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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 | 69 Effective Month: September 2023 Procedures for Processing Applications of DOM Office of Eligibility employees, Members of Their Household or Immediate Family Members Any application or active case involving a DOM Office of Eligibility employee, household member or immediate family member, as defined above, in any regional office must be processed using the following guidelines:

Application or renewal form and documents must be sent electronically to appointed Central Office staff. Central Office staff only will access the case in MEDS to register, upload, and scan any documents. The employee’s name and relationship to the client must be reported by the RO. Conflict of interest cases or relative cases that are not within the specified degree of relationship listed above should be handled by Regional Office supervisory staff. Cases for DOM Employees who do not work for the Office of Eligibility should be handled by the Regional Office.

Prior to authorizing eligibility, the assigned Central Office staff member will thoroughly review the case and determine the accuracy of the eligibility decision. This may include additional contact with the applicant or others when deemed necessary to make a determination of eligibility. The process described above includes all activity on affected cases at the time of application and review, including special reviews of all such cases. Regional Office staff should inform the Central Office when employees who have an employee or family member case leave the agency. Central Office staff will remove the employee indicator and transfer the case back to the Regional Office. 101.13 SERVICE DELIVERY SYSTEMS The Division of Medicaid operates under two different payment models for services which are fee for service and coordinated care. Once an applicant is approved for Medicaid or CHIP, the individual is enrolled in one of these payment models based on their category of eligibility, age and whether enrollment is mandatory or optional for their category.