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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 | 50 Effective Month: September 2023

101.07.02 EXCEPTIONS TO TIMELY PROCESSING The agency must determine eligibility within established standards, except in unusual circumstances when a decision cannot be reached because of: • Failure or delay on the part of the applicant. • A disability decision has not been returned by DDS. • Administrative or other emergency delay that could not be controlled by the agency.

Time standards may not be used by the agency as a waiting period before determining eligibility or as a reason to deny eligibility because the agency has not determined eligibility within the time standards.

101.07.03 ABD STANDARDS OF PROMPTNESS Federal rules require that applications be approved or denied, and the applicant notified, within 45 days from the date the application was filed. The processing timeframe is 90 days when a disability determination is required before the eligibility determination can be completed. However, if a separate disability decision is not required, the 45-day standard applies. The applicable standard of promptness, i.e., 45 or 90 days, is applied to an ABD application from the date an application is filed to the date the notice of decision is issued to the applicant. When there is a delay, the reason must be documented in the record. 101.07.04 MAGI-RELATED STANDARD OF PROMPTNESS MAGI-related programs have a 45-day standard of promptness. No more than 45 days may lapse from the date an application is filed to the date the notice of decision is issued to the applicant. Any delays in processing MAGI-related applications must be client-caused or requested. When there is a delay, the reason must be documented in the record.