Application Processing and Case Overview
Case Review
After you submit an application for Mississippi Medicaid health benefits, the regional office that serves your county of residence will be in contact with you by phone or you may get a letter regarding your eligibility determination. If something is incorrect, missing or needs
clarification a regional office staff member will contact you.
Case Approval
If you are approved to receive health benefits, a letter and a blue Medicaid identification card will be mailed to you. Mississippi Medicaid has a large network of health care providers available for medical services. When you make an appointment be sure the provider you choose accepts Mississippi Medicaid.
You may be eligible for health benefits through a coordinated care program called Mississippi Coordinated Access Network (MississippiCAN). Those who are automatically qualified for this program will have the option of choosing between one of three Coordinated Care Organizations (CCO): Magnolia Health, UnitedHealthcare Community Plan and Molina Healthcare. Mandatory populations are not eligible for dis-enrollment.
Those individuals who qualify for this program in an optional population have the choice to either enroll in a CCO or choose to stay in the traditional Medicaid “fee-for-service” program.
The Children’s Health Insurance Program (CHIP) is currently administered by Molina Healthcare and UnitedHealthcare Community Plan.
Case Renewal
If you are eligible for Mississippi Medicaid
health benefits and your case is approved, it will be reviewed on an annual basis. Near your renewal date you will receive a letter to review your personal information and have the opportunity to make changes. If anything needs to be updated, indicate the changes on the form and mail it back or notify your case worker.
Eligibility Hearings and Appeals
An eligibility hearing is an administrative process that you may ask for if you do not agree with a decision that has been made about your Medicaid eligibility. Beneficiaries/applicants are entitled to a fair hearing if they disagree with actions taken by the Division of Medicaid to deny, terminate or reduce services.
For more information regarding hearings, visit the Eligibility Hearing webpage.
Eligibility Hearings Contacts
The Office of Appeals is responsible for coordinating, scheduling, and facilitating appeals for Medicaid beneficiaries. Cases are heard by an impartial hearing officer employed by or on contract with the agency. If you have questions regarding fair hearings for Medicaid eligibility decisions, contact the Mississippi Division of Medicaid:
Toll-free: 800-421-2408
Phone: 601-359-6050
Or contact the regional
office that serves your county of residence
If you have questions regarding fair hearings for Medicaid eligibility decisions that are part of a Supplemental Security Income (SSI) decision for the low income aged, blind or disabled, contact the Social Security Administration (SSA):
Toll-free: 800-772-1213
Social Security Administration website: //www.ssa.gov
Although Medicaid is a joint federal and state program the states operate the program on a day-to-day basis, including taking applications and making determinations of eligibility. That means you must contact a local office in your state to apply for Medicaid. To apply for Medicaid you will have to:
- Fill out an application form
- Provide documentation to verify general and financial requirements
Once the state finds you eligible for Medicaid, you will have to go through a functional eligibility assessment if you want to receive long-term care services.
You may apply for Medicaid coverage yourself, or you may designate another person, such as a family member, your attorney, or a friend, to apply for you. If someone else apples for you, that person should be familiar with your situation, be able to answer all eligibility questions, and have access to your financial records. The state may also require a face-to-face interview.
If you own a home, the state may ask you to document the current fair market value of the home and any loans for the home, such as mortgages or equity loans. The state may ask for these documents:
- A current tax bill
- A real estate appraisal
- Copies of your mortgage
The state may ask for this documentation because, while your home is not counted as an asset when determining your eligibility for Medicaid, how much equity you have in your home can affect whether Medicaid will pay for your long-term care services. See the section on "Limits on Home Equity" for more information about this.
If the value of your assets went down a lot within the past five years, the state may ask you to explain what happened to the assets. In particular, the state will want to know whether you gave away any of your assets in the past five years.
If you are married and in a nursing home, you will also be asked to document your assets when you first entered the nursing home—this can help establish how much of your assets your spouse is able to keep. See the section on "Considerations for Married People" for more information about this.
Where to Apply for Medicaid:
All states have local Medicaid eligibility offices where you can file applications. Many states also provide applications at different locations in your community, including Aging and Disability Resource Centers (ADRCs). Your can also apply by phone by calling your local Medicaid office. In most states, you can also apply online, or find an application online that you can complete and mail to the local office.
Contact your State Medical Assistance Office to find out where and how you can apply for Medicaid benefits.
When to apply for Medicaid:
The best time to apply depends on your medical situation, your marital status, and the complexity of your finances. If your finances are straightforward, the state may be able to process your application faster. If you find that you need long-term care, you should apply as soon as possible because it may take some time for the state to process your application and make an eligibility determination. For the most part, the date you become eligible is based on the date you apply for Medicaid, assuming you meet all of the eligibility requirements when you apply. The longer you wait to apply, then, the later your date of eligibility will be.
The Medicaid agency usually has 45 days to process your application. If the application requires a disability determination, the agency can take 90 days. But, it may take longer for the state to determine your eligibility if you do not provide the required documents on time. If Medicaid thinks that you are not cooperating, it can deny your application for failing to cooperate. If this happens, you may have to start your application over again once you have your documents in hand. This will delay the date you become eligible for Medicaid even longer.
If the Medicaid agency determines that you are eligible, you will receive a letter with your date of eligibility and the amount you must pay toward the cost of your care. This could be your spenddown liability if you are eligible as medically needy, or your share of cost if you are eligible on some other basis. See the sections on "Medically Needy – Spenddown" and "Share of Cost" for more information about this.
Medicaid will review your eligibility status every year. During the yearly review, you may need to document your income and assets again, especially if either your income or assets have changed much in the last year. The review process is usually simpler than the original application process.
If the Medicaid agency determines that you are not eligible, you will receive a letter that explains the reason for denial. The notice will also explain how you can appeal the decision.