Page 91

MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |515 Effective Month: December 2016

101.15.09 SSI REVIEWS REQUIRED FOR SSI TERMINATIONS The SSI review process is a type of exparte review. When individuals are terminated from SSI due to income and/or resources, they are systematically issued an SSI Termination Notice and an SSI Review Form, DOM-300B, upon receipt of SDX notification of termination. This form is to be completed and returned to the appropriate regional office if the recipient wants to apply for continued Medicaid coverage and is eligible under one of the coverage groups described in the SSI Termination Notice. A signed form is required. The form may be complete or incomplete. If incomplete, the specialist will take the necessary steps to obtain needed information. NOTE: The SSI Termination Notice advises the individual to complete and return the form to the regional office with 10-days from receipt of the notice; however, allow the form to be returned prior to the date of the SSI closure. SSI/Medicaid closures are effective for the end of current month only if the SSI transaction to close SSI/Medicaid is received by the 10th day of the month; otherwise, the closure is effective at the end of the following month. If the DOM-300B is not received timely, the individual can apply at any time using the full ABD application form. An in–person interview is not conducted, even if the program is one that normally requires an interview. However, all necessary factors of eligibility must be verified, such as disability, residency, utilization of benefits, etc. In addition, if other health insurance coverage is indicated on the 300B, TPL information must also be obtained. SSI redeterminations have a 30-day processing standard, unless a DDS determination must be obtained.