satisfactory cooperation, good cause for failure to cooperate and
				satisfactory cooperation after a period of non-compliance are determined by the
				IV-D agency.
1. If a non-compliance decision
				is received from the IV-D agency, the 85 adult's eligibility will be terminated
				allowing adverse action notice.
2.
				The sanction can only be removed when the adult has complied fully with child
				support requirements as required by the IV-D agency.
3. The requirement to cooperate as a
				condition of eligibility impacts the eligibility of an adult only. The
				eligibility of a child is not impacted.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 7 - Non-Financial Requirements - ABD Programs › Rule 23-102-7.1 - Definition of Adult Disability

Current through June 25, 2024
A. The law defines
				disability as the inability to do any substantial gainful activity by reason of
				any medically determinable physical or mental impairment which can be expected
				to result in death or which has lasted or can be expected to last for a
				continuous period of not less than twelve (12) months.
1. This means the adult is unable to do his
				previous work or any other substantial gainful activity which exists in the
				national economy.
2. The adult's
				residual functional capacity, age, education and work experience are considered
				in the disability determination process.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 7 - Non-Financial Requirements - ABD Programs › Rule 23-102-7.2 - Definition of Childhood Disability

Current through June 25, 2024
A. An individual
				under the age of eighteen (18) is considered disabled under the SSI program if
				that child has a medically determinable physical or mental disability, which
				results in marked and severe functional limitation, and which can be expected
				to result in death or which has lasted or can be expected to last for a
				continuous period of at least twelve (12) months.
1. No individual under the age of eighteen
				(18) who engages in substantial gainful activity may be considered
				disabled.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 7 - Non-Financial Requirements - ABD Programs › Rule 23-102-7.3 - Definition of Blindness

Current through June 25, 2024
A. Statutory
				blindness is central visual acuity of 20/200 or less in the better eye with the
				use of a correcting lens. An eye which has a limitation in the field of vision
				so that the widest diameter of the visual field subtends an angle no greater
				than 20 degrees is considered to have a central visual acuity of 20/200 or
				less.
1. An individual's ability to work will
				not affect eligibility based on blindness.
2. Throughout the remainder of this section,
				the term "disability" also refers to blindness.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 7 - Non-Financial Requirements - ABD Programs › Rule 23-102-7.4 - Disability Determination Process

Current through June 25, 2024
A. In Mississippi,
				an application for SSI is also an application for Medicaid.
1. This does not mean a separate Medicaid
				application cannot be filed by an SSI applicant; however, the Medicaid agency
				is not required to obtain a separate Medicaid disability determination for any
				months of potential SSI eligibility, starting on the effective filing date of
				the SSI application.
a) The applicant is
				required to wait until SSA makes the SSI eligibility determination.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 7 - Non-Financial Requirements - ABD Programs › Rule 23-102-7.5 - Independent Disability Determinations

Current through June 25, 2024
A. An independent
				disability determination when a separate Medicaid application has been filed
				under one of the following circumstances:
1.
				The individual has not applied for SSI or has applied and been denied for a
				reason other than disability;
2. An
				individual applies separately for both SSI and Medicaid and SSI fails to make a
				decision within ninety (90) days.
a) In this
				instance, DDS must provide Medicaid with a decision prior to the SSI
				decision.
3. An
				individual applies for Medicaid and alleges a disabling condition that is
				different from, or in addition to, that considered by SSA.
4. An individual meets all three (3) of the
				criteria below:
a) Applies for Medicaid more
				than twelve (12) months after SSA last made a final determination that the
				individual was not disabled; and
b)
				The individual alleges his condition has deteriorated since that final
				decision; and
c) The individual has
				not reapplied for SSI.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 7 - Non-Financial Requirements - ABD Programs › Rule 23-102-7.6 - Exceptions to Obtaining Disability Approvals

