23 Miss. Code. R. 101-6.1 - Making an Eligibility Decision

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.

Notes

23 Miss. Code. R. 101-6.1

42 C.F.R. § 435. 940 through § 435.960.

Amended 4/1/2018