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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 100 – General Provisions P a g e | 38

Effective Month: March 2019 • Client Error In situations involving client error, there is no proof that individual (applicant, recipient or his authorized representative) acted willfully and intentionally to obtain more benefits than those he was entitled to receive. Instead, the individual gave incomplete, incorrect or misleading information because he misunderstood, was unable to comprehend the relationship of the facts about his situation to eligibility requirements or there was other inadvertent failure on the individual’s part to supply the pertinent or complete facts affecting Medicaid or CHIP eligibility. The specialist must be alert to whether the individual understood that the information he gave or withheld had a bearing on his eligibility or the amount of his Medicaid Income. • Agency Error Agency errors occur in instances such as the following: o The specialist misapplies policy or fails to follow procedures which would have resulted in denial or closure if the correct action had been taken. o The specialist makes a mathematical error in the test for financial need; enters incorrect income or resource figures in the system, transposes figures or otherwise determines eligibility using incorrect income or resources when the correct information was available in the case record. o The redetermination is not completed timely, and the specialist subsequently finds information leading to ineligibility. In this instance all benefits received following the review due date are improper due to agency error. Had the review been completed timely, the case could have been closed to prevent improper benefits from being received.

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Page 38

Official source

MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 100 – General Provisions P a g e | 38

Effective Month: March 2019 • Client Error In situations involving client error, there is no proof that individual (applicant, recipient or his authorized representative) acted willfully and intentionally to obtain more benefits than those he was entitled to receive. Instead, the individual gave incomplete, incorrect or misleading information because he misunderstood, was unable to comprehend the relationship of the facts about his situation to eligibility requirements or there was other inadvertent failure on the individual’s part to supply the pertinent or complete facts affecting Medicaid or CHIP eligibility. The specialist must be alert to whether the individual understood that the information he gave or withheld had a bearing on his eligibility or the amount of his Medicaid Income. • Agency Error Agency errors occur in instances such as the following: o The specialist misapplies policy or fails to follow procedures which would have resulted in denial or closure if the correct action had been taken. o The specialist makes a mathematical error in the test for financial need; enters incorrect income or resource figures in the system, transposes figures or otherwise determines eligibility using incorrect income or resources when the correct information was available in the case record. o The redetermination is not completed timely, and the specialist subsequently finds information leading to ineligibility. In this instance all benefits received following the review due date are improper due to agency error. Had the review been completed timely, the case could have been closed to prevent improper benefits from being received.