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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |225

Effective Month: December 2016 101.04 FILING THE APPLICATION Individuals inquiring about program eligibility requirements should be informed of their opportunity to apply and informed about the various means of applying. If a hardcopy application is requested, the regional office must provide an application to the individual or mail it, as applicable. If another person or agency refers the name of an individual in need of medical assistance to the regional office, the individual will be contacted, if possible, and the various means of applying explained. Otherwise, an application will be mailed if an address is available. 101.04.01 RIGHT TO APPLY Individuals wishing to file an application must be afforded the opportunity to do so without delay. When an individual inquires about making an application at any regional office, an application form must be provided and the person offered the opportunity to file that day. The agency must allow an individual or individuals of an applicant’s choice to accompany and assist an applicant or recipient in the application or redetermination process; however, in order to officially represent the applicant or recipient, an individual must become an authorized, self-designated or legal representative. Refer to 101.03.04 for a discussion of authorized representatives and individuals or organizations needing access to case information, in which case the HIPAA release form may be more appropriate. 101.04.02 REQUEST FOR AN INFORMAL MEDICAID ELIGIBILITY OPINION An individual seeking assistance from other social service agencies may be required to obtain a statement from DOM advising that he is not eligible for Medicaid in order to obtain that agency’s services. If the individual indicates through questioning that none of the categorical requirements would be met, i.e., the person is not aged, blind, disabled, pregnant, under age 19 or part of a family with dependent children, the regional office may provide the individual with a statement that he is not eligible based on the self-declared information. The statement must also explain to the individual that the decision is not an official denial and cannot be appealed. If an official denial notice is required, an application must be filed and a decision rendered after all eligibility factors have been examined according to policy. The “Request for Unofficial Denial” form is located in the Appendix page by the same name and must be used to issue an unofficial denial of eligibility.