For individuals who can get full Medicaid benefits, the following services available through a variety of programs may be covered if medically necessary:
Children
Mississippi Health Benefits for Children
Health benefits for children from birth to age 19 are provided through Medicaid. Some children may be eligible for Medicaid. Other children whose families make too much money to qualify for Medicaid may be eligible for the Children’s Health Insurance Program (CHIP).
Children’s Health Insurance Program (CHIP)
The Children’s Health Insurance Program provides insurance coverage for uninsured children up to age 19 whose family income does not exceed 209% of FPL. Families may earn up to 209% of the federal poverty level and be eligible for CHIP. A child must be determined ineligible for Medicaid before eligibility for CHIP can be considered. Children with current health insurance coverage at the time of application are not eligible for CHIP.
Early and Periodic Screening and Diagnostic Treatment (EPSDT)
The Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program is a federally mandated service which provides preventive and comprehensive health services for children under 21 years of age. It provides critical services to improve the health of infants, children and adolescents.
Expanded Mississippi Early and Periodic Screening and Diagnostic Treatment (EPSDT)
The EPSDT program was expanded in the Omnibus Budget Reconciliation Act of 1989 to allow for additional services to be offered.
Early Intervention/Targeted Case Management
Early Intervention/Targeted Case Management (EI/TCM) is an active, ongoing process that involves activities carried out by a case manager to assist and enable a child (0 to 3 years of age) enrolled and participating in the Mississippi Early Intervention Program gain access to needed medical, social, educational and other services.
Perinatal High Risk Management/Infant Services System (PHRM/ISS)
Perinatal High Risk Management/Infant Services System is a multidisciplinary case management program established to help improve access to health care and to provide enhanced services to certain Medicaid eligible pregnant/postpartum women and infants. The enhanced services for this target population include case management, psychosocial and nutritional counseling/assessments, home visits and health education.
Vaccines for Children (VFC)
Vaccines for Children is a federally funded and state operated program that began October 1994. The program provides vaccines free of charge to VFC eligible children through public and private providers. Providers are reimbursed by Medicaid for vaccine administration only.
Institutional Long Term Care
Civil Money Penalty (CMP) Grant Awards Program
The goal of the Mississippi Division of Medicaid Civil Money Penalty Grant program is to facilitate the use of Federally Imposed Civil Money Penalty Funds to support activities that support, protect and benefit residents living in nursing facilities. Only CMP fund applications that meet the statutory intent of the regulations, Federal law and policy will be considered.
Transition to Community Referral (TCR)
Effective April 5, 2021, the Mississippi Access to Care (MAC) Center is replacing Mississippi Division of Medicaid (DOM) as the designated Local Contact Agency to receive and distribute Transition to Community Referrals (TCR) to the appropriate case management agencies (CMA). Please see the following link for the new fillable form and instructions. http://www.mdhs.ms.gov/aas-transition-to-community-referral.
Long Term Care Pre-Admission Screening
To enter a Long Term Care program (except Hospice and ICF/IID) , an eligible Beneficiary must have a Pre-Admission Screening Application completed by a health care professional . A score of 50 or above is the required threshold to be considered for entry into the Long Term Care programs of Nursing Homes; Elderly and Disabled Waiver, Independent Living Waiver and Traumatic Brain Injury/Spinal Cord Injury Waiver; and Assisted Living Waiver programs. Any exceptions are noted in the Administrative Code Title 23 Medicaid, Part 207.
Pre-Admission Screening and Resident Review (PASRR)
Pre-Admission Screening and Resident Review (PASRR) is a process that ensures that an individual is appropriate for nursing facility placement and aids in determining whether an individual with an indication of Mental Illness, Intellectual Disability and/or a related condition could benefit from specialized or rehabilitative services. The screenings and resident reviews are conducted by the DOM PASRR Contractor and/or the Department of Mental Health.
Nursing Facilities and Case Mix Reimbursement
All Medicaid certified nursing facilities are surveyed and receive a case mix review annually.
Home and Community Based Services (HCBS) Long Term Care
Home and Community Based Services is responsible for operating five areas which include the Assisted Living waiver, Elderly and Disabled waiver, Independent Living waiver, Intellectual Disability/Developmentally Disabled waiver and the Traumatic Brain/Spinal Cord Injury waiver. HCBS Programs offer in-home services to help people live at home instead of in nursing homes. You must apply and be approved for these services. Click on the links below to learn more about HCBS waivers and programs.
