Mississippi

Medicaid

Authored By: North Mississippi Rural Legal Services LSC Funded
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Medicaid

  1. What Is Medicaid?
  2. What Are the Recent Changes in the Mississippi Medicaid Program?
  3. What Are the Eligibility Requirements for the Medicaid Poverty Level Aged and Disabled Program?
  4. What Are the Medicaid Eligibility Requirements for the Qualified Medicare Beneficiary Program (Qmb)?
  5. What Are the Medicaid Specified Low Income Medicare Beneficiary Program (Slmb) and QI-1 Programs?
  6. What Is the QI-2 Program under Medicaid?
  7. What Is the Working Disabled Program?
  8. Which Resources Do Not Count in Determining Medicaid Eligibility?
  9. Can Grandparents Who Are Custodians, Apply for Medicaid for Grandchildren?
  10. What Are the Eligibility Requirements for Children under Medicaid and the Chip Program?
  11. Are SSI Recipients Eligible for Medicaid?
  12. What is the Disabled Child Living at Home program?
  13. Where Can a Person Apply for Medicaid in Mississippi?

What is Medicaid?

Medicaid is a program administer by the Mississippi Division of Medicaid, a state agency. A list of addresses and telephone numbers for Mississippi's State and Regional Medicaid offices can be found at www.dom.state.ms.us. Go to Medicaid Regional Offices. Medicaid pays for many, but not all health care services for state residents who meet the eligibility requirements. Medicaid is funded jointly by the state and federal governments. In order to receive services under Medicaid, a person must meet eligibility guidelines. Medicaid services and eligibility guidelines vary from state to state.

Also, eligibility requirements vary depending on which Medicaid program an individual applies for. For instance, the income limits vary from program-to-program. Also, some Medicaid benefits do not have a resource limit. As a result, a person who owns non-exempt property or has other resources such as a bank account that exceeds the resource limits for some Medicaid programs, may be eligible for other Medicaid programs. The eligibility requirements for the Medicaid programs change each year in February or March when the Federal Poverty Level is established by Congress. Also, changes occur during the year due to actions of the Mississippi Legislature; actions taken by the federal regulatory agency, the Center for Medicare and Medicaid Services; and actions taken by the state agency, The Division of Medicaid.

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What are the recent changes in the Mississippi Medicaid program?

Everyone following the news this Spring (2002) has been aware that the Mississippi Division of Medicaid is experiencing a budgetary crises. The crisis has been temporarily averted by the allocation of Tobacco Funds, funds from other sources and some program changes. Some of the very recent program changes are as follows:

Effective May 1, recipients are responsible for increased copayments. (Copayments do not apply to children under age 18, nursing facilities, family planning services, or emergency room services certified as a true emergency.)

Effective June 1, the Division of Medicaid will not reimburse for a name brand drug if an equally effective generic equivalent drug is available.

Effective May 1 all prescriptions will be filled for a maximum 34 day supply.

Effective May 1 the maximum number of prescriptions allowed per beneficiary was reduced from 10 per month to 7 per month (5 without prior authorization). The physician must sign and submit a letter explaining the diagnosis and the medical necessity. If Medicaid approves, the pharmacy will be given a prior approval number.

Effective May 1, Medicaid will reimburse for one pair of eyeglasses every five years for adults and one pair of eyeglasses per year for beneficiaries under the age of 21 years (and with prior authorization additional medically necessary eyeglasses).

The Health MACS primary care case management program was eliminated April 1, thus ending the only Medicaid managed care program in Mississippi.

Drug claims for beneficiaries eligible for both Medicare and Medicaid must first be billed to Medicare for payment before Medicaid will process the claim.

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What are the eligibility requirements for the Medicaid Poverty Level Aged and Disabled program?

The Poverty Level Aged and Disabled (PLAD) program of Medicaid benefits includes the fullest range of benefits, including a prescription medicine card and coverage for the gaps in Medicare, for eligible Medicare recipients, among other benefits. Eligibility for this group may begin up to three months before the month of application.

Income/month:Individual$1,047
Couple$1,394
Resources:Individual$4000
Couple $6000

Additionally, the State allows earned income that is irregular to be averaged over a 12 month period.

Currently, Medicaid pays for up to seven prescriptions per month. The recipient can obtain five prescriptions per month without the necessity of pre-approval by Medicaid. An additionally two prescriptions per month can be ordered by the recipient's doctor and approval can be obtained for the additional prescriptions above and beyond the first five by the physician submitting the needed information to the Division of Medicaid.

If a physician order a prescription drug that the pharmacist cannot supply through Medicaid, without approval, the individual can return to the physician and request that the physician contact Medicaid to obtain a prior authorization number. Then the designated pharmacist can be given the authorization number.

