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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |231

Effective Month: December 2016

Combination ABD/MAGI Households Combination ABD/MAGI households are defined as cases in which there is both an ABD applicant or recipient living in the same household as MAGI applicants or recipients. ABD and MAGI individuals living in the same household are treated as one case in the system and one physical record is created, with the person designated as the head of household as the primary case head. The regional office that serves the household’s county of residence is the office responsible for the ABD/MAGI members, regardless of where the application is filed or whether the ABD and MAGI applications are filed at the same time or separately. If an ABD applicant/recipient is institutionalized which causes other ABD/MAGI applicants or recipients to live apart from the institutionalized individual but the household remains bound by relationship (marriage, parent/child), two separate cases are set up in the system; one for the at-home household members and one for the institutionalized member. One physical case record is established with the person who is the head of household of the ABD institutionalized case as the primary case head. The regional office that serves the county where the nursing facility is located is responsible for both ABD and MAGI records. Applications Filed With the Federally Facilitated Marketplace (FFM) Applications for MAGI-related Medicaid or CHIP may also be filed on-line with the Federally Facilitated Marketplace or FFM. The FFM is also referred to as the health insurance exchange. An FFM operates in states that choose not to build their own state-operated exchange. The FFM for MS determines eligibility for enrollment in qualified health plans and insurance affordability programs and assists in determining eligibility for Medicaid and CHIP by verifying certain application information through a Data Services Hub. If an individual or family appears to be eligible for Medicaid or CHIP based on Hub verified data, the FFM transfers the electronic account, referred to as an Account Transfer, to MS for completion of the application. • An individual who applies for Medicaid coverage in MS through the FFM has their electronic application information transferred to DOM via a process referred to as an Account Transfer (AT).