- Assisted Living (AL) Waiver
- Elderly and Disabled (E&D) Waiver
- Independent Living (IL) Waiver
- Traumatic Brain/Spinal Cord Injury (TBI/SCI) Waiver
- Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver
Office of Mental Health
The Office of Mental Health provides a way for people to get the mental health treatment they need in a variety of settings, depending on age and conditions. However, several of our programs are limited to children under age 21. Some services are not covered, while others may require a specific diagnosis to be covered. Additionally, some services require prior authorization for coverage. Geriatric psychiatric services are not covered. The Office of Mental Health is comprised of three divisions: Mental Health Programs, Special Mental Health Initiatives, and Mental Health Services.
Mental Health Programs
The Mental Health Programs division oversees the following programs:
- Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
Special Mental Health Initiatives
The Special Mental Health Initiatives division oversee the following programs:
- Autism Spectrum Disorder (ASD) Services
- Community Support Program 1915(i)
- Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver
- Mississippi Youth Programs Around the Clock (MYPAC)
- Substance Use Disorder (SUD) Services
Mental Health Services
The Mental Health Services division oversees the following programs:
- Acute Freestanding Psychiatric Facilities
- Community/Private Mental Health Centers (CMHC/PMHC)
- Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC)
- Outpatient Mental Health Hospital Services
- Psychiatric Residential Treatment Facilities (PRTF)
- Psychiatric Units at General Hospitals
- Psychiatric Services by Physicians or Nurse Practitioners
- Therapeutic and Evaluative (T&E) Mental Health Services for Children
Managed Care – Mississippi Coordinated Access Network (MississippiCAN)
The Division of Medicaid has implemented a managed care program called the Mississippi Coordinated Access Network (MississippiCAN). There are certain beneficiaries that will qualify for this program. The program MississippiCAN is designed to get a better return on Mississippi’s health care investment by improving the health and well-being of Medicaid beneficiaries. The Division of Medicaid has contracts with two coordinated care organizations, who are responsible for providing services to the Mississippi Medicaid beneficiaries who participate in the MississippiCAN program. Click the link below to learn more about managed care, the MississippiCAN program.
Dual Special Needs Plans
Dual Eligible Special Needs Plans (DSNPs) serve individuals who are eligible for both Medicaid and Medicare, known as “dual eligibles.” DSNPs offer care coordination and provide supplemental benefits to their members to improve the coordination of services and enhance quality of care. Dual eligible individuals have the option to enroll in a DSNP during their Medicare annual election period or at the start of every month.
Click the link below to learn more about Dual Special Needs Plans in Mississippi.
Women
Perinatal High Risk Management/Infant Services System (PHRM/ISS)
Perinatal High Risk Management/Infant Services System is a multidisciplinary case management program established to help improve access to health care and to provide enhanced services to certain Medicaid eligible pregnant/postpartum women and infants. The enhanced services for this target population include case management, psychosocial and nutritional counseling/assessments, home visits and health education.
Other
Family Planning Waiver
The Family Planning Waiver program is for women and men who receive Medicaid benefits limited solely to family planning services. This includes one annual visit and subsequent visits related to their birth control methods. These beneficiaries will not be eligible to receive any other Medicaid benefits.
Hospice
Hospice Benefit is a State Plan service for terminally ill individuals at the end of their life cycle and having certification from a physician with a life expectancy of six (6) months or less. Hospice provides palliative treatment such as nursing care, medical social services, physician services, counseling short term patient care, medical appliances and supplies, drugs related to terminal condition, home health aide or homemaker, or non-restorative therapies.
Healthier Mississippi Waiver
The Healthier Mississippi Waiver Demonstration Extension was submitted to the Centers for Medicare and Medicaid Services (CMS) on Jan. 30, 2015. Visit the Healthier Mississippi Waiver Demonstration renewal application submitted to CMS post to view the document with changes. This waiver covers individuals who are not eligible for Medicare. Once Medicare starts, eligibility for the Healthier Mississippi Waiver ends.
American Rescue Plan Act HCBS Enhancement Opportunities
The American Rescue Plan Act (ARPA) of 2021 was signed into law on March 11, 2021. Section 9817 of ARPA provides states with a temporary ten (10) percentage point increase to the federal medical assistance percentage (FMAP) for Medicaid Home and Community-Based Services.
Care Management Services for Medicaid Beneficiaries with Specific Conditions
Care management services are available to Mississippi Medicaid fee-for-service (FFS) beneficiaries if they meet one of these five conditions: Hepatitis-C, Hemophilia, HIV/AIDS, women 60 days postpartum after delivery and Disabled Children Living at Home (DCLH). This care management program provides beneficiaries with support to help manage their healthcare and medical conditions. This program is for those not enrolled with MississippiCAN (MSCAN).
