23 Miss. Code. R. 101-9.2 - Regular Redeterminations

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.

Notes

23 Miss. Code. R. 101-9.2

42 CFR§435.916 (Rev. 1986). Miss. Code Ann. 43-13-115.