Mississippi Medicaid Office

Mississippi Medicaid office (DOM)

The Mississippi Division of Medicaid (DOM) runs the state's Medicaid program from a single Jackson headquarters and routes member, provider, and stakeholder questions through a small set of intake forms rather than a county office network. The provider side moves through the MESA Portal; the member side goes through the toll-free line, mailed paperwork, and category-specific enrollment pages for MississippiCAN, CHIP, and the home- and community-based waivers.

How to reach DOM

• General phone — toll-free 1-800-421-2408 or 601-359-6050.
• Fax — 601-359-6294.
• Mailing address — P.O. Box 2222, Jackson, MS 39225.
• MESA Portal (providers) — portal.ms-medicaid-mesa.com/MS/Provider for enrollment, claims, and provider self-service.
• Agency website — medicaid.ms.gov for policy manuals, news, and the Eligibility Policy and Procedures Manual.

DOM intake forms — file the right one

DOM directs specific requests to dedicated SmartSheet forms rather than the general phone line. Pick the one that matches what you need:

• Report Third Party Insurance — when a member has new or changed private insurance that should bill before Medicaid.
• Report Fraud and Abuse — to flag suspected misuse of Medicaid benefits by a member or provider.
• Subrogation Request — for claims or lien information when a third party may be liable for a member's medical costs.
• Public Records Request — official request under the Mississippi Public Records Act of 1983.
• Data Request — for non-public-records data extracts; reviewed separately from records requests.
• Request for Coverage (RFC) — to propose a new or existing benefit for DOM review (experimental, non-FDA-approved, investigational, or cosmetic services are not considered).

For protected health information, DOM asks requestors to review the agency's Notice of Privacy Practices before submitting any form.

Who qualifies for Mississippi Medicaid?

Mississippi has not adopted the ACA Medicaid expansion. Working-age adults without dependent children, a disability, or pregnancy generally do not qualify on income alone, regardless of how low that income is — DOM directs those applicants to the federal marketplace instead, where premium tax credits are available between the poverty level and 400% FPL.

Five basic requirements to qualify

Before DOM looks at any category-specific rule, an applicant must clear five threshold tests:

• U.S. citizen or qualified alien
• Resident of Mississippi
• Meet age, disability, and income tests for the applicable category; meet resource limits for aged, blind, or disabled coverage groups
• File an application form
• Provide requested verification within the allowed time limits

Populations covered by Mississippi Medicaid

DOM lists the eligible groups on its Medicaid Coverage page — the agency's published populations are children, low-income families, aged or blind or disabled adults, and pregnant women. Each category has its own income standard, and some categories also carry a resource (asset) test:

• Children under 19 — Medicaid or the separate CHIP program at higher income standards than adult coverage.
• Pregnant women — covered through pregnancy and the postpartum period; the Mississippi CHIP State Plan covers pregnant women through CHIP as well.
• Parents and caretaker relatives (TANF-related) — covered at the state family income standard, below the children's threshold.
• SSI recipients and other aged, blind, or disabled adults — non-MAGI category with both income and resource limits.
• Long-term services and supports (LTSS) — nursing facility, ICF/ID, and HCBS waiver applicants meet a separate financial test plus a functional (level-of-care) test.

Marketplace screening flows back to DOM

An application submitted at HealthCare.gov is screened for Medicaid and CHIP first. If any household member looks Medicaid- or CHIP-eligible, the marketplace transfers the account to DOM for a formal decision — no separate Medicaid application is needed. This is the primary path for households that started at the marketplace and then learned a child or pregnant family member could qualify for Medicaid.

What benefits each category gets is in the policy manual

The Eligibility Policy and Procedures Manual on medicaid.ms.gov is the authoritative source for exact category criteria, income standards by household size, and verification rules. Use it (or call 1-800-421-2408) before relying on any category-specific number.

Mississippi Medicaid income limits

The clearest published Mississippi Medicaid income-limit chart appears on DOM's MississippiCAN populations page — the percentages below are verbatim from that chart. They define who must enroll in MississippiCAN managed care versus who has an option to stay in fee-for-service Medicaid. Children's coverage limits in Mississippi step down sharply with age, so a household with a 4-year-old and a 14-year-old may see them qualify under different income standards.

Children's income limits (MississippiCAN mandatory)

Pregnant women and parents/caretakers (MississippiCAN mandatory)

Adults qualifying on disability or specific conditions

Who is not enrolled in MississippiCAN

Three groups remain in regular (fee-for-service) Medicaid rather than MississippiCAN:

• Beneficiaries in any HCBS waiver — Elderly and Disabled (E&D), Independent Living (IL), Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI), Assisted Living (AL), or Intellectual Disabilities/Developmental Disabilities (ID/DD).
• Beneficiaries who have both Medicare and Medicaid (dual eligibles).
• Beneficiaries in institutions — Nursing Facilities, Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/ID), correctional facilities, and similar.

SSI children, disabled children living at home, and foster care children (Title IV-E and CWS pathways) ages 0–19 are listed as optional MississippiCAN populations — they can choose between MississippiCAN managed care and regular Medicaid.

