101.06.01 INTERVIEW DISCUSSION

In general, during an interview for ABD or MAGI-related applications, the specialist reviews: • Household composition and relationships to explain the individuals who are required to be included in the application and/or budgetary process and those who cannot be included. • The specific programs and services available to the applicant and/or family through the Division of Medicaid, such as non-emergency transportation for individuals eligible for full Medicaid. • Services offered by other agencies with referrals made, as appropriate. The following policy provisions are required for both ABD and MAGI interviews: Provision Required Discussion Points Filing an application The agency must allow individual(s) of the applicant’s choice to accompany and assist the applicant in the application or review process. Coverage groups Eligibility requirements for the coverage group(s) the applicant appears potentially eligible in must be explained. Coverage limited to one source Coverage is limited to only one source of eligibility. If the individual is eligible under another source, that source must terminate before ABD or MAGI-related eligibility begins. Purpose of application The use and purpose of the application, including that the applicant is agreeing to all the rights and responsibilities specified on the application by signing the form. Processing limits The applicable Standards of Promptness (SOP). Conditions of eligibility Discuss critical factors such as age or disability, providing a SSN, citizenship or alien status, assignment of rights, who is authorized to sign the application or act on behalf of the applicant and other factors as applicable as the application is completed or reviewed. QC reviews The Quality Control review process. Computer matching The use of Social Security Numbers in computer matching programs. Appeals Rights to a fair hearing for adverse actions, exceeding SOP, erroneous actions. Provision Required Discussion Points Covered services Available services such as the EPSDT program and the annual physical for adults. Verification of eligibility Verification requirements and methods to be used to establish eligibility, including the use of electronic databases, collateral contacts, and documentary verification. Reporting changes The change reporting requirements. Voter registration Voter registration opportunities. Managed care Enrollment in MississippiCAN for mandatory populations. The following explanations are specific to ABD institutional applications (LTC and HCBS) and must be addressed as applicable: Provision Required Discussion Points Estate Recovery Estate recovery as it applies to excluded resources, such as the home or income producing property. Provide copy of Estate Recovery Fact Sheet from DOM website. Income Trust If applicable, provide copy of LTC or HCBS Income Trust document and repayment requirements, either through payment of Medicaid Income or direct payment to DOM of overage or both. If payment is due for month of entry for LTC, explain option to delay Medicaid coverage to following month to avoid payment of amount that is above the institutional limit. Discuss setting up a separate bank account for funding HCBS & if applicable, LTC IT’s. Annuities If applicable, provide copy of ABD handout on annuities and discuss verification and annuity requirements, such as making DOM the beneficiary of the annuity if required. Transfer of Assets Discuss prohibition of transfer of assets within 5-year lookback period and as an ongoing prohibition. Provide the ABD Transfer of Assets handout to all institutional applications (LTC & HCBS). Asset Verification System (AVS) Explain the authorization for financial institutions to disclose financial account information is a condition of eligibility (AVS matching). Provision Required Discussion Points Spousal resource & income rules If applicable, discuss spousal impoverishment rules and provide a copy of the Spousal Resource and Income Rules handout. Discuss the 90- day period for transferring assets to the CS subject to the CS limit. Assets over the spousal limit are considered available to the IS. Discuss the spousal income allocation. PAS and 317 forms from NF For LTC applicants, explain the requirement for medical necessity of the NF placement and that forms submitted by the NF will document the level of care requirement. Post-eligibility For LTC applicants, discuss Medicaid Income requirements including income used in the Medicaid Income calculation (counting lump sum payments and averaging income that varies or is infrequent). Explain deductions such as the Personal Needs Allowance, CS and/or other family member deduction, and the allowance of non-covered medical expenses and the need to timely submit any out-of-pocket expenses. Determine if allowable pre-eligibility expenses need to be submitted. Miscellaneous Discuss any other provisions applicable to the case, such as: Medicare covered days, Substantial Home Equity disqualification period, the 30-consecutive day requirement and any other provisions as applicable. The following explanations are specific to ABD at-home cases: Provision Required Discussion Points Deeming of income & resources from a spouse If applicable, deeming of income and resources from an ineligible (non-applying) spouse to an eligible spouse is required, if living together. Higher couple need standards are then used to determine eligibility (couple FPL or FBR and couple resource limit). Deeming of income & resources from parent to child If applicable, deeming of income and resources from ineligible (non- applying) parent(s) to an eligible child or eligible children is required, if living together. The exception is deeming from a stepparent to a stepchild. The parent(s) income is subject to certain deductions (allocating to ineligible children, a living allowance, etc.) prior to deeming to the child or children. Resources of the parent(s) are also subject to a reduction before deeming. Asset Verification System (AVS) Explain the authorization for financial institutions to disclose financial account information is a condition of eligibility (AVS matching). If accounts cannot be verified electronically, the applicant must provide the needed verification. Verification of income & resources Explain that income & resources will be verified electronically to the extent possible. Income and resources that cannot be verified electronically must be verified through other means. Income and resources of the spouse or parent(s) must also be verified. Deductions from income Explain income deductions for at-home budgeting (student earned income deduction, impairment related work expense(s), excluded income) for at-home budgeting. The following explanations are specific to MAGI-related applications and must be addressed if the MAGI applicant requests assistance in completing the application: Provision Required Discussion Points Children’s eligibility All possibilities for Medicaid eligibility must be tested before considering CHIP eligibility. Children who qualify for Medicaid cannot be approved for CHIP. The income of a stepparent living in the home with applicant children must be considered toward the children’s eligibility. Parent or Caretaker Eligibility Child Support cooperation requirements and income of an applicant’s spouse must be considered toward the applicant’s eligibility, unless the spouse receives SSI. A spouse can qualify for Medicaid eligibility as a 2-parent household or caretaker/spouse household. Verifications Requested verifications must be provided for each person included in the budgeting process if the verification cannot be obtained through available data sources. Failure to provide information may result in individual or multiple denials, depending on the program or type of verification which is lacking. Income is verified electronically to the extent possible but if not possible, the head of household is responsible for securing the needed verifications. Non-applicants Verification of personal information, income and expenses is not needed for household members who are not included in the budgeting process. Non-countable assets Resources are not considered & non-taxable income is not counted.