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Eligibility Policy and Procedures Manual

Eligibility Policy and Procedures Manual

Chapter 100: General Provisions

Chapter 100 – General Provisions
Section 100.01 – History and Legal Base
Section 100.02 – Agency Duties

Section 100.02.01 – Duties of the Division of Medicaid (DOM)
Section 100.02.02 – Duties of the Department of Human Services (DHS)

Section 100.03 – Rights of Applicants and Recipients

Section 100.03.01 – Opportunity to Apply
Section 100.03.02 – Civil Rights and Non-Discrimination
Section 100.03.03 – Access to Information
Section 100.03.04 – Confidentiality of Information

Section 100.03.04A – Release of Information Without Client Consent
Section 100.03.04B – Release of Program Information
Section 100.03.04C – Safeguarding Confidential Information
Section 100.03.04D – Safeguard Awareness Training

Section 100.03.05 – Right to Appeal Fair Hearing

Section 100.03.05B – Continuation of Benefits
Section 100.03.05C – Regional Office Responsibilities in the Hearing Process

Section 100.03.05C1 – Supervisory Review
Section 100.03.05C2 – Preparation of the Hearing Record
Section 100.03.05C3 – Holding the Local Hearing
Section 100.03.05C4 – Issuing the Local Hearing Decision
Section 100.03.05C5 – Taking Action on the Case
Section 100.03.05C6 – State Hearing Requested After Adverse Local Decision

Section 100.03.06 – State Hearings

Section 100.03.06A – Review by State Hearing Officer
Section 100.03.06B – Holding the State Hearing
Section 100.03.06C – Recessing or Continuing a State Hearing
Section 100.03.06D – Changes Which Occur During the Hearing Process
Section 100.03.06E – Review by DDS Staff
Section 100.03.06F – Recommendation of the State Hearing Officer
Section 100.03.06G – Decision of the Agency
Section 100.03.06H – Chip Agency Errors

Section 100.04 – Improper Payments

Section 100.04.01 – Improper Payment Report
Section 100.04.02 – Claims Against Estates

Section 100.05 – Quality Control

Section 100.05.01 – MEQC Disagreement Resolution Process

Chapter 102: Non-Financial Requirements

Chapter 102 – Non-Financial Requirements
Section 102.01 – Introduction

Section 102.01.01 – Verification of Non-Financial Requirements

Section 102.02 – Identity
Section 102.03 – State Residency

Section 102.03.01 – Residency Requirements
Section 102.03.02 – Specific Residency Prohibitions
Section 102.03.03 – Temporary Absence from the State
Section 102.03.04 – Individuals Receiving a State Supplementary Payment
Section 102.03.05 – Individuals Receiving a Title IV-E Payment
Section 102.03.06 – Determination of Residency (Under Age 21)
Section 102.03.07 – Determination of Residency (Age 21 and Older)
Section 102.03.08 – State Placement in an Out-of-State Institution
Section 102.03.09 – Out-of-State Placements
Section 102.03.10 – Residency Issues
Section 102.03.11 – Out-of-State Recipient Moving to MS
Section 102.03.12 – MS Recipient Moving to Another State
Section 102.03.13 – Migrant and Seasonal Farm Workers
Section 102.03.14 – Homeless Individuals
Section 102.03.15 – Verification of State Residency

Section 102.04 – United States Citizens

Section 102.04.01 – Citizenship
Section 102.04.02 – Identity
Section 102.04.03 – Verification of Citizenship and Identity
Section 102.04.04 – Exemptions from Requirements
Section 102.04.05 – Evidences of U.S. Citizenship
Section 102.04.06 – Evidences of Identity

Section 102.05 – Aliens

Section 102.05.01 – Grandfathered Aliens
Section 102.05.02 – Classifications of Qualified Aliens
Section 102.05.03 – 5-Year Disqualification Period
Section 102.05.04 – 40 Qualifying Quarters
Section 102.05.05 – Alien Classifications Subject to 5-Year Ban
Section 102.05.06 – Alien Classifications Exempt from 5-Year Ban
Section 102.05.07 – Continuously Present in the U.S.
Section 102.05.08 – Victims of Severe Forms of Trafficking
Section 102.05.09 – Battered Aliens
Section 102.05.10 – Veteran or Active Duty Military
Section 102.05.11 – Non-Qualified Aliens
Section 102.05.12 – Criteria for Approval of Emergency Services
Section 102.05.13 – Budgeting Citizen Children of Non-Qualified Aliens
Section 102.05.14 – Public Charge
Section 102.05.15 – Alien Status Chart

Section 102.06 – Social Security Number (SSN)

Section 102.06.01 – Exceptions to the Enumeration Requirement for Applicants
Section 102.06.02 – Non-Applicants and Enumeration
Section 102.06.03 – Use of SSNs
Section 102.06.04 – Application for a Social Security Number
Section 102.06.05 – Verification of the SSN

Section 102.07 – Categorical Relationship
Section 102.08 – General Eligibility Requirements

Section 102.08.01 – Verification of Age
Section 102.08.02 – Marital Relationships (ABD)

Section 102.08.02A – Marital Relationships (FCC)

Section 102.08.03 – Definition of a Child (ABD)

Section 102.08.03A – Definition of a Child (FCC)

Section 102.08.04 – Utilization of Other Benefits – General

Section 102.08.04A – Utilization of Other Benefits – (ABD)
Section 102.08.04B – Utilization of Other Benefits – (FCC)

Section 102.08.05 – Assignment of Third Party Rights (General)

Section 102.08.05A – CHIP and Other Insurance

Section 102.08.06 – Child Support Requirements – General

Section 102.08.06A – Child Support Requirements (ABD)
Section 102.08.06B – Child Support Requirements (FCC)

Section 102.09 – ABD Non-Financial Requirements

Section 102.09.01 – Definitions
Section 102.09.02 – Disability Determination Process
Section 102.09.03 – Exceptions to Obtaining DDS Approvals
Section 102.09.04 – Obtaining DDS Disability Decisions
Section 102.09.05 – Temporary SSI Closures
Section 102.09.06 – Estate Recovery Requirements

Section 102.10 – FCC Non-Financial Requirements

Section 102.10.01 – Deprivation
Section 102.10.02 – Temporary Absence from the Home
Section 102.10.03 – Relationship

Section 102.10.03A – FPL Programs
Section 102.10.03B – Medical Assistance Program

Section 102.11 – Residents of an Institution

Section 102.11.01 – Institutions
Section 102.11.02 – Inmate Status
Section 102.11.03 – Verification of Inmate Status
Section 102.11.04 – Inmate Application Process