Medicaid Costs and Coverage in Mississippi

“How much is Medicaid in Mississippi?” is a question you may be asking yourself now that your application for Medicaid has been approved. To answer the question of how much does Medicaid cost enrollees, it is important to note that it will depend on the types of Medicaid coverage that beneficiaries in the state have obtained. Medicaid cost estimates range depending on the service. In Mississippi, Medicaid services include but are not limited to dental, durable medical equipment, hospice care, mental health, transportation, professional medical and wellness services. Continue reading the topics below to find out more about Medicaid costs and coverage in Mississippi

How much does Medicaid cost in Mississippi?

In Mississippi, how much does Medicaid cost depends on the amount of the beneficiary’s copay for his or her health services. If a Medicaid applicant qualifies for Mississippi Medicaid coverage, then he or she might be required to cover the cost of a copay, or a small fee, for some medical services offered by the program. According to Medicaid coverage in MS, copays are not required from the following groups:

  • Children younger than 18 years of age
  • Pregnant women
  • Beneficiaries in nursing homes or facilities

Medicaid coverage also states that copays are not required for services that include family planning, annual physical exams and emergency services in an emergency room. Those who receive Medicaid coverage in Mississippi are encouraged to get a free yearly health screening from either their doctor or clinic. The yearly screening, or physical examination, is covered by Medicaid and will not be used to determine your Medicaid eligibility in Mississippi. You do not pay for this health screening and it also does not count as one of your office visits.

Coverage for Medicaid in Mississippi states that out-of-pocket costs typically apply to every Medicaid beneficiary except those who are specifically exempted by a law and that most are limited to nominal amounts. In MS, exempted groups include, children, terminally ill beneficiaries and those residing in an institution. Since Medicaid coverage in MS covers low-income and very sick patients, services cannot be withheld to them for failure to pay. But beneficiaries may be held liable for unpaid copays.

In Mississippi, services provided by Medicaid coverage that require copays to be paid to the provider at the time of the service include ambulance, eyeglasses, dental, home health, hospital inpatient and outpatient, physician, prescription drugs and rural health clinics. Additional services covered by Medicaid copays include durable medical equipment for orthotics and prosthetics and federally qualified health centers. Download our comprehensive Medicaid guide to learn about the mandatory covered services available to beneficiaries nationwide.

How does Medicaid coverage work in Mississippi?

What services are covered by Medicaid in Mississippi? While it is up to the state to run its program and select optional Medicaid-covered services, Mississippi it must follow federal guidelines since the state and the federal government fund the program jointly. Coverage for Medicaid in MS states that beneficiaries do not directly receive money from the Medicaid program to pay for the covered health benefits. This is important information about Medicaid, as residents who pay for services will not be compensated later.

The MS Medicaid program states that coverage for Medicaid pays for a set number of office visits plus a physical exam from July 1to June 30 each calendar year. If a doctor sends Medicaid a plan of care saying there is a need for a child to have more than the allotted number of visits, then children can be granted more doctor’s visits. To receive coverage for Medicaid from the state, the Division of Medicaid (DOM) requires a beneficiary to report any health insurance he or she may have. If you have both Mississippi Medicaid coverage and health insurance, then you are responsible for giving your insurance information to your doctor when you get health care services. Any medical payments, regardless of the source, must be reported to Medicaid. These sources include insurance, workers compensation, liability coverage, CHAMPUS, employer liability, accident, and lawsuits. For more information on the health insurance program, download our detailed national Medicaid guide here.

What services are covered by Medicaid in Mississippi?

Medicaid coverage for Mississippi states that beneficiaries who are eligible for full Medicaid benefits are covered for services such as office visits, family planning services, inpatient and outpatient hospital care, prescription drugs, eyeglasses, long-term care services and inpatient psychiatric care. Coverage for Mississippi Medicaid also includes outpatient prescription drugs to all eligible beneficiaries. Beneficiaries who are eligible for Medicaid coverage may get five prescriptions per month and no more than two of the five prescriptions may be name brands, which includes refills. It is important to know information about Medicaid eligibility, as the group a beneficiary belongs to will influence which and how many services are covered by the program.

Coverage for Medicaid under the Home and Community-Based Services (HCBS) Programs in Mississippi offers both in-home and community-based services instead of a standard institutional care. Beneficiaries who qualify for this Medicaid covered service are the most vulnerable and severely ill of the program. These beneficiaries include the elderly and disabled, Supplemental Security Income (SSI) recipients, disabled children who are living at home and those beneficiaries with a traumatic brain injury or spinal cord injury. Applicants will find out if they are eligible for these extended programs after completing the Medicaid application process in Mississippi.

Through Mississippi’s Medicaid covered Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program, which is Medicaid’s definitive standard of care for children, Medicaid provides children enrolled in the program with access to the care that they need at a cost that their parents can afford. The EPSDT program provides a wide and comprehensive array of services under Medicaid coverage for children, which includes developmental, vision and hearing screenings.

Also included in Mississippi Medicaid coverage is the Non-Emergency Transportation (NET) service. The NET service helps beneficiaries travel to and from their medical appointments if the services are deemed medically necessary and when the beneficiary has no other means of transportation. The NET service is covered by Medicaid and is rendered by a Medicaid-approved provider, as long as the beneficiary has not exceeded any service limits that may be associated with the covered service.

What does Medicaid not cover in Mississippi?

In MS, services that are not covered by Medicaid include cosmetic surgery. Medicaid coverage is not available for services and treatments considered elective, as the program is intended to assist with medically necessary procedures and supplies. Medicaid does not cover cosmetic surgery to alter or improve appearance or self-esteem or to treat any psychological symptomatology or psychosocial complaints related to appearance.