Appeals regarding eligibility must be filed with the agency
through which the applicant/beneficiary first applied. Agencies include:
A. Mississippi Division of Medicaid,
1. The Mississippi Division of Medicaid is
responsible for making eligibility determinations for the following groups:
a) Families,
b) Children,
c) Pregnant Women, and
d) Aged, blind and disabled individuals who
do not qualify for Social Security Income.
2. If the Division of Medicaid determines
that an applicant is ineligible for Medicaid, and the applicant disagrees with
the decision, the applicant may request a local and/or state hearing by
contacting the Regional Office that made the decision or by contacting the
Division of Medicaid Central Office.
3. Hearing requests must be made within
thirty (30) days of the date of the letter providing notice of the adverse
action to deny, terminate or reduce Medicaid benefits. All adverse action
notices issued to applicants contain their appeal rights and explain how to
request a hearing.
B.
Social Security Agency (SSA),
The SSA is the Federal agency charged with the responsibility
of determining who is eligible for Supplemental Income (SSI). In Mississippi,
individuals who are eligible for SSI are automatically eligible for Medicaid.
Applicants who are denied SSI are also denied Medicaid.
Applicants/beneficiaries whose entitlement to SSI is terminated also lose
Medicaid eligibility. Appeals of SSI decisions must be made through the
SSA.
C. The Mississippi
Department of Child Protection Services (MDCPS).
1. The Mississippi Department of Child
Protection Services (MDCPS) is the State agency charged with the responsibility
of determining Medicaid eligibility for foster children in the custody of
MDCPS.
2. In the event MDCPS
denies, terminates or reduces the Medicaid benefits of a foster child, the
Division of Medicaid is the agency responsible for handling the appeals of such
adverse actions.
