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Mississippi Envision :: Quality Healthcare Services Improving Lives

Beneficiary Information



1. WHAT IS MEDICAID?
MS Medicaid is a healthcare program that pays for medical services for qualified people. Medical payments are made from both state and federal government Monies. It helps pay for medical services for low-income and disabled people. For those eligible for full Medicaid services, Medicaid pays providers of health care. Providers are doctors, hospitals and pharmacies who are enrolled as MS Medicaid Providers.

2. WHERE DO I APPLY FOR MEDICAID?
You may apply for Medicaid for low-income families and children under 19 and pregnant women at your Medicaid Regional Office. You may call 1-800-421-2408 to locate your nearest Medicaid Regional Office. If you are disabled, working disabled or 65 or older and not receiving Social Security Income, you may apply for benefits at the Medicaid Regional Offices listed below.

Medicaid Regional Offices
Brandon 601-825-0477 Kosciusko 662-289-4477
Brookhaven 601-835-2020 Laurel 601-425-3175
Canton 601-859-3230 McComb 601-249-2071
Clarksdale 662-627-1493 Meridian 601-483-9944
Cleveland 662-843-7753 Natchez 601-445-4971
Columbia 601-731-2271 New Albany 662-534-0441
Cleveland 662-843-7753 Natchez 601-445-4971
Columbus 662-329-2190 Newton 601-683-2581
Corinth 662-286-8091 Pascagoula 228-762-9591
Greenville 662-332-9370 Philadelphia 601-656-3131
Greenwood 662-455-1053 Picayune 601-798-0831
Grenada 662-226-4406 Senatobia 662-562-0147
Gulfport 228-863-3328 Starkville 662-323-3688
Hattiesburg 601-264-5386 Tupelo 662-844-5304
Holly Springs 662-252-3439 Vicksburg 601-638-6137
Jackson 601-961-4361 Yazoo City 662-746-2309


THINGS YOU NEED TO KNOW


Freedom of Choice:  Most Medicaid Beneficiaries may choose the doctor or clinic they wish to use. The doctor or clinic must be willing to accept Medicaid's Payment.
Other Health Insurance (Third Party Liability / TPL):  You must report to the Division of Medicaid any health insurance you may have. If you have health insurance and Medicaid, you must give your insurance information to your doctor when you get services. Medical payments from any source (insurance, liability coverage, Worker's Comp, employer liability, CHAMPUS, lawsuits, accidents or other) that you get for services covered by Medicaid must be reported to Medicaid. In order to be eligible for Medicaid, you must assign your rights to medical payments from any source to the Division of Medicaid. In order to be eligible Medicaid/CHIP, you must assign your rights of medical payments from any source to the Division of Medicaid.
Medicaid Identification (ID) Card:   Once Medicaid eligibility has been approved, each Medicaid-eligible member in a family will get a Plastic ID card in the mail. The card is green with a gray Medicaid symbol and has the beneficiary's name and ID number printed in black writing.
Things You Must Do To Get Health Care Services:   Always remember to take your Medicaid ID card every time you go to get health services. Remember that not all doctors, dentists and other providers accept Medicaid. You should always ask the provider if he accepts MS Medicaid before you get services.
Civil Rights:   Participating providers of services in the Medicaid program must comply with the requirements of Title VI of the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973. Under the terms of those laws, a participating provider or vendor of services under any program using federal funds is prohibited from making a distinction in the provision of services to beneficiaries on the grounds of race, age, gender, color, national origin or disability. This includes distinction made on the basis of race or disability with respect to (a) waiting room, (b) hours for appointments or (c) order of seeing patients.
Fair Hearings:   The Social Security Administration (SSA) holds fair hearings for Medicaid eligibility decisions that are part of a Supplemental Security Income (SSI) decision for low income, aged and blind and disabled individuals. You may call the SSA at 1-800-772-1213. The Division of Medicaid (DOM) holds fair hearings for Medicaid eligibility decisions handled by Medicaid Regional Offices. You may call the DOM toll-free at 1-800-421-2408 or local at 601-359-6050 or 601-359-6133 for the office nearest you.
What To Do If . . .:  
    Your health care provider is giving a service that you think you may not need or
    You think your health care provider may be billing for services you did not get or
    Your provider wants you to pay for a service you think Medicaid covers.
If you have any of these situations, call the Bureau of Program Integrity Hotline at 1-800-880-5920.

