HB1725: Medicaid; seek federal waiver for plan to allow Medicaid coverage for persons described in the federal Affordable Care Act.

Legislative Summary

An Act To Direct The Division Of Medicaid To Enter Into Negotiations With The Federal Government To Obtain A Waiver Of Applicable Provisions Of The Medicaid Laws And Regulations To Create A Plan To Allow Medicaid Coverage In Mississippi For Individuals Described In The Federal Affordable Care Act, To Be Known As Healthy Mississippi Works (hmw); To Specify The Provisions That The Division Shall Seek To Have Included In The Waiver Plan, Which Include The Coverage Group, Copayments For Nonemergency Use Of The Emergency Room, Benefit Packages, Funding Of The Plan, And The Timing For Approval Of The Waiver; To Provide That The Coverage Group For Eligibility Under Hmw Shall Be Individuals Who Are 19 Through 64 Years Of Age Whose Income Is Not More Than 138% Of The Federal Poverty Level, And To The Extent Approved In The Waiver, Who Are Employed For At Least Twenty Hours Per Week In A Position For Which Health Insurance Is Not Provided By The Employer Or Enrolled As A Full Time Student In Secondary Or Post-secondary Education Or Enrolled Full Time In A Workforce Training Program; To Provide That The Coverage Group Shall Not Include Individuals Who Have Health Insurance Coverage Through Their Employer Or Private Health Insurance And Who Voluntarily Disenroll From That Health Insurance Coverage Until Twelve Months After The Ending Date Of That Coverage; To Provide That The Coverage Group Shall Not Include Non-united States Citizens Who Are Ineligible For Medicaid Benefits; To Provide That All Individuals In The Coverage Group Shall Be Enrolled In And Their Services Shall Be Provided By The Managed Care Organizations (mcos), Coordinated Care Organizations (ccos) Provider-sponsored Health Plans (pshps) And Other Such Organizations Paid For Services To The Medicaid Population On A Capitated Basis By The Division; To Provide That All Individuals In The Coverage Group Enrolled Under Hmw Must Pay A Copayment Of Ten Dollars For Nonemergency Use Of The Emergency Room, Which Copayment Will Be Waived Under Certain Circumstances; To Provide That Individuals In The Coverage Group Enrolled Under Hmw Who Are 19 Or 20 Years Of Age Will Receive All Epsdt Benefits To Which They May Be Entitled Under Federal Law And Regulation; To Provide That Individuals Enrolled Under Hmw Who Are 21 Through 64 Years Of Age Will Have Access To The State Plan Benefit Package For Adults Eligible Under The Federal Affordable Care Act; To Provide That The Mcos, Ccos, Pshps And Other Such Organizations Shall Provide The Following Services To Assist Individuals Enrolled Under Hmw With Resources To Enhance Their Workforce Opportunities: Workforce Training And Skills-building To Assist The Individual With Finding A Job Or Advancing Their Career, And Financial Literacy Materials To Promote Wise Financial Decision-making; To Provide That If The Federal Matching Fund Proportion For Medical Services Provided To The Hmw Population Ever Falls Below 90%, The Waiver For Hmw Shall Be Discontinued To Coincide With The Effective Date Of Such A Decrease In The Federal Matching Fund Proportion; To Provide That The State Matching Funds For Hmw Shall Include Contributions From Hospitals That Are Generated Through An Assessment On Hospitals And Contributions From Mcos, Ccos, Pshps And Other Such Organizations In The Form Of An Assessment As Provided In This Act; To Provide If The Waiver As Described In This Act Is Not Substantially Approved Before September 30, 2024, Or If The Waiver Is Approved But Is Subsequently Terminated, Then The Division Shall Allow For Medicaid Coverage In Mississippi For Individuals Described In The Federal Affordable Care Act, To Be Known As The Healthy Mississippi Works (hmw) Category Of Eligibility, And Shall Move With All Deliberate Speed To Submit The Required State Plan Amendments To Effectuate Medicaid Coverage For Those Individuals; To Provide That The Coverage Group, Delivery Systems, Benefit Packages And Funding Of The Hmw Category Of Eligibility Will Be Substantially The Same As Those In The Waiver Plan; To Provide For The Levy Of An Assessment Upon Each Managed Care Organization, Coordinated Care Organization, Provider Sponsored Health Plan Or Other Organization Paid For Services On A Capitated Basis By The Division, In The Amount Of Four Percent On The Total Paid Capitation, Excluding Any Such Paid Amount That Is Attributable To Supplemental Payments; To Amend Section 43-13-115, Mississippi Code Of 1972, To Conform To The Preceding Provisions; To Provide That All Of The Provisions Of This Act Shall Stand Repealed On January 31, 2029; And For Related Purposes.