Current through June 25, 2024
A. There may be
				instances when DDS has already determined disability using SSI criteria for the
				same period of time to be covered by a Medicaid application. If so, a separate
				Medicaid determination is not needed.
B. However, if the disability onset date, as
				established by SSA, does not include all months of requested Medicaid
				eligibility, a separate DDS decision is required.
Miss. Code Ann. §
				  43-13-121.1 (Rev. 2005).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 7 - Non-Financial Requirements - ABD Programs › Rule 23-102-7.7 - Situations Not Requiring a Separate DDS Decision

Current through June 25, 2024
A. In the
				following situations a separate blindness/disability determination for Medicaid
				is not needed. The applicant/beneficiary is considered to be blind/disabled:
1. Applicant Receives Title II Disability;
a) The Medicaid applicant receives Title II
				disability benefits on an ongoing basis based on his own disability and the
				disability onset date is verified to include all months to be covered by the
				Medicaid application, i.e. the month of application and any retroactive months.
				Receipt of Title II disability must be re-verified at each
				redetermination.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 7 - Non-Financial Requirements - ABD Programs › Rule 23-102-7.8 - Separate Disability Decisions

Current through June 25, 2024
A. If there is no
				indication that any of the above exceptions apply, a separate disability
				decision must be obtained from Disability Determination Services when an
				applicant applies for Medicaid on the basis of disability or
				blindness.
Miss. Code Ann. §
				  43-13-121.1 (Rev. 2005).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 7 - Non-Financial Requirements - ABD Programs › Rule 23-102-7.9 - Temporary SSI Closures

Current through June 25, 2024
A. Some cases that
				are SSI-eligible terminate once per quarter and are reinstated by SSI after one
				or two (2) months of ineligibility.
B. The usual cause of the temporary SSI
				closure is earned income in a five (5) week month.
C. The individual whose SSI is temporarily
				terminated can apply for Medicaid coverage during the missing SSI months by
				filing an application with the regional office.
Miss. Code Ann. §
				  43-13-121.1 (Rev. 2005).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 7 - Non-Financial Requirements - ABD Programs › Rule 23-102-7.10 - Estate Recovery Requirements

Current through June 25, 2024
A. The Division of
				Medicaid is required to seek recovery of payments for nursing facility services
				and Home and Community-Based Services (HCBS) as well as related hospital and
				prescription drug services from the estates of deceased Medicaid recipients who
				were fifty-five (55) or older when Medicaid benefits were received.
B. The estate recovery provision applies to
				all Medicaid recipients in a nursing facility as of July 1, 1994, and all
				Medicaid recipients who entered the Home and Community-Based Waiver (HCBS)
				Program on or after July 1, 2001, who:
1. Are
				age fifty-five (55) or older at time of death;
2. Own real or personal property at time of
				death that can be considered an estate.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 7 - Non-Financial Requirements - ABD Programs › Rule 23-102-7.11 - Estate Property

Current through June 25, 2024
A. Estate property
				includes any real or personal property owned by the recipient in its entirety
				or by shared ownership.
1. Ownership of life
				estate interests or ownership of property that has been transferred into a
				trust is not subject to estate recovery.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 7 - Non-Financial Requirements - ABD Programs › Rule 23-102-7.12 - Exceptions to the Estate Recovery Provision

Current through June 25, 2024
A. Estate recovery
				rules to not apply to a deceased recipient if at the time of death the
				recipient has:
1. A legal surviving spouse,
				or
2. A surviving dependent child
				under the age of twenty-one (21); or
3. A dependent blind or disabled child of any
				age.
a) The blind or disabled individual must
				be dependent on the Medicaid recipient for home or income, such as a disabled
				child drawing benefits from the parent's record.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 7 - Non-Financial Requirements - ABD Programs › Rule 23-102-7.13 - Assets and Resources Exempt from Estate Recovery

Current through June 25, 2024
A. The
				following assets and resources of American Indians and Alaska natives are
				exempt from estate recovery:
1. Interest in
				and income derived from Tribal land and other resources currently held in trust
				Status and Judgment funds from the Indian Claims commission and the U. S.
				claims court;
2. Ownership interest
				in trust or non-trust property, including real property and I improvements
				located on a reservation.
3.
				Reservation payments to special populations.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 8 - Non-Financial Requirements - FCC Programs › Rule 23-102-8.1 - Deprivation

