Medicaid Ms Gov Programs Managed Care

Date:

Office Of Mental Health

Medicaid Managed Care Organization Learning Hub – Medicaid MCO Overview and Financing Presentation

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.

The Mental Health Programs division oversees the following programs:

  • Intermediate Care Facilities for Individuals with Intellectual Disabilities

The Special Mental Health Initiatives division oversee the following programs:

  • Autism Spectrum Disorder Services
  • Community Support Program 1915

The Mental Health Services division oversees the following programs:

  • Acute Freestanding Psychiatric Facilities
  • Community/Private Mental Health Centers
  • Federally Qualified Health Centers and Rural Health Clinics
  • Outpatient Mental Health Hospital Services
  • Psychiatric Residential Treatment Facilities
  • Psychiatric Units at General Hospitals
  • Psychiatric Services by Physicians or Nurse Practitioners
  • Therapeutic and Evaluative Mental Health Services for Children

Managed Care Quality Strategy Report

Posted June 21, 2018: Pursuant to 42 C.F.R. Section 438.340, public notice is hereby given to the Division of Medicaids Managed Care Quality Strategy Report.

A copy of the proposed Managed Care Quality Strategy Report will be available in each county health department office and in the Department of Human Services office in Issaquena County for review. A hard copy can be downloaded and printed from www.medicaid.ms.gov or may be requested at or 601-359-2081.

Written comments will be received by the Division of Medicaid, Office of the Governor, Office of Policy, Walter Sillers Building, Suite 1000, 550 High Street, Jackson, Mississippi 39201, or for thirty days from the date of publication of this notice. Comments will be available for public review at the above address and on the Division of Medicaids website at www.medicaid.ms.gov.

American Disabilities Act Notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

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Managed Care Mississippi Coordinated Access Network

The Division of Medicaid has implemented a managed care program called the Mississippi Coordinated Access Network . There are certain beneficiaries that will qualify for this program. The program MississippiCAN is designed to get a better return on Mississippis 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.

Unitedhealthcare Dual Complete Plans

Mississippi Chips Program

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

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Medicaid Spending In Mississippi

This article does not contain the most recently published data on this subject. If you would like to help our coverage grow, consider donating to Ballotpedia.

Medicaid spending in Mississippi
  • 9Footnotes
  • Mississippi’sMedicaid program provides medical insurance to groups of low-income people and individuals with disabilities. Medicaid is a nationwide program jointly funded by the federal government and the states. Medicaid eligibility, benefits, and administration are managed by the states within federal guidelines. A program related to Medicaid is the Children’s Health Insurance Program , which covers low-income children above the poverty line and is sometimes operated in conjunction with a state’s Medicaid program. Medicaid is a separate program from Medicare, which provides health coverage for the elderly.

    This page provides information about Medicaid in Mississippi, including eligibility limits, total spending and spending details, and CHIP. Each section provides a general overview before detailing the state-specific data.

    HIGHLIGHTS

  • Mississippi had not expanded Medicaid under the Affordable Care Act as of June 2017.
  • GovernorPhil Bryant expressed opposition to Medicaid expansion in 2014, stating that for the state “to enter into an expansion program would be a fool’s errand” in case the ACA was repealed.
  • Children’s Health Insurance Program

    The Children’s Health Insurance Program is a public healthcare program for low-income children who are ineligible for Medicaid. CHIP and Medicaid are related programs, and the former builds on Medicaid’s coverage of children. States may run CHIP as an extension of Medicaid, as a separate program, or as a combination of both. Like Medicaid, CHIP is financed by both the states and the federal government, and states retain general flexibility in the administration of its benefits.

    CHIP is available specifically for children whose families make too much to qualify for Medicaid, meaning they must earn incomes above 138 percent of the federal poverty level, or $33,948 for a family of four in 2017. Upper income limits for eligibility for CHIP vary by state, from 175 percent of the federal poverty level in North Dakota to 405 percent of the FPL in New York. States have greater flexibility in designing their CHIP programs than with Medicaid. For instance, fewer benefits are required to be covered under CHIP. States can also charge a monthly premium and require cost sharing, such as copayments, for some services the total cost of premiums and cost sharing may be no more than 5 percent of a family’s annual income. As of January 2017, 14 states charged only premiums to CHIP enrollees, while nine states required only cost sharing. Sixteen states required both premiums and cost sharing. Eleven states did not require either premiums or cost sharing.

