23 MAC Pt. 101, R. 12.4
Pre-Populated Renewals
Cite as 23 Miss. Admin. Code Pt. 101, R. 12.4
Pre-Populated Renewals
A. If the Division of Medicaid cannot renew eligibility based on information available to the
agency from electronic data matches, the Division of Medicaid issues a pre-populated renewal
form to the recipient displaying the information that is available to the Division of Medicaid.
B. The beneficiary has a minimum of thirty (30) days from the date the renewal form is issued to
respond and provide any necessary information needed to renew eligibility, including returning
the signed renewal form. The signed renewal form and any paper verifications must be returned
to the Division of Medicaid through any of the modes permitted for submission of applications
listed in Miss. Admin Code Part 101, Part 4.2.
C. If a signed renewal form is not returned by the due date or if all requested information is not
provided a telephone contact is attempted prior to taking action to terminate eligibility.
D. If the beneficiary is determined no longer eligible at the time of the annual redetermination of
eligibility, the Division of Medicaid reviews the information in the case record for possible
eligibility under any other available coverage within Medicaid or the Children’s Health
Insurance Program (CHIP), if appropriate.
1. Terminated individuals are referred for health coverage through the Federally Facilitated
Marketplace (FFM), as appropriate.
2. Eligibility is not terminated by the Division of Medicaid until after the pre-populated
review form is issued and the beneficiary is allowed the opportunity to respond to the
information.
E. If a renewal form and/or requested information is not returned timely for either a modified
adjusted gross income (MAGI) or aged, blind and disabled (ABD) renewal but the beneficiary
subsequently submits the signed renewal form and any necessary information needed to renew
eligibility within ninety (90) days after the case is terminated, the case will be reinstated
without requiring a new application, provided all eligibility factors are met.
F. When a renewal form or other requested information is not returned, the worker must use
available electronic data sources to complete a renewal. Any beneficiaries who could be
renewed ex parte must be renewed ex parte. Any clients who would change from Medicaid to
CHIP, CHIP to Medicaid, or to a lower coverage group must be changed to the new coverage.