Current through June 25, 2024
A. Deprivation is an eligibility factor for
				dependent children under age eighteen (18). Deprivation must exist within the
				household in order for the parent(s) or caretaker relative to obtain
				eligibility. The child's eligibility is not tied to deprivation but there must
				be a dependent child under the age of eighteen (18) in the home in order for
				the adult to qualify for coverage.
B. A condition of deprivation is not
				applicable in any other Medicaid programs or CHIP.
C. The deprivation factor means a dependent
				child is deprived of the support of one or both of their parents for one of the
				following reasons:
1. Death;
2. Continued absence from the home;
3. Physical or mental incapacity (two (2)
				parent families only); and
4.
				Unemployment or Underemployment (two (2) parent families only).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 8 - Non-Financial Requirements - FCC Programs › Rule 23-102-8.2 - Legally Responsible Parents

Current through June 25, 2024
A. The following
				are legally responsible parents:
1. The
				child's biological, adoptive or step mother;
2. The child's biological, adoptive or step
				father;
3. The adoptive parent who
				has been legally granted a final decree of adoption.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 8 - Non-Financial Requirements - FCC Programs › Rule 23-102-8.3 - Legal Father

Current through June 25, 2024
A. For the
				deprivation determination, a child's legal father is one of the following:
1. A man whose name appears on the child's
				birth certificate unless a court has determined otherwise;
2. A man who has been declared to be the
				child's father by a court order;
3.
				A man who has acknowledged paternity of the child in an Admission of Paternity
				if there is no legal father either on the birth certificate or in a court
				order;
4. A man who married the
				child's mother subsequent to the birth and publicly acknowledges that he is the
				father of the child when there is no legal father listed on the child's birth
				certificate and a paternity order has not been issued establishing a different
				person as the father.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 8 - Non-Financial Requirements - FCC Programs › Rule 23-102-8.4 - Continued Absence

Current through June 25, 2024
A. Continued
				absence exists when a parent does not live in the home with the child as the
				result of divorce, legal separation, desertion, incarceration, long term
				hospitalization, institutional care, court-ordered removal of the child from
				the home or because paternity has not been established.
B. Deprivation is also established if the
				parent is convicted of an offense and sentenced to perform unpaid public work
				or community service during working hours and is allowed by the court to live
				at home.
C. However, deprivation
				does not exist when a parent lives at an address separate and apart from the
				child, and:
1. The parent is out of the home
				solely to seek or accept employment or
2. The parent is out of the home solely due
				to active duty in the uniformed service of the United States.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 8 - Non-Financial Requirements - FCC Programs › Rule 23-102-8.5 - Incapacity

Current through June 25, 2024
A. A child who lives with biological, legal
				or adoptive parents is deprived of parental support or care if one (1) or both
				parents receive Social Security Disability or SSI.
42 CFR
				  §435.601(a); 42 CFR §435.601(b) (Rev.
				  1993).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 8 - Non-Financial Requirements - FCC Programs › Rule 23-102-8.6 - Under/Unemployment

Current through June 25, 2024
A. A child who lives with both of his parents
				is deprived of parental support or care if the combined family income is equal
				to or below the program gross and net income limits for the appropriate family
				size.
42 CFR
				  §§435.601(a) and (b) (Rev. 1993).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 8 - Non-Financial Requirements - FCC Programs › Rule 23-102-8.7 - Temporary Absence from the Home