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    Stakeholder Insights On Engaging Children And Families With Incentive Programs

    Stakeholders felt that engaging children and families was challenging but critical for successful incentive programs. Engagement strategies were heterogeneous, ranging from automatic program enrollment to beneficiaries needing to enroll or complete health risk screenings. Clinician involvement in beneficiary incentive programs also varied from none to clinicians confirming visit attendance. Stakeholders identified 3 unique opportunities for child and family engagement: intergenerational engagement, health-promoting material prizes, and incentives addressing the social determinants of health .

    Apply For Medicaid In Mississippi

    Centene Medicaid Managed Care: $100B in Revenue

    You can enroll through HealthCare.gov or you can fill out a PDF of the Mississippi Medicaid Application Form. You can also enroll by phone at 800-318-2596.

    Eligibility: Parents with dependent children are eligible with household incomes up to 22% of FPL. Children are eligible for Medicaid or CHIP with household incomes up to 209% of FPL, and pregnant women are eligible with household incomes up to 194% of FPL.

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    Unitedhealthcare Connected For Mycare Ohio

    UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.

    Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .

    Unitedhealthcare Senior Care Options Plan

    UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

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    Stakeholder Insights On Rationale For Incentive Programs For Child Health

    Stakeholders identified several rationales for launching beneficiary incentive programs for child health. Some identified a morally and politically popular motivation to improve childrens health care access, which they believed could strengthen clinician-family partnerships and promote self-efficacy in navigating health systems: I dont think anyones going to dispute that getting kids in for well-child checkups is a good thing to do. Some stakeholders felt that incentive programs in Medicaid should target children, who constitute substantial proportions of Medicaid beneficiaries.

    Institutional Long Term Care

    Massachusetts Medicaid Provider Fee Schedule 2018

    Civil Money Penalty Grant Awards ProgramThe 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 Effective April 5, 2021, the Mississippi Access to Care Center is replacing Mississippi Division of Medicaid as the designated Local Contact Agency to receive and distribute Transition to Community Referrals to the appropriate case management agencies . Please see the following link for the new fillable form and instructions. .

    Long Term Care Pre-Admission ScreeningTo enter a Long Term Care program , 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.

    All Medicaid certified nursing facilities are surveyed and receive a case mix review annually.

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    Unitedhealthcare Connected Benefit Disclaimer

    This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

    You can get this document for free in other formats, such as large print, braille, or audio. Call , TTY 711, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.

    You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

    Language Line is available for all in-network providers.

    Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al , TTY 711, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

    Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

    Los servicios Language Line están disponibles para todos los proveedores dentro de la red.

    How Does Mississippican Enrollment Work

    All Medicaid beneficiaries who are in the categories of eligibility will receive an enrollment packet in the mail that will explain the program in more detail.

    The beneficiaries that are optional will have the choice to choose one of the coordinated care organizations , choose not to participate or opt-out. Those who are mandatory will only have the choice to choose between the three CCO plans, UnitedHealthcare Community Plan, Magnolia Health or Molina Healthcare.

    Beneficiaries may join the health plan of their choice or opt-out if eligible to do so. If Medicaid does not get an answer from the beneficiary within 30 days about joining or opting out after receiving the initial letter, the beneficiary will be assigned to one of the health plans.

    A Medicaid beneficiary has 90 days to either change to the other health plan, opt-out or stay in the program that their currently in.

    After 90 days a beneficiary cannot get out of the program or make any changes until the next open enrollment period. Open enrollment is Oct.1 through Dec. 15 of each year, with an effective date of Jan. 1 the following year.

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    Mississippi Stories: Matthew Mccluney

    The Division of Medicaid typically takes its direction from the governor, but Westerfield said the agency believes it can extend its contract with Magnolia for another year on its own as long as it has approval from the Public Procurement Review Board.

    Reeves office did not respond to Mississippi Todays questions regarding the governors support for a contract extension.

