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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |208
Effective Month: December 2016 101.03.07 REASONABLE EFFORTS TO ASSIST The Regional and Central Office of DOM is expected to: • Provide orderly surroundings to persons who come to the office; • Provide courteous service to all persons who come to or contact the office; • Provide the appropriate application form to anyone who requests one; • Allow any individual the right to apply for any benefits, regardless of circumstances. This includes allowing a clearly ineligible individual to apply; • Communicate in a clear and courteous manner information regarding programs and services offered through DOM; • Determine as soon as possible if the person asking for help is seeking a type of assistance which the agency offers. If the individual is not requesting a type of assistance offered by the regional office, he should be referred to another community agency or resource to meet his needs, if one is available.
In addition, it is required that Medicaid Specialists make reasonable efforts to assist all applicants in order to have the applicant’s eligibility determined and/or re-determined. Assistance includes, but is not limited to, the following: • Help with forms completion; • Help with securing a representative, if needed; • Help in obtaining necessary information from third parties; and • Providing information that will assist the applicant in making informed decisions about Medicaid eligibility. Medicaid program policies are public information. Each applicant has a right to know the policies that will impact his eligibility. MAGI and/or ABD applicants who ask for assistance or are not capable of handling the application process and have no available family member or friend capable of assisting or have representatives who do not act responsibly for a MAGI or ABD applicant require special handling. Otherwise, the application will result in multiple denials that must be avoided if agency intervention is needed to resolve a failure to comply with application or renewal processing. Action needed is as follows: