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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 100 – General Provisions P a g e | 41 Effective Month: March 2019 Calculating Overpayments Overpayments may result when a recipient is found ineligible or eligible for reduced benefits or a different amount of Medicaid Income. In calculating the overpayment, the specialist will: • Determine the action which would have been taken at the time had the correct information been known to the agency or had the agency taken timely action. • Determine the effective date action would have been taken had the correct information been known to the agency. o For an unreported change, determine the earliest date the agency can substantiate that the recipient was aware of the change. The effective date of the change will be used if the agency cannot document an earlier date. Then allow time for the change to have been reported by the individual (10 days) and acted on by the agency (10 days). Then consider the 15-day adverse action notice or timely notice requirement, as applicable, in determining the beginning month of the overpayment. Example: On August 25th, the RO received verification a CHIP recipient became covered by other full health insurance effective May 1st. Eligibility is terminated effective September 30th. The beginning month of the CHIP overpayment is July (allowing the 10/10/15 day rule) and the improper payment period runs through September. Example: An ongoing recipient failed to report a new marriage which occurred on May 10th. The marriage was reported on August 9th. The spouse’s income causes ineligibility, and the case was closed September 30th. The DOM-354 must be submitted in September for the period July through September using the 10/10/15 rule for determining the beginning date of the improper payment period. o When dealing with information withheld or improperly reported at application, the first benefit month will be the first month of the