    The original three-year contract, which began in 2017 and was extended last year, is set to expire at the end of June, but contains an optional renewal through 2022. The Medicaid tech bill lawmakers passed this year also allows for an one-year emergency extension on the contract. Either would allow Magnolia to continue receiving millions from the state, even as the investigation continues.

    We as taxpayers deserve better than were getting, said state Rep. Becky Currie, R-Brookhaven. We need to let the RFP run its course in September just like it always does. I just believe that putting it off a year is just going to give Centene time to sweep things under the rug.

    Officials expect the investigation to conclude as early as this summer.

    Join our member community

    The Mississippi Legislature addressed PBMs in 2018 when it prohibited the companies from including gag clauses in their contracts with pharmacies. These provisions had prevented pharmacists from telling patients cheaper ways to pay for their medication, such as if their copay is higher than the cash price of the drug.

    State And Federal Spending

    DeWine unveils first major overhaul of Ohio’s Medicaid program in 15 years
    See also: Medicaid spending and enrollment statistics

    During fiscal year 2016, Medicaid spending nationwide amounted to nearly $553.5 billion. Spending per enrollee amounted to $7,067 in fiscal year 2013, the most recent year for which per-enrollee figures were available as of June 2017. Total Medicaid spending grew by 33 percent between fiscal years 2012 and 2016. The Medicaid program is jointly funded by the federal and state governments, and at least 50 percent of each state’s Medicaid funding is matched by the federal government, although the exact percentage varies by state. Medicaid is the largest source of federal funding that states receive. Changes in Medicaid enrollment and the cost of healthcare can impact state budgets. For instance, in Mississippi, the percentage of the state’s budget dedicated to Medicaid rose from 22.9 percent in 2010 to 24.8 percent in 2015. However, state cuts to Medicaid funding can also mean fewer federal dollars received by the state.

    During fiscal year 2016, combined federal and state spending for Medicaid in Mississippi totaled about $5.4 billion. Spending on Mississippi’s Medicaid program increased by about 21.2 percent between fiscal years 2012 and 2016. Hover over the points on the line graph below to view Medicaid spending figures for Mississippi. Click on the red bar below the graph to view these figures as compared with three of Mississippi’s neighboring states.

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    Mississippi Medicaid Enrollment Numbers

    Total Mississippi Medicaid enrollment was 618,767 as of May 2021, and 82,642 children had health insurance coverage under CHIP.

    Looking back to the when the ACA and Medicaid expansion were initially rolling out, nearly 14,000 Mississippi residents enrolled in Medicaid or CHIP between October 2013 and April 2014. During the second open enrollment period , 10,699 Mississippi residents enrolled in Medicaid or CHIP. All of these enrollees were already eligible for Medicaid under the existing guidelines, but had not enrolled prior to the opening of the ACA exchanges.

    Medicaid enrollment is year-round though, and people can also apply directly through the Mississippi Division of Medicaid . As of July 2016, total Medicaid/CHIP enrollment in Mississippi was 8% higher than it had been prior to October 2013. Net enrollment increased by 49,990 people during that time period. But by the end of 2017, net enrollment in Mississippi Medicaid/CHIP was only 4% higher than it had been in 2013.

    Given that 30% of Mississippis remaining uninsured population is in the coverage gap, there is no doubt that Medicaid expansion would significantly reduce the uninsured rate in the state. Instead, Mississippi officials are seeking federal permission to implement a Medicaid work requirement thats expected to reduce Medicaid enrollment by about 5,000 people per year.

    How Do I Enroll In Medicaid In Mississippi

    If you are under 65 and dont have Medicare:

    • You can enroll through HealthCare.gov, either online or by phone at 1-800-318-2596.
    • You can fill out the PDF version of the Mississippi Medicaid Application Form and either click the application submit button, or save the completed PDF and email it to
    • You can also print out the PDF application, complete it by hand, and fax, mail, or deliver it in person. You can fax it to 601-576-4164. You can mail it to 550 High Street, Suite 1000, Jackson, MS 39201. Or you can take it to your nearest Mississippi Division of Medicaid regional office.

    If you are 65 or older or have Medicare, use this website to apply for Medicaid.

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