Income standards change each January when the federal poverty level updates. Verify a specific figure with DOM at 1-800-421-2408 or in the agency's Eligibility Policy and Procedures Manual before relying on a number for an application.

How to apply for Mississippi Medicaid

Unlike states that funnel every Medicaid application through one consumer portal, Mississippi splits the application path by category. Children's coverage often starts at HealthCare.gov and transfers to DOM; MississippiCAN, CHIP, and the Mississippi Access to Care (MAC) long-term care framework each have their own enrollment paths; and the broad federal Medicaid timelines apply to all of them.

Where to start

• Start at HealthCare.gov if you may also qualify for marketplace coverage — a single application screens for Medicaid, CHIP, and federal premium tax credits. If any family member looks Medicaid- or CHIP-eligible, the marketplace electronically transfers the account to DOM for a formal Medicaid decision; you do not file a separate Medicaid application.
• Call DOM at 1-800-421-2408 for help finding the right paper form or to ask which category fits the household.
• Mail completed paperwork to P.O. Box 2222, Jackson, MS 39225 or fax to 601-359-6294.

What to submit

The five basic Medicaid requirements (citizenship or qualified-alien status, Mississippi residency, age or disability, income, and a filed application with verification) translate into a small document checklist:

• Proof of identity and citizenship or qualified-alien status
• Proof of Mississippi residency (utility bill, lease, mail addressed to the household)
• Pay stubs, employer statements, or self-employment records covering the past month or two
• Bank statements and other resource documentation if applying as aged, blind, or disabled
• Proof of pregnancy when applying as a pregnant individual
• Social Security numbers for each household member applying

How long does a decision take?

Federal Medicaid rules give Mississippi up to 45 days to decide a non-disability application and up to 90 days for an application based on disability. Pregnancy and presumptive-eligibility decisions can be same-day at hospitals and qualified clinics. Coverage may be retroactive up to three months before the application month when the applicant had qualifying medical bills during that window.

Specialized application paths

• CHIP and MississippiCAN enrollment — DOM publishes dedicated enrollment pages for the CHIP program and the MississippiCAN managed-care program; the same medicaid.ms.gov site links each one. CHIP and MississippiCAN paths exist alongside (not in place of) the standard Medicaid application.
• Long-term services (MAC 2.0) — applicants needing nursing-facility, ICF/ID, or HCBS waiver coverage apply through the Mississippi Access to Care framework. MAC 2.0 unifies the state's Money Follows the Person demonstration, the federal Balancing Incentive Program, and the Sustainable Housing planning work; ask the toll-free line for the right intake.

What Mississippi Medicaid covers

Mississippi Medicaid runs on a hybrid delivery model: most MississippiCAN-mandatory members receive their care through one of three Coordinated Care Organizations (CCOs), while members in HCBS waivers, dual eligibles, and institutionalized members stay in fee-for-service Medicaid. The CCO contracts require the same core benefit package; the CCOs compete on extras.

The three MississippiCAN CCOs

• Magnolia Health — magnoliahealthplan.com
• TrueCare — mstruecare.com
• Molina Healthcare — molinahealthcare.com

DOM's published rule is direct: all three plans cover the same services Medicaid offers, and each plan adds its own extras (the agency specifically names additional vision and physician-visit benefits as examples). Members compare brochures, confirm their doctor and hospital accept the plan, and pick the plan that best matches their needs. After enrollment, the plan card and the Medicaid card must both be shown at every visit.

Covered services across all three plans

• Physician office visits (the CCO is required to cover more than fee-for-service Medicaid in this category)
• Durable medical equipment (DME)
• Vision (the CCO is required to cover more than fee-for-service Medicaid)
• Dental services — full for children under 21 (EPSDT), limited for adults over 21
• Therapy services (physical, occupational, speech)
• Hospice services
• Pharmacy services
• Mental health services
• Outpatient hospital services (chemotherapy, ER visits, X-rays)
• Inpatient hospital services
• Non-emergency transportation (NET)

Pharmacy rules — the same PDL across all three plans

The three CCOs must use Mississippi Medicaid's Universal Preferred Drug List (PDL) and apply the same prior-authorization criteria as fee-for-service Medicaid. A pharmacist may dispense a 72-hour emergency supply of a non-preferred medication while a prior-authorization request is pending. CCOs may cover additional medications beyond the PDL, but all medications on the regular Medicaid PDL — and all over-the-counter medications covered by regular Medicaid — must also be covered by the CCOs.

What MississippiCAN does NOT cover

The CCOs are not required to pay for long-term care services or waiver services. Those benefits stay with DOM's fee-for-service Medicaid program — that includes nursing facility care and the five HCBS waivers (Elderly and Disabled, Independent Living, Traumatic Brain Injury/Spinal Cord Injury, Assisted Living, and Intellectual Disabilities/Developmental Disabilities).

Provider networks

Each CCO builds its own provider network. All in-network providers must also be enrolled as Mississippi Medicaid providers. CCOs may subcontract for dental, vision, durable medical equipment, lab, and other specialty services — so a member's vision benefits, for example, may run through a dental/vision vendor under the CCO contract rather than through the CCO directly.

Other state Medicaid pages