Page 42

MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 100 – General Provisions P a g e | 42 Effective Month: July 2025 overpayment. Do not apply the 10/10/15 day rule for improper payments that begin with the month of application. Example: A Healthier MS applicant is approved effective May 1. It is subsequently determined on November 12th he had failed to report resources exceeding the limit at time of application. The case is closed effective November 30th. The beginning month of the Medicaid overpayment is May, and the improper payment period runs through November. DOM-354 must be submitted in December, the month after the month of discovery of the improper payment. Example: An applicant fails to report a spouse with income living in the household when applying on January 10th. The case was approved effective January 1st. The unreported marriage and spouse living in the home was discovered by the RO in August and the case is closed September 30th. The Improper Payment period is January through September. DOM-354 must be submitted in September. o If a change was reported timely, but the agency failed to act on the reported change, the first month of the overpayment will be the effective month the regional office should have made the change. Allow 10 days for the specialist to process the change and 15 days for the advance notice period. o A child under age 19 is entitled to 12-months continuous eligibility provided the approval of eligibility was correct at the time of application or renewal. The continuous eligibility period does not apply to a child approved in error at application or at renewal. For instance, if health insurance coverage is not reported on the MAGI application for a child approved in CHIP, any months the child was on CHIP with insurance are improper payment months. • Use appropriate income and resource levels for the time period in question. o For cases with unreported resources or income, obtain verification and re-budget using the verified resources or income received during the period in question.