Current through June 25, 2024
A. The temporary
				absence of the parent, other adult caretaker or the child from the home does
				not affect the eligibility determination, provided the absent member does not
				establish a home elsewhere and the reasons for the absence is
				temporary.
B. In addition, the
				adult must retain legal responsibility for the child during the absence. The
				case must be documented with the reason for separation, the approximate
				duration and plan for the child or adult to return to the home.
C. The following situations are considered
				temporary absences:
1. Either the adult or
				child is temporarily out of the home receiving care or treatment in a medical
				facility, such as a hospital, a maternity home or drug treatment
				facility;.
2. Either the adult or
				child is out of the home for a visit;
a)
				Example: A child spending a summer vacation with his non-custodial parent, who
				lives in MS or out-of-state;
3. Either the adult or child is out of the
				home to attend school or training;
a) Example:
				The child is in Job Corps or the parent is attending college;
4. The adult works away from home
				and retains responsibility for the child, even though day-to-day care is
				delegated to someone else;
5. The
				child is in a juvenile facility that is not a state institution and the
				qualified relative retains legal responsibility for the child even though the
				facility has physical custody;
6.
				The child is in a Psychiatric Residential Treatment Facility (PRTF);
7. Absence of parent(s) due to fulfilling a
				military obligation;
a) A legal parent who is
				away from home on military duty is considered part of the budget group unless
				there is abandonment of the family. Benefits will not authorized for the person
				away on military duty.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 8 - Non-Financial Requirements - FCC Programs › Rule 23-102-8.8 - Relationship

Current through June 25, 2024
A. The responsible adult may be a relative or
				a non-relative for children eligible under a federal poverty level and
				CHIP.
B. To meet the requirement of
				relationship as a parent or caretaker relative, a child must live in the home
				with a biological, adopted or step parent or one of the following relatives
				within the specified degree of relationship:
1. Grandfather or grandmother (extends to
				great, great-great and great-great- great);
a)
				A grandparent-in-law is within the required degree;
b) The relationship of grandparent-in-law
				occurs when one of the child's grandparents remarries;
c) For instance, if the child's paternal
				grandmother dies and his paternal grandfather marries again, this second wife
				of the child's grandfather becomes the child's grandmother-in-law;
d) A step-grandparent is not within the
				degree of relationship;
(1) A step-grandparent
				is the parent of a child's stepmother or stepfather;
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 9 - Residents of an Institution › Rule 23-102-9.1 - Residents of an Institution

Current through June 25, 2024
A. Residence in an
				institution can affect an applicant's or recipient's eligibility for any
				Medicaid program and for CHIP.
B.
				An individual is not eligible when:
1. The
				individual is an inmate; and
2. The
				facility in which the individual is residing is a public institution.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 9 - Residents of an Institution › Rule 23-102-9.2 - Age and Institutionalization

Current through June 25, 2024
A. Individuals
				under age twenty-two (22) may receive Medicaid while in an institution for
				mental diseases if they are receiving psychiatric services.
B. Individual between the ages of twenty-two
				(22) and sixty-five (65) are not eligible to receive any Medicaid benefits
				while residing in an institution for mental diseases.
C. Individuals age sixty-five (65) or older
				may not receive Medicaid benefits while in an institution unless they reside in
				a long term care facility.
42 CFR §435.1010
				  (Rev. 2006).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 9 - Residents of an Institution › Rule 23-102-9.3 - Inmate Eligibility

Current through June 25, 2024
A. Inmate status is
				interrupted when an individual is admitted as an inpatient to a medical
				institution.
B. An inmate may be
				eligible for Medicaid only while an inpatient in a medical facility (hospital,
				nursing facility, juvenile psychiatric facility or intermediate care
				facility).
C. When determining
				inmate eligibility, all groups of Medicaid coverage are considered, including
				children, pregnant women and aged, blind or disabled.
D. Inmates must meet all non-financial and
				financial eligibility factors of the program for which they are being
				considered.
E. If an inmate does
				not meet citizenship requirements, but qualifies for Emergency Service, the
				inmate is eligible for emergency inpatient services only.
42 CFR §435.1009
				  (Rev. 2006).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 102 - Non-Financial Requirements › Chapter 9 - Residents of an Institution › Rule 23-102-9.4 - Institutions

Current through June 25, 2024
A. An institution is an establishment that
				provides food, shelter and some treatment or services to four or more person
				unrelated to the proprietor.
42 CFR §435.1010
				  (Rev. 2006).