Division of Medicaid and Dept. of Human Services; revise provisions under the Transparency and Fraud Prevention Act.

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To: Medicaid
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Eubanks

HOUSE BILL NO. 1387

AN ACT TO AMEND SECTION 43-12-5, MISSISSIPPI CODE OF 1972, TO 1
REQUIRE THE DEPARTMENT OF HUMAN SERVICES AND THE DIVISION OF 2
MEDICAID TO USE AN ELIGIBILITY DETERMINATION SERVICE NO LESS 3
FREQUENTLY THAN QUARTERLY BETWEEN ELIGIBILITY DETERMINATIONS; TO 4
CREATE NEW SECTION 43-12-6, MISSISSIPPI CODE OF 1972, TO REQUIRE 5
THE DEPARTMENT OF HUMAN SERVICES AND THE DIVISION OF MEDICAID TO 6
MONTHLY ASSESS CONTINUED ELIGIBILITY BASED ON A REVIEW OF FEDERAL 7
DATA SOURCES; TO CREATE NEW SECTION 43-12-10, MISSISSIPPI CODE OF 8
1972, TO PROVIDE THAT INDIVIDUALS WHO ARE NOT UNITED STATES 9
CITIZENS SHALL NOT BE ELIGIBLE FOR SNAP OR MEDICAID UNLESS THE 10
INDIVIDUAL MEETS THE DEFINITION OF AN ELIGIBLE ALIEN; TO PROVIDE 11
THAT THE DEPARTMENT OF HUMAN SERVICES AND THE DIVISION OF MEDICAID 12
MUST VERIFY THE ELIGIBILITY OF THOSE INDIVIDUALS DURING ENROLLMENT 13
AND ELIGIBILITY REDETERMINATION USING THE SAVE SERVICE; TO REQUIRE 14
THE DIVISION AND THE DEPARTMENT TO REPORT TO THE APPROPRIATE LAW 15
ENFORCEMENT AUTHORITIES OR FEDERAL AGENCIES INFORMATION CONCERNING 16
ANY HOUSEHOLD MEMBER FOR WHOM IT IS UNABLE TO VERIFY ELIGIBLE 17
ALIEN STATUS; TO CREATE NEW SECTION 43-12-18, MISSISSIPPI CODE OF 18
1972, TO REQUIRE THE DIVISION OF MEDICAID TO LIMIT RETROACTIVE 19
ELIGIBILITY FOR MEDICAID TO NO MORE THAN TWO MONTHS BEFORE THE 20
MONTH IN WHICH A PERSON SUBMITS A COMPLETED APPLICATION; TO CREATE 21
NEW SECTION 43-12-20, MISSISSIPPI CODE OF 1972, TO REQUIRE THE 22
DIVISION OF MEDICAID TO CONDUCT ELIGIBILITY REDETERMINATIONS FOR 23
ALL NONELDERLY ADULT MEDICAID RECIPIENTS AT LEAST ONCE EVERY SIX 24
MONTHS, AND AT LEAST ONCE EVERY TWELVE MONTHS FOR ALL OTHER 25
MEDICAID RECIPIENTS; TO CREATE NEW SECTION 43-12-24, MISSISSIPPI 26
CODE OF 1972, TO REQUIRE THE DEPARTMENT OF HUMAN SERVICES TO 27
ASSIGN CERTIFICATION PERIODS FOR ELIGIBILITY FOR THE SNAP PROGRAM 28
NO GREATER THAN FOUR MONTHS TO CERTAIN HOUSEHOLDS, AND PERIODS OF 29
ONE OR TWO MONTHS FOR CERTAIN OTHER HOUSEHOLDS; TO AMEND SECTION 30
43-12-29, MISSISSIPPI CODE OF 1972, TO REQUIRE THE DEPARTMENT OF 31
HUMAN SERVICES TO VERIFY IDENTITY, HOUSEHOLD COMPOSITION AND 32
EXPENSES BEFORE CERTIFICATION OR RECERTIFICATION; TO PROHIBIT THE 33
DEPARTMENT FROM ACCEPTING THE SELF-ATTESTATION OR SELF-DECLARATION 34
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OF AN APPLICANT OR ENROLLED AS VERIFICATION OF INCOME, ASSETS OR 35
EXPENSES; TO PROHIBIT THE DIVISION OF MEDICAID FROM ACCEPTING 36
ELIGIBILITY DETERMINATIONS FROM A HEALTH INSURANCE EXCHANGE; TO 37
PROHIBIT THE DIVISION OF MEDICAID FROM ACCEPTING SELF-ATTESTATION 38
OF CERTAIN INFORMATION WITHOUT VERIFYING THAT INFORMATION BEFORE 39
ENROLLMENT; TO AMEND SECTION 43-12-39, MISSISSIPPI CODE OF 1972, 40
TO REQUIRE THAT THE REPORT PROVIDED BY THE DEPARTMENT OF HUMAN 41
SERVICES TO THE LEGISLATURE ABOUT SNAP AND TANF BENEFIT SPENDING 42
TO INCLUDE THE NUMBER OF HOUSEHOLDS IN WHICH TRANSACTIONS OCCURRED 43
EXCLUSIVELY OUTSIDE THIS STATE FOR SIXTY CONSECUTIVE DAYS; TO 44
AMEND SECTION 43-12-41, MISSISSIPPI CODE OF 1972, TO REQUIRE THAT 45
THE REPORT PROVIDED BY THE DIVISION OF MEDICAID AND THE DEPARTMENT 46
OF HUMAN SERVICES TO THE LEGISLATURE TO INCLUDE EFFORTS BY THE 47
DIVISION AND DEPARTMENT TO MINIMIZE ELIGIBILITY ERRORS AND FRAUD 48
AND REQUIRE THAT CERTAIN ADDITIONAL INFORMATION BE INCLUDED IN THE 49
REPORT; TO AMEND SECTION 43-13-115.1, MISSISSIPPI CODE OF 1972, TO 50
CONFORM TO THE PROVISIONS OF THIS ACT; AND FOR RELATED PURPOSES. 51
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 52
SECTION 1. Section 43-12-5, Mississippi Code of 1972, is 53
amended as follows: 54
43-12-5. Real-time eligibility verification service. (1) 55
Definitions. For purposes of Sections 43-12-5 through 43-12-17, 56
the following definitions apply: 57
(a) "Department" means the Division of Medicaid or the 58
Department of Human Services, as the case may be. 59
(b) "Identity information" means an applicant or 60
recipient's full name, aliases, date of birth, address, social 61
security number and other related information, including, but not 62
limited to, the information in subsection (2)(a) of this section. 63
