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Programs

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 UnitedHealthcare insurance, otherwise known as 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 shot 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)
As the Local Contact Agency (LCA) DOM has the responsibility of ensuring that individuals in nursing facilities who express a desire to talk with someone about the possibility of returning to the community are provided timely information about available options and supports for community living and to support individual choice.

Long Term Care Pre-Admission Screening
A pre-admission screening application must be completed to determine clinical eligibility for individuals seeking admission to a Division of Medicaid certified nursing facility on all residents regardless of payment source. This application must be completed by a health care professional and certified by a physician. A score of 50 or above is the required threshold to be considered for entry into the Long Term Care services of Nursing Homes. Any exceptions are noted in the Administrative Code Title 23 Medicaid, Part 207 Chapter 1.

Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
The Institutional Long Term Care Division is responsible for the development, monitoring and enforcement of policy for nursing facilities and intermediate care facilities for individuals with intellectual disabilities (ICF/IID) approved by Medicaid and federal certification requirements established by the Centers for Medicare and Medicaid.

Nursing Facility Case Mix
The Institutional Long Term Care Division is responsible for the Case Mix program which ensures accuracy of nursing facility resident assessment data used to establish resident classification and subsequent reimbursement payment rates for nursing facilities.

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.

Mental Health

Mental health programs provide 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 programs is comprised of two divisions: Mental Health Services and Special Mental Health Initiatives.

Special Mental Health Initiatives
The Special Mental Health Initiatives division oversee the following programs:

  • Autism pilot program
  • Federally qualified health centers and rural health clinics
  • In-patient detox for chemical dependency
  • Intellectual disabilities/developmental disabilities
  • Mississippi Youth Programs Around the Clock (MYPAC)
  • Psychiatric services by physician or nurse practitioner

Mental Health Services
The Mental Health Services Division oversees the following programs:

  • Acute freestanding psychiatric facilities
  • Community/private mental health centers
  • Therapeutic and evaluative mental health services for children
  • Outpatient mental health hospital services
  • Pre-admission screening and resident review
  • Psychiatric residential treatment facilities
  • Psychiatric units at general hospitals

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.

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 Wavier
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 women 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.

Mississippi Access to Care (MAC) 2.0
Mississippi Access to Care 2.0 is a continuation of Mississippi’s earlier efforts in long term care reform. Its purpose and that of the stakeholder groups is to bring together any and all projects that support home and community based services and community living for seniors and individuals with disabilities.