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Mississippi Medicaid is a state-offered program that covers the cost of many healthcare services for eligible residents. The program ensures you can access quality medical care regardless of income and circumstances. The following guide provides a general program overview, explaining who is eligible for Mississippi Medicare and how to apply, the various coverage options, and available benefits.
Only Mississippi residents who are U.S. citizens or qualified aliens may apply for Medicaid and must fall within the specified income guidelines to receive benefits.
With about 40% of the population considered low-income and a significant portion of those living below the federal poverty level, there’s a great deal of interest in Mississippi Medicaid health benefits. According to mississippitoday.org, as of June 2023, over 900,000 Mississippians are enrolled in medicaid. As healthcare costs and health insurance rates soar to record levels, many families need extra help paying for vital medical care.
Mississippi Medicaid secures newborns to the elderly. The program pays for annual doctor visits, life-saving surgeries, and more. It’s a critical lifeline for people who may not otherwise have access to the preventive and acute care they need to live a healthy and productive life.
On this page, Insurdinary aims to answer all your most urgent questions about Medicaid in the Magnolia State, from what MS Medicaid coverage is to how to apply for MS Medicaid. Once you know how the program works and whether you meet the eligibility requirements, you can make wise decisions about your healthcare coverage, including determining whether you need a more comprehensive range of benefits and services by way of private health insurance.
Also known as MS Medicaid, Mississippi Medicaid is a cooperative program between the state and federal governments that provides free or low-cost healthcare to qualifying residents who otherwise cannot afford or access health insurance. Medicaid beneficiaries do not get money to cover their healthcare. Rather, medical providers receive reimbursement payments from the state for their services.
Most beneficiaries receive benefits under the Mississippi Coordinated Access Network or MississippiCAN. This program improves the overall well-being of Mississippians by requiring Medicaid members to choose a Coordinated Care Organization (CCO) to manage their healthcare and provide services. Members can choose from one of three CCOs:
Medicaid recipients also on Medicare, individuals who receive benefits under particular waiver programs, and those who live in a long-term care or nursing facility remain on traditional Medicaid and do not choose a CCO.
Many wonder who pays for Medicaid and whether the program is free for members. In the past, some MS Medicaid members had to pay a nominal copayment for certain services to help share the costs. However, as of May 1, 2023, the state no longer requires copayments for prescriptions or medical services, and the federal and state governments cover the total program cost.
The CCO you select will issue you a membership card when you enroll. The card includes details about your policy, including a group name, number, and membership ID, which the provider will use to bill Medicaid for services. The card shown above is just one example of what an actual Mississippi Medicaid card will look like. A Magnolia Health card for example will look different.
If you also receive Medicare benefits, you will have a separate Medicare card that includes your Medicare ID number. Expect to present both cards when you seek medical care.
The Mississippi Division of Medicaid requires individuals to apply for Medicaid benefits. You can apply online, in person at your nearest regional office or outstation, or via phone, fax, or email.
You can also apply via the online federally facilitated marketplace (FFM) for healthcare coverage at Healthcare.gov. The application is the same, and if the FFM determines you qualify for MS Medicaid benefits, it will return your application to the Mississippi Division of Medicaid for further processing.
Before you apply for Medicaid, gather the following information:
Expect to submit documentation of the information you provide to the state. The online application allows you to do this electronically. If the agency requires additional information to verify your information, they will request it. Not submitting the documents as requested by the deadline will result in an application denial.
Once you submit the completed information and supporting documents, the agency will review it and perform an eligibility assessment. If they approve the application, you will receive Medicaid benefits. If not, your application will automatically go to the FFM, and you can purchase a healthcare insurance policy.
Mississippi Medicaid health benefits vary by individual depending on age, income, and family size and situation. These factors determine what program you qualify for and whether you receive full, reduced, or limited benefits. In addition, certain services fall outside of basic Medicaid plans, but you may be eligible for a waiver program to cover them.
With that in mind, all applicants must meet basic requirements to apply for coverage. To qualify, you must:
The IRS’s Modified Adjusted Gross Income (MAGI) calculation determines the income limits for Medicaid eligibility for children and parents. Your gross income must be less than the MAGI for your household size in your category to qualify. Except for the Children’s Health Insurance Program (CHIP), your household income must be less than 194% of the federal poverty level to get Medicaid benefits.
Some individuals over 65 who receive Medicare benefits can also apply for Medicaid. Mississippi Medicare is a federal health coverage program for seniors without regard to their income. Most seniors qualify and pay a flat monthly fee for their coverage.
Under specific Medicaid programs, qualifying Medicare beneficiaries can get help paying their Medicare premiums, copayments, and deductibles. The state will pay all or some of these costs for low-income seniors whose income is below the limit.