Medicaid also now pays for a pair of eyeglasses for adults every 5 years. Effective May 1, 2002, Medicaid will reimburse for one pair of eyeglasses per year for beneficiaries under the age of 21. Medicaid will pay for additional medically necessary eyeglasses for children with prior authorization.

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What are the Medicaid eligibility requirements for the Qualified Medicare Beneficiary program (Qmb)?

QMB includes coverage for those people who are eligible for Medicare Part A, filling the gaps in Medicare benefits for eligible Medicare recipients, including deductibles, co-insurance amounts and premiums. Prescription medicine is not covered unless given in an institutional setting.

Income/month:Individual $789
Couple $1,045
Resources:No limits

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What are the Medicaid Specified Low Income Medicare Beneficiary Program (Slmb) and QI-1 Programs?

The Specified Low Income Medicare Beneficiary Program (SLMB) and Qualified Individual (QI-1) programs pay only the Medicare Part B premiums ($54/mo/ in 2002) for those recipients of Medicare Part A whose incomes are within the limits as follows:

Income/monthIndividual$1047
Couple$1394
ResourcesNo limits

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What is the QI-2 Program under Medicaid?

The qualified Individual (QI-2) benefit pays only a small portion of the Medicare Part B premium, $3.91/month, in 2002. This benefit is for those individuals with Medicare Part A whose incomes are between 135 and 175% FPL. Medicaid will pay this benefit cumulatively at the end of the year.

Income/month Individual $1,343
Couple$1,792
ResourcesNo limits

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What is the Working Disabled Program?

To qualify for full Medicaid with this group a person must: be working at least 40 hours per month; be determined disabled; have monthly income less than;

Earned Income:Individual$3757
Couple$5041
Unearned Income:Individual$1047
Couple$1394
Have resources less than: Individual$24,000
Couple$26,000

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Which resources do not count in determining Medicaid eligibility?

Many resources are exempt and are not counted in determining eligibility for Medicaid. They include: the home and contingent land if it is or was the person's primary place of residence; income producing property if it produces a net annual return of 6% of the equity value; two automobiles; all household goods; personal property valued at $5000 or less; whole life insurance with a face value of $10,000 on each person; term life insurance of any value; burial plots intended for family members; burial funds up to $6000/couple; the value of in-kind support and maintenance for most categories; the general exclusion has been raised from $20 to $50; unlimited exclusion of irrevocable burial funds; no resource limits for QMB, SLMB, QWDI, QI-1, QI-2 categories of recipients.

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Can grandparents who are custodians apply for Medicaid for grandchildren?

Grandparents can assist grandchildren in their custody and care by applying for Medicaid for the child/children. The income of the grandparent will not be counted against the child in the eligibility process. Furthermore, income will not be deemed from parents to pregnant women.

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What are the eligibility requirements for children under Medicaid and the Chip programs?

Children ages 1-6 whose family income is up to 133% of the Federal Poverty Level are eligible for Children's Health Benefits through Medicaid. Children ages 6-18 whose family income is below the Federal Poverty Level are also eligible for Children's Health Benefits through Medicaid.

The State Child Health Insurance Program (CHIP) is a federal program that provides funding to states to expand health insurance coverage for children in low-income families. Under Phase I of CHIP, children in Mississippi are currently covered by Medicaid up to 100% of poverty level to the age of 19. Phase II of the CHIP program, a program that is administered by private insurance, expanded coverage to those with an income level of $200% of the poverty level who have no other credible health coverage and who do not participate in Phase I. There are no resource limitations for the CHIP Program. A chart showing the eligibility requirements for these programs is as follows:

INCOME SCALES FOR HEALTH
BENEFITS PROGRAMS
EFFECTIVE MARCH 1, 2002
UNINSURED CHILDREN UP TO AGE 19
CHIP PHASE II
(ME/99 - 200% FPL)

FAMILY SIZE 12 3 4567 8
MONTHLY INCOME$1477 $1990 $2503$3017$3530 $4043 $4557 $5070

If more than 8 members add $514 for each additional person

CHILDREN UP TO AGE 1 AND PREGNANT WOMEN
INFANT SURVIVAL
(IS/88-185% FPL)

FAMILY SIZE1 2 34 56 78
MONTHLY INCOME$1366$1,841$2316$2791$3266$3741$4215$4690

If more than 8 member add 475 for each additional person

CHILDREN UP TO AGE 6
EXPANDED MEDICAID
(EM/87-133% FPL)

FAMILY SIZE12345678
MONTHLY INCOME$982$1324$1665$2007$2348$2689 $3031$3372

If more than 8 members add $342 for each additional person

CHILDREN UP TO AGE 19
POVERTY LEVEL
(PL/91 CHIP PHASE I - 100% FPL)

FAMILY SIZE12345678
MONTHLY INCOME$739$995$1252$1509$1765 $2022$2279$2535

If more than 8 members add $257 for each additional person.