MEDICAID SERVICES
         (For beneficiaries eligible for full Medicaid benefits, the following are covered services)
Office Visits and Family Planning Services -- Medicaid pays for 12 office visits from July 1 to June 30 each year. (Children can get more visits if the doctor sends Medicaid a plan of care that says there is a medical need for the child to have more visits.)
Hospital Care - Inpatient Services -- Adults get 30 days of inpatient hospital services from July 1 to June 30 each year. Children can get more visits with a plan of care.
Hospital Care - Outpatient Services -- Beneficiaries get 6 emergency room visits from July 1 to June 30 each year. Children can get more visits with a plan of care.
Prescription Drugs -- You may get five (5) prescriptions per month. No more than two (2) of the five prescriptions may be name brands, including refills. Children under 21 years of age may get more than five (5) prescriptions if the doctor sends Medicaid a plan of care.
Eyeglasses -- Adults can get one (1) pair of eyeglasses every five (5) years. Children may get up to two (2) pairs of eyeglasses per year. If a child needs more than two (2) pairs of eyeglasses in a year, the doctor has to send Medicaid a plan of care which says there is a medical need for the child to have another pair of eyeglasses.
Home Health Services -- Adults get 25 home health visits from July 1 to June 30 each year. Children can get more visits with a plan of care.
Long Term Care Services -- Medicaid pays for nursing facility care, intermediate care facility services for the mentally retarded, and psychiatric residential treatment facility care (under age 21).
Inpatient Psychiatric Care -- Psychiatric residential treatment services are covered for children under age 21. Prior authorization is required. Acute Freestanding Psychiatric Facility services are covered for children under the age of twenty one. Prior authorization is required. Acute Psychiatric Services at general hospitals are covered for children and adults. Beneficiaries can get 30 days from July 1 to June 30 each year. Children may get more if medically necessary. Prior authorization is required. Geriatric Psychiatric services are not covered. Psychiatric services by physician or nurse practitioner are limited to 12 visits from July 1 to June 30 each year and do not count against the 12 physician office visits for medical issues. Children may get more if medically necessary and prior authorized.
Non-Emergency Transportation Services -- Medicaid will help eligible persons to travel to and from medical appointments when they have no other way to get there. Call 1-866-331-6004 to find out how to get help with transportation to your appointment.

COVERED SERVICES ALSO INCLUDE
Ambulatory Surgical Center
Chiropractic Services
Dental Extractions and Related Treatment
Dialysis Services
Durable Medical Equipment
Emergency Ambulance Services
Hospice Services
Laboratory Services
Radiology
Medical Supplies
Mental Health Services
Physician Services, Physician's Assistant Services, Nurse Practitioner Services
Physical, Occupational, Speech Therapy
Transplants
Medicaid Beneficiaries are encouraged to get a yearly health screening from your doctor or clinic.

This Physical examination will not be used to determine your eligibility for the Medicaid Program.

MEDICAIDS PROGRAMS
EPSDT -- is a FREE health care program for Mississippi's children ages birth through 21 who are eligible for Medicaid. It provides a way for children to get the medical exams, checkups, follow-up treatment, and special care they need to make sure they are healthy.
           EPSDT exam will include:
A complete physical examination
Hearing and vision examinations
Any shots that are needed
Necessary blood and urine tests
Blood lead levels
An examination of the child's development -- how he or she behaves, walks, talks, dresses, climbs, and eats
An evaluation of the family's nutritional habits--what foods the child and his or her family eat
Medical referral or referral to another health care provider if special problems are discovered during the exam
Adolescent Counseling
Home and Community Based Services (HCBS) -- is responsible for operating five HCBS programs, which include the Elderly and Disabled waiver, Independent Living waiver, and the Mentally Retarded/Developmentally Disabled waiver, the Assisted Living waiver, and the Traumatic Brain/Spinal Cord Injury waiver. The 1999 Legislature mandated that these programs be expanded over the next five years. HCBS Programs offer in-home services to help people live at home instead of in nursing homes. You must apply and be approved for these services. To learn more about this program, call the Home and Community Based Services program at 1-800-421-2408 or local at 601-359-6050 or 601-359-6133.
Mississippi Health Benefits for Children -- Health benefits for children from birth to age 19 are provided through Medicaid. Some children may be eligible for Medicaid. Other children whose families make too much money to qualify for Medicaid may be eligible for Blue Cross Blue Shield health insurance, otherwise known as the Children's Health Insurance Program (CHIP). Families may earn up to 200% of the federal poverty level and be eligible for CHIP.

CO-PAYMENTS
A co-payment is a small cost you must pay for the service you get.
Children under the age of 18, pregnant women and persons in nursing homes do not have to pay a co-payment.
You do not have to pay a co-payment if you are getting family planning services or emergency services in an emergency room.
The following fees are paid to the provider at the time service is provided.
    Ambulance(per trip) $3.00
    Dental (per visit) $3.00
    Federally Qualified Health Center $3.00
    Home Health (per visit)) $3.00
    Hospital Patient (per visit) $10.00
    Hospital Outpatient (per visit) $3.00
    Physician (per visit) $3.00
    Prescription (per prescriptions; generic and brand) $3.00
    Rural Health Clinic (per visit) $3.00
    Eyeglasses (per pair) $3.00
    Durable Medical Equipment,Orthotics and Prosthetics (up to) $3.00