Page 22

Official source

MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |202

Effective Month: December 2016 SIGNATURE REQUIREMENTS (Continued) • Unsigned applications and/or applications signed with a mark that are not witnessed must be returned to the applicant with an explanation of the signature requirements. An unsigned application or an “X” marked application that has not been witnessed is not valid. • Applications that are signed but are incomplete are accepted as valid applications. The Specialist will work with the applicant to complete the information needed. • Applications that are signed by an individual other than a person who is authorized to apply, as specified in “Who Can File” below, are accepted as valid applications. The Specialist must work with the applicant or head of household to obtain an acceptable signature on the submitted application form.

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Page 22

Official source

MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |202

Effective Month: December 2016 SIGNATURE REQUIREMENTS (Continued) • Unsigned applications and/or applications signed with a mark that are not witnessed must be returned to the applicant with an explanation of the signature requirements. An unsigned application or an “X” marked application that has not been witnessed is not valid. • Applications that are signed but are incomplete are accepted as valid applications. The Specialist will work with the applicant to complete the information needed. • Applications that are signed by an individual other than a person who is authorized to apply, as specified in “Who Can File” below, are accepted as valid applications. The Specialist must work with the applicant or head of household to obtain an acceptable signature on the submitted application form.