Authored By: North Mississippi Rural Legal Services
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.
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.
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.
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.
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.
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:
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.
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;
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.
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.
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
If more than 8 members add $514 for each additional person
CHILDREN UP TO AGE 1 AND PREGNANT WOMEN
If more than 8 member add 475 for each additional person
CHILDREN UP TO AGE 6
If more than 8 members add $342 for each additional person
CHILDREN UP TO AGE 19
If more than 8 members add $257 for each additional person.
FAMILIES AMD CHILDREN UP TO AGE 18
If more than 8 members add $75 for each additional person
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.
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.
MEDICAID REGIONAL OFFICE ADDRESSES
BRANDON REGIONAL OFFICE
BROOKHAVEN REGIONAL OFFICE
CLARKSDALE REGIONAL OFFICE
CLEVELAND REGIONAL OFFICE
COLUMBIA REGIONAL OFFICE
COLUMBUS REGIONAL OFFICE
CORINTH REGIONAL OFFICE
GREENVILLE REGIONAL OFFICE
GREENWOOD REGIONAL OFFICE
GRENADA REGIONAL OFFICE
GULFPORT REGIONAL OFFICE
HATTIESBURG REGIONAL OFFICE
HOLLY SPRINGS REGIONAL OFFICE
JACKSON REGIONAL OFFICE
KOSCIUSKO REGIONAL OFFICE
LAUREL REGIONAL OFFICE
McCOMB REGIONAL OFFICE
MERIDIAN REGIONAL OFFICE
NATCHEZ REGIONAL OFFICE
NEWTON REGIONAL OFFICE
PASCAGOULA REGIONAL OFFICE
PHILADELPHIA REGIONAL OFFICE
STARKVILLE REGIONAL OFFICE
TUPELO REGIONAL OFFICE
VICKSBURG REGIONAL OFFICE