Approved MS Medicaid applicants receive an enrollment package that includes information about the MississippiCAN program and their options for a CCO. You can choose the plan that works best for you in terms of your medical needs and submit the enrollment form. If you don’t select a plan before the deadline, the Department of Medicaid will choose one for you; if you don’t like it, you have 90 days to change it.
Once you enroll in a MississippiCAN program, the insurance company will send you a card and program coverage materials. The card will include your membership number and other information. Present the card when receiving medical services within the provider network.
MS Medicaid rules require enrollees to reconfirm their eligibility every year. Although federal regulations prohibited states from disenrolling beneficiaries during the COVID-19 pandemic, those rules expired in March 2023. Going forward, if you receive Medicaid, you must provide the Department of Medicaid with documentation proving your ongoing eligibility to remain in the program.
The state also requires you to notify the department if your circumstances change before your eligibility review. For example, if you get a new job with health insurance or your income increases significantly, you must report this change to the state. If you no longer meet the criteria to receive benefits, you won’t be able to use your MississippiCAN benefits anymore and will have to seek alternative coverage.
If you lose or damage your health insurance coverage card, contact the MississippiCAN CCO to replace it. You may also contact them via phone, toll free at 1-800-884-3222.
When applying for help with healthcare from the state, most people ask what MS Medicaid covers. Regular Medicaid and MississippiCAN CCOs offer a long list of benefits, including the following:
If you need help getting to your medical appointments, Medicaid offers free non-emergency transportation services to members who pre-arrange a ride.
Overall, the benefits of a MississippiCAN plan are more generous than traditional Medicaid. For example, Medicaid only pays for a new pair of eyeglasses every five years, while MississippiCAN programs cover new glasses every one to three years. The CCO programs offer additional benefits, like a 24-hour hotline where you can speak with a nurse, more home health visits (36 as opposed to 25 per year), and a rewards program.
Healthy teeth and gums are critical to overall well-being, and Mississippi Medicaid covers dental services to support good oral health. Regular Medicaid covers medically necessary dental visits, oral surgery, and orthodontia. MississippiCAN programs also pay for up to six dental treatment visits in a year for most people. Mississippi Medicaid offers a dental plan to cover the costs of appointments and procedures. Children from birth to 20 years old can receive many services free of charge, including:
Medicaid programs offer dental coverage for more than just kids, teens, and young adults. If you’re 19 years old or older, you may be eligible to receive the following dental services through Mississippi Medicaid:
For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Mississippi is advisable.
Federal law does not require state Medicaid plans to cover prescription drugs, but all states, including Mississippi, offer some form of prescription drug coverage in their plans. With this coverage, you can get up to six monthly prescriptions, two of which can be brand-name drugs.
The Universal Preferred Drug List (PDL) guides prescription benefits for Medicaid enrollees. The PDL is a list of covered drugs that beneficiaries can get at no cost through the plan. The state chooses these drugs because they are the most cost-effective, safe, and effective treatments.
If you need a medication not on the PDL, your physician can request a pre-authorization to cover the drug. A pharmacy can also fill a 72-hour supply while pre-authorization is in progress.
Mississippi children who qualify for Medicaid can also receive vaccines for free under the Vaccines for Children program. This program reimburses public and private providers for vaccine administration to eligible children. Prescription benefits also cover certain over-the-counter medications.
Enrolling in a MississippiCAN plan gives you access to a rewards program that supports better health and well-being. Program details vary by carrier and include everything from complimentary car seats for staying on track with prenatal care to gift cards for scheduling specific screenings and points programs that pay for everyday expenses. Here is an example of the rewards program that is offered by Magnolia Health.
Mississippi residents with special needs can access extended healthcare benefits from the state medical assistance program. Benefits include mental health counseling, substance abuse treatment, dialysis, and speech and occupational therapy. Medicaid also covers some alternative treatments, including chiropractic treatment and acupuncture. While the state offers comprehensive coverage for many different situations, many patients require additional care, but they go without because of financial concerns, lack of coverage, and restricted access. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.
Are you planning to travel out of state? Don’t count on using your Medicaid benefits if you get sick or injured while outside Mississippi. Medicaid benefits don’t work from state to state, so if you need medical treatment while away from home, you could be on the hook for the bill. The major exception is emergency treatment in a life-threatening situation when you cannot return home for care.
In some cases, you may be able to use your Medicaid benefits in a state bordering Mississippi. If residents often use a specific facility in a nearby state, your benefits may work there. Confirm whether your policy will apply before you make an appointment to avoid receiving a bill for services that Medicaid doesn’t cover. If you are traveling outside of Mississippi for leisure, invest in proper travelers insurance.
