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Mississippi Medicaid State Plan

Mississippi Medicaid State Plan

The Mississippi Medicaid State Plan (State Plan) is a detailed agreement between the State of Mississippi and the Federal Government that describes the nature and scope of Mississippi’s Medicaid Program. The State Plan is based on the federal requirements and regulations found in Title XIX of the Social Security Act. Changes to the State Plan, called State Plan Amendments (SPAs), must be approved by the Centers for Medicare and Medicaid Services (CMS) prior to implementation.

Notification of updates on the State Plan, Administrative Code or Waivers
If a provider or individual would like to be added to the distribution list for notification of updates to the State Plan, Administrative Code, or Waiver please notify the Division of Medicaid at

Section 1 – Single State Agency Organization

Designation and Authority
Intergovernmental Cooperation Act Waivers
Eligibility Determination and Fair Hearings
Organization and Administration
Single State Agency Assurances
Financial Eligibility Requirements for Non-MAGI Groups
1.5 Pediatric Immunization Program
1.6 State Option to use Managed Care-Population Health Management Program

Section 2 – Coverage and Eligibility

2.1 Application, Determination of Eligibility and Furnishing Medicaid
2.2 Coverage and Conditions of Eligibility
2.3 Residence
2.4 Blindness
2.5 Disability
2.6 Financial Eligibility
2.7 Medicaid Furnished Out of State

Section 3 –  Services: General Provisions

3.1 Amount, Duration and Scope of Services
3.2 Coordination of Medicaid with Medicare and other insurance
3.3 Medicaid for Individual Age 65 or Over in Institutions for Mental Disease
3.4 Special Requirement Applicable to Sterilization Procedure
3.5 Families Receiving Extended Medicaid Benefits

Section 4 – General Program Administration

4.1 Methods of Administration
4.2 Hearings for Applicants and Recipients
4.3 Safeguarding Information on Applicants and Recipients
4.4 Medicaid Quality Control
4.46 Provider Screening and Enrollment
4.5 Medicaid Agency Fraud Detection and Investigation Program
4.6 Reports
4.7 Maintenance of Records
4.8 Availability of Agency Program Manuals
4.9 Reporting Provider Payments to the Internal Revenue Service
4.10 Free Choice of Providers
4.11 Relations with Standard-Setting and Survey Agencies
4.12 Consultation to Medical Facilities
4.13 Required Provider Agreement
4.14 Utilization/Quality Control
4.15 Inspection of Care in Intermediate Care Facilities for the Mentally Retarded, Facilities Providing Inpatient Psychiatric Services for Individuals Under 21, and Mental Hospitals
4.16 Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees
4.17 Liens and Adjustments or Recoveries
4.18 Recipient Cost Sharing and Similar Charges
4.19 Payment for Services
4.20 Direct Payments to Certain Recipients for Physicians’ or Dentists’ Services
4.21 Prohibition Against Reassignment of Provider Claims
4.22 Third Party Liability
4.23 Use of Contracts
4.24 Standards for Payments for Nursing Facility and Intermediate Care Facility For the Mentally Retarded Services
4.25 Program for Licensing Administrators of Nursing Homes
4.26 Drug Utilization Review Program
4.27 Disclosure of Survey Information and Provider or Contractor Evaluation
4.28 Appeals Process
4.29 Conflict of Interest Provisions
4.30 Exclusion of Providers and Suspension of Practitioners and Other Individuals
4.31 Disclosure of Information by Provider and Fiscal Agents
4.32 Income and Eligibility Verification System
4.33 Medicaid Eligibility Cards for Homeless Individuals
4.34 Systematic Alien Verification for Entitlements (SAVE)
4.35 Remedies for Skilled Nursing and Intermediate Care Facilities that Do Not Meet Requirements of Participation
4.35 Enforcement of Compliance for Nursing Facilities
4.36 Required Coordination Between the Medicaid and WIC Programs
4.38 Nurse Aide Training and Competency Evaluation for Nursing Facilities
4.39 Preadmission Screening and Annual Resident Review in Nursing Facilities
4.43 Cooperation with Medicaid Integrity Program Efforts
4.44 Medicaid Prohibition on Payments to Institutions or Entities Outside of the United States

Section 5 – Refer to Section 1

Section 6 – Financial Administration

6.1 Fiscal Policies and Accountability
6.2 Cost Allocation
6.3 State Financial Participation

Section 7 – General Provisions

7.1 Plan Amendments
7.2 Nondiscrimination
7.3 Maintenance of AFDC Efforts (deleted per 3/92 memo from OMP)
7.4 State Governor’s Review

Section 8 – Eligibility Groups, Conditions, and Requirements: Oct 1, 2013 & Jan. 1, 2014

List of Attachments

1.1-A Attorney General’s Certification

1.2-A Organization and Function of Medicaid State Agency

2.1-A Definition of a Health Maintenance Organization

2.2-A Groups Covered and Agencies Responsible for Eligibility Determinations

2.6-A Eligibility Conditions and Requirements

3.1-A Amount, Duration, and scope of Medical and Remedial Care and Services Provided to the Categorically Needy

3.1-C Standards and Methods of Assuring High Quality Care

3.1-D Methods of Providing Transportation

3.1-E Standards for the Coverage of Organ Transplant Procedures

3.1-F Condition or Requirement for Coordinated Care Organizations

3.1-i Home and Community-Based Services Administration and Operation

3.2-A Coordination of Title XIX with Part A & B of Title XVIII

4.11-A Standards for Institutions

4.16-A Cooperative Arrangements with State Health and State Vocational Rehabilitation Agencies

4.17-A Liens and Adjustments or Recoveries

4.18-A Charges Imposed on Categorically Needy

4.19-A Methods and Standards for Establishing Payment Rates

4.19-B Methods and Standards for Establishing Payment Rates – Other Types of Care

4.19-C Policy Regarding Payment for Reserving Beds during a Recipient’s absence from a Long Term Care Facility

4.19-D Guide Lines for the Reimbursement for Medical Assistance Recipients of Long Term Care Facilities

4.19-E Definition of Claim

4.22-A Requirements for Third Party Liability – Identifying Liable Resources

4.22-B Requirements for Third Party Liability – Payment for Claims

4.22-C State Medicaid on Cost Effectiveness of Employer Based Group Health Plans

4.32-A Income and Eligibility Verification System

4.33-A Method of Issuance of Medicaid Eligibility Cards to Homeless Individuals

4.34-A Requirements for Advance Directives Under State Plans for Medical Assistance

4.35-A – 4.35-H Enforcement of Compliance for Nursing Facilities

4.38 Disclosure of Additional Registry Information

4.38-A Collection of Additional Registry Information

4.39 Definition of Specialized Services

4.42-A False Claims Act

7.2-A Methods of Administration For Recipients of Federal Financial Assistance Title VI-Civil Rights Compliance