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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 | 85 Effective Month: September 2023
101.15.06 TIMELY PROCESSING It is important for redeterminations to be completed in a timely manner to prevent overdue cases. Since a recipient’s eligibility does not expire, benefits continue until the agency completes the review and an eligibility decision is made to either approve or terminate coverage. A review becomes overdue when more than 12 months have passed since the last eligibility determination. It is the responsibility of regional office staff to ensure reviews are processed timely.
When to Begin Processing a Review It is permissible to begin the review process as early as the 10th month of a 12- month eligibility period or no more than 2 months early. However, to ensure timeliness, the review process must begin no later than the month prior to the review month. This means for a case with a review due date of August, the redetermination process may begin as early as June but must begin no later than July. 101.15.07 TIMELY AUTHORIZATION The approval of a Medicaid redetermination is timely if it is authorized by the last day of the month in which the review is due. If Medicaid or CHIP benefits are terminated, the action must be authorized no later than the adverse action deadline in the review month to be effective the following month.
When a redetermination closure is not authorized by the adverse action deadline in the review month, the case or individual is out of certification. However, an improper payment report is not required for the untimely closure. Ineligibility must exist for another reason for an improper payment report to be prepared.
Adverse Action Deadlines The adverse action deadline is the 15th of the month in order to allow 10-days advance notice plus 5 days mailing time. Action must be taken by the adverse action deadline in the review month if coverage is to be terminated at the end of the review month.