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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 102 – Non-Financial Requirements Page |93 Effective Month: September 2018 • Deceased Applicants - A verified death date establishes disability if a disability, due to any illness or accident which resulted in death, existed in all months for which Medicaid eligibility was requested. Example: A traumatic onset of disability occurred on September 14, 2008, due to an accident. On October 12, 2008, individual dies as a result of injuries sustained in the accident. The application for Medicaid is filed on November 3, 2008. Under this exception, Medicaid eligibility can only be established starting September, the month of the accident, forward. • Disabled Adult Children – Disability has previously been established by SSA for an applicant who is over age 18, entitled to Medicare and receiving Title II benefits as a child (C1-C9 beneficiary). The disability onset date must be determined. 102.09.04 OBTAINING DDS DISABILITY DECISIONS If there is no indication that any of the above exceptions apply, the Medicaid Specialist will use the following procedures to obtain a DDS decision when an applicant applies for Medicaid on the basis of disability or blindness. Procedures for DDS Forms Completion • Complete Form DOM-323, Disability or Blindness Report. This form is used to record the applicant’s condition and medical background based on the applicant’s responses and worker observations. If the applicant has medical records from the providers listed on the 323 in his possession, submit the medical records with the 323. • If the applicant is a child, complete Form DOM-323A, Disabled Child Questionnaire, in addition to the DOM-323. The 323A is used for children age 18 or under to record medical and educational information based on the parent/representative’s responses. • If the applicant is currently employed, include detailed information regarding work hours, income, name and type of employer, etc., on the DOM-323. Also indicate whether the applicant has been examined by a physician within the last 3 months. If so, specify the physician. • If the applicant has a communication problem due to language, speech or hearing difficulties which would make it hard for DDS to contact the applicant, complete Form DOM-324, Vocational Report, as a supplement to the DOM-323.