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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |200

Effective Month: December 2016 101.03 HOW TO APPLY This chapter provides guidelines on the process of applying for eligibility determinations for all coverage groups. 101.03.01 APPLICANT An applicant is someone whose signed application form has been received by the Division of Medicaid (DOM) and is requesting an eligibility determination. An applicant is also someone whose signed application is received by another agency or entity authorized to make Medicaid certifications. An applicant includes someone who applies for coverage in MS through the Federally Facilitated Marketplace (FFM) and has their electronic application information transferred to DOM via a process referred to as an Account Transfer (AT). 101.03.01A Deceased Applicants An application for Medicaid may be made on behalf of a deceased individual. The application must be filed before the end of the third month following the date of death in order for DOM to be able to consider the month of death for coverage, using the rules that apply for retroactive Medicaid. 101.03.01B Non-Applicants This is an individual who is not requesting an eligibility determination for himself or herself but is included in the applicant’s household to determine eligibility for the applicant. 101.03.02 DOM APPLICATION FORM(S) DOM uses two types of application forms to determine eligibility: • For MAGI-related purposes, the Mississippi Application for Health Benefits is the single streamlined application form used to apply for Medicaid and CHIP. Information from this form is also used to refer individuals to the FFM for health coverage if ineligible for health coverage through DOM.