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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 100 – General Provisions P a g e | 39

Effective Month: March 2019 o The specialist fails to act on a reported or anticipated change, fails to check information available to the agency or overlooks a clue which, if pursued to conclusion, would have led to a finding of ineligibility. Examples are: • Failure to follow-up when the individual reports that he expects a definite stated change in his income, living arrangement or other area impacting eligibility. • Failure to follow-up when an applicant or recipient is asked to apply for a possible benefit, such as Social Security, veteran’s benefits, unemployment compensation or other retirement or disability benefits. • Failure to follow-up when the individual reports a plan to sell, transfer, or otherwise dispose of his property, real or personal, or to buy or acquire property otherwise. • Failure to check data sources for unreported income. ▪ The central or regional office, through system or human oversight or failure, authorizes or continues eligibility to an ineligible person or improperly computes Medicaid Income. There are no exceptions for taking corrective action to resolve an agency or client caused error and there are no exceptions for preparing and submitting an Improper Payment Report for improperly paid Medicaid or CHIP benefits when one is applicable.

100.05.01 IMPROPER PAYMENT REPORTING Completion of the Improper Payment Report by Regional Office Form DOM-354, Improper Payment Report, will be prepared to report improper payments for ABD and MAGI. The 354 should be completed no later than the month following the month of discovery according to form instructions with the following information included: • The factor of eligibility involved, and how the information given or withheld affects eligibility or Medicaid Income.