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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 101 – Coverage Groups and Processing Applications and Reviews P a g e | 29 Effective Month: September 2023 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 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 in the Appendix page by the same name and must be used to issue an unofficial denial of eligibility. 101.04.03 SUBMITTING AN APPLICATION AND APPLICATION FILE DATE An application for Medicaid may be filed in any of the following described submission methods. The application file date is the date a valid application form is received by the agency: • In person in any regional office, official out-stationed location or other location outside the regional office where eligibility staff are on official duty, such as a nursing home, hospital or other public facility. The filing date is the date received by the office or other location. • By mail in any regional office - o Applications received by mail which arrive after the end of the month but were postmarked by the last day of the month will be considered to have been received by the regional office on the last day of the month in which they are postmarked. • By fax in any regional office. The filing date is the date received by the agency (central or regional office, whichever office first receives the application). An original signature is not required, • By on-line submission of the application to DOM. The filing date is the date received by the agency (central or regional office). An electronic signature is accepted for applications filed on-line with the agency.