Under the Affordable Care Act, students and young adults can remain on their parents’ insurance policies until age 26, but this does not apply to Medicaid. MS Medicaid only covers children up to age 19. If you age out of Medicaid eligibility, you’ll have to explore other coverage options like the FFM or low-cost plans offered by your college or university.
Seniors have more options for Medicaid coverage. Depending on your income, you may qualify for programs like:
Elderly individuals with full Medicaid benefits can also receive coverage for long-term care in an institutional setting and at home. All eligible individuals can receive assistance for care in a nursing home or help with personal care or adult day care. You can also apply for a Medicaid waiver for home-based care, but because this isn’t an entitlement program, demand is high, and you will likely have to wait for an open slot to receive services.
Some subgroups have additional options for healthcare coverage from the state of Mississippi.
Children qualify for Medicaid coverage up to age 19 if their parents qualify. If their family earns too much money for Medicaid, they may be eligible to enroll in the Children’s Health Insurance Program (CHIP). This program provides health insurance for children up to age 19 if their parents earn less than 209% of the federal poverty level.
Other programs that Medicaid-eligible children can access when medically necessary include an array of early intervention screening and diagnostic programs, such as the following:
Individuals ages 13 to 44 who do not qualify for full Medicaid but are low-income and do not have any other form of health insurance coverage can apply for a family planning waiver. This waiver provides coverage limited to family planning services. Beneficiaries get one annual visit and up to three additional visits with a provider for services related to their birth control methods.
The family planning waiver program covers prescription contraceptives and medication to treat diagnosed sexually transmitted infections (STIs). It also covers STI screenings and lab tests.
Although Mississippi’s Medicaid program covers most medical services the average person needs, it doesn’t pay for everything. If you need any of the following services, you’ll pay out of pocket or use another insurance policy or resource to cover them:
Mississippi Medicaid will only cover a limited dollar amount towards the cost of a funeral. Considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.
Because every state has guidelines about what Medicaid does and doesn’t cover, many people aren’t sure what services and procedures they can get. Although the following list isn’t exhaustive, and the rules change frequently, it is a current overview of what Mississippi Medicaid and the MississippiCAN programs will pay for:
| Dental | |
|---|---|
| X-Rays and Exams | Yes |
| Oral Surgery | Yes |
| Tooth Extraction | Yes |
| Orthodontia | Yes |
| Office Visits | |
|---|---|
| Visits | Yes, 16 office visits throughout the calendar year |
| Annual Physical | Yes |
| Routine Lab Work | Yes |
| Chronic Disease Management | Yes |
| Vision | |
|---|---|
| Eye Exams | Yes |
| Glasses | Yes |
| Laser Eye Surgery | Yes, if medically necessary |
| Treatment for Eye Disease | Yes |
| Surgery | |
|---|---|
| Emergency Surgery | Yes |
| Rhinoplasty | Yes, if medically necessary |
| Breast Reduction | Yes, if medically necessary |
| Inpatient and Outpatient Procedures | Yes |
| Hospital | |
|---|---|
| Hospital stays | Yes, if medically necessary |
| Giving birth | Yes, for labour and delivery |
| Sexual Health | |
|---|---|
| Gynecologist visits | Yes |
| Birth Control | Yes, for approved birth control |
| Prenatal Care | Yes |
| Specialist Services | |
|---|---|
| Chiropractor | Yes |
| Speech Therapy | Yes |
| Acupuncture | Yes |
| Dialysis | Yes |
| Allergy Testing and Allergist | Yes |
| Durable Medical Equipment and Supplies | Yes |
| Transportation | |
|---|---|
| Ambulance Services | Yes, if medically necessary |
| Non-emergency Transportation | Yes, Medicaid will help eligible persons to travel to and from medical appointments when they have no other way to get there |
Again, this list does not include everything a Mississippi Medicaid recipient receives. For a complete list of inclusions, refer to the program information you receive from your CCO plan or the Department of Medicaid.
Although the Mississippi Medicaid program covers most of the healthcare services the average individual needs, it doesn’t cover everything. Many people need a private or third-party health insurance policy to meet all their needs, especially Medicare beneficiaries who also qualify for Medicaid. Investing in supplemental Medicaid insurance ensures total coverage for healthcare services the state program doesn’t cover, including:
Choosing the best medical coverage for you and your family isn’t always easy. Insurdinary understands and makes the process simpler with clear, accurate comparisons of policy quotes from leading providers to fill in the gaps in MS Medicaid.Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing. Let us help you find the perfect plan to fit your budgetary and healthcare needs with low copayments, wide provider networks, and more flexibility so you get the best possible care.
When you’re ready to compare Mississippi Medicare and private insurance options, let Insurdinary help you make sense of what’s available to you. Request free quotes from the best insurance carriers in your area today and get peace of mind while you save.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
