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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 100 – General Provisions P a g e | 9 Effective Month: March 2019 individual or their representative, to persons involved with the individual’s care, to business associates in their legitimate duties or as required by law. The agency has specified the agencies, persons and circumstances under which applicant or recipient information may be released with or without a recipient’s consent. Any other exceptions are subject to prior approval of the DOM Executive Director or the Eligibility Deputy Administrator and DOM’s Privacy Officer. Refer to DOM HIPAA Privacy Procedures for a complete discussion of disclosure rules. 100.03.05 PROTECTED INFORMATION Protected information is of two general types: eligibility/financial and medical. It includes, but is not limited to, the following information: 1. Eligibility information • Name and address of applicants/recipients. • Social and economic conditions or circumstances. • Evaluation of personal information such as financial status, citizenship, residence, age and other demographic characteristics. • Information received in connection with the identification of legally liable third-party resources. • Information received for verifying income eligibility and benefit level. NOTE: Income information verifying income eligibility and benefit level received from the Social Security Administration, the Internal Revenue Service, the Veteran’s Administration, State Retirement Board or Medicare must be safeguarded according to the requirements of the agency that furnished the data. 2. Medical information • Medical data, including diagnosis and history of disease or disability. • Medical services provided. • Medical status, psycho behavioral status, and functional ability. • Results of laboratory tests.