FAMILIES AMD CHILDREN UP TO AGE 18
MEDICAL ASSISTANCE
(MA/85 - TANF NEED STANDARD)

FAMILY SIZE12345678
MONTHLY INCOME$218$293$368 $443$518$593$668$743

If more than 8 members add $75 for each additional person

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Are SSI Recipients Eligible for Medicaid?

Children (and adults) who have established disability through the Social Security Administration and have qualified for Supplemental Security Income benefits are also eligible for Medicaid.

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What is the Disabled Child Living at Home program?

Disabled children who are living at home, may qualify for Medicaid if: The child needs nursing home or hospital level of care; the child can receive the same level of care at home; the cost of caring for the child at home is no more expensive than that of a nursing home or hospital.

Income limits: The child must have no more than $1635/mo (2002). Resource limits: The child must have no more that $2000.

Eligibility is based upon the child's income and resources alone, without counting the income and resources of the child's parents.

The child's eligibility begins with the month he or she is determined to be qualified, which may be up to three (3) months before the month of application.

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Where Can a Person Apply for Medicaid in Mississippi?

MEDICAID REGIONAL OFFICE ADDRESSES

BRANDON REGIONAL OFFICE
1647 W. Government Street
Brandon, Ms 39042-2410
601-825-0477

BROOKHAVEN REGIONAL OFFICE
128 S. First Street
Brookhaven, MS 39601-3317
601-835-2020

CLARKSDALE REGIONAL OFFICE
325 Lee Drive
Clarksdale, MS 38614-1912
662-627-1493

CLEVELAND REGIONAL OFFICE
201 E. Sunflower, Suite 5
Cleveland, MS 38732-2715
662-843-7753

COLUMBIA REGIONAL OFFICE
1111 Hwy 98 Bypass, Suite B
Columbia, MS 39429-3701
601-731-2271

COLUMBUS REGIONAL OFFICE
2207 5th Street North
Columbus, MS 39701-2211
662-329-2190

CORINTH REGIONAL OFFICE
2907 Hwy 72 West
Corinth, MS 38834-9399
662-286-8091

GREENVILLE REGIONAL OFFICE
585 Tennessee Gas Road
Greenville, MS 38701-8160
662-332-9370

GREENWOOD REGIONAL OFFICE
805 W. Park Avenue, Suite 6
Greenwood, MS 38930-2832
662-455-1053

GRENADA REGIONAL OFFICE
1321 Sunset Drive, Suite C
Grenada, MS 38901-4005
662-226-4406

GULFPORT REGIONAL OFFICE
101 Hardy Court Shopping Center
Gulfport, MS 39507-2528
228-863-3328

HATTIESBURG REGIONAL OFFICE
132 Mayfair Blvd
Hattiesburg, MS 39402
601-264-5386

HOLLY SPRINGS REGIONAL OFFICE
695 Hwy 4 East
Holly Springs, MS 38635-2109
662-252-3439

JACKSON REGIONAL OFFICE
5202 Keele Street, Suite 1
Jackson, MS 39206-4398
601-961-4361

KOSCIUSKO REGIONAL OFFICE
405 W. Adams Street
Kosciusko, MS 39090
662-289-4477

LAUREL REGIONAL OFFICE
1100 Hillcrest Drive
Laurel, MS 39440-4731
601-425-3175

McCOMB REGIONAL OFFICE
301 Apache Drive
McComb, MS 39648-6309
601-249-2071

MERIDIAN REGIONAL OFFICE
3848 Old Hwy 45 N.
Meridian, MS 39302-4939
601-483-9944

NATCHEZ REGIONAL OFFICE
116 S. Canal Street
Natchez, MS 39120-3456
601-445-4971

NEWTON REGIONAL OFFICE
105 School Street Ext
Newton, MS 39345-2622
601-683-2581

PASCAGOULA REGIONAL OFFICE
2035 Old Mobile Avenue
Pascagoula, MS 39567-4413
228-762-9591

PHILADELPHIA REGIONAL OFFICE
1120 E. Main Street, Eastgate Plaza, Suite 1
Philadelphia, MS 39350-2300
601-656-3131

STARKVILLE REGIONAL OFFICE
LeGalerie Shopping Center
500 Russell Street, Suite 28
Starkville, MS 39759-5405
662-323-3688

TUPELO REGIONAL OFFICE
1830 N. Gloster Street
Tupelo, MS 38804-1218
662-844-5304

VICKSBURG REGIONAL OFFICE
2734 Washington Street
Vicksburg, MS 39180-4656
601-638-6137

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