(2) Establishment of enhanced eligibility verification 64
service. 65
(a) The department shall establish and use a 66
computerized income, asset, residence and identity eligibility 67
verification service in order to verify eligibility, eliminate the 68
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duplication of assistance, and deter waste, fraud, and abuse 69
within each respective assistance program administered by the 70
department. The information verified shall include, but not be 71
limited to: 72
(i) Earned and unearned income; 73
(ii) Employment status and changes in employment; 74
(iii) Immigration status; 75
(iv) Residency status, including a nationwide 76
best-address source to verify individuals are residents of the 77
state; 78
(v) Enrollment status in other state-administered 79
public assistance programs, as available in a cost-efficient 80
manner; 81
(vi) Financial resources; 82
(vii) Incarceration status; 83
(viii) Death records; 84
(ix) Enrollment status in public assistance 85
programs outside of this state, as available in a cost-efficient 86
manner; and 87
(x) Potential identity fraud or identity theft. 88
(b) The department may issue a Request for Proposals 89
(RFP) from multiple third-party vendors, regardless of the amount 90
of funds to be expended under the contract, for the purposes of 91
identifying fraud in the programs described in this chapter and 92
pursuant to the specifications prescribed in this subsection (2). 93
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After evaluating the proposals submitted, the department shall 94
enter into a competitively bid contract with a third-party vendor 95
for the purposes of using and accessing an eligibility 96
verification service by which to verify the income, assets, 97
residence, identity, and other information in paragraph (a) of 98
this subsection (2) to prevent fraud, misrepresentation, and 99
inadequate documentation when determining an applicant's 100
eligibility for assistance before the distribution of 101
benefits, * * * no less frequently than quarterly between 102
eligibility redeterminations, and during eligibility 103
redeterminations and reviews, as prescribed in this section. The 104
department may use more than one (1) eligibility verification 105
service and/or third-party vendor, if doing so is more 106
cost-efficient. The department may renegotiate an existing 107
contract with a current vendor for the purposes stated in this 108
paragraph (b) if doing so is more cost-efficient than issuing a 109
Request for Proposals (RFP) from multiple third-party vendors. If 110
the department determines that it is not more cost-efficient to 111
renegotiate an existing contract with a current vendor, the 112
department shall issue a Request for Proposals (RFP) from multiple 113
third-party vendors as provided in this paragraph (b), regardless 114
of the amount of funds to be expended under the contract. The 115
department may also enter into a competitively bid contract with a 116
third-party vendor to provide information to facilitate reviews of 117
recipient eligibility conducted by the department. 118
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(c) When the department enters into a competitively bid 119
contract with a third-party vendor or renegotiates an existing 120
contract with a current vendor for the purposes of carrying out 121
this eligibility verification service, the vendor, in partnership 122
with the department, shall be required by contract to establish 123
annualized savings realized from implementation of the eligibility 124
verification service. It is the intent of the Legislature that 125
savings exceed the total yearly cost for implementing the 126
eligibility verification service. 127
(d) To avoid any conflict of interest, when the 128
department enters into a competitively bid contract with a 129
third-party vendor or renegotiates an existing contract with a 130
current vendor, that primary vendor may not currently or will not 131
be allowed to bid on or be awarded a state contract to run 132
enrollment services. 133
(e) It shall be the responsibility of the contracted 134
third-party vendor to obtain access to any data, data sources and 135
databases, not already being used by the department, for the 136
purposes of implementing the eligibility verification service. 137
The payment structure for the contracted third-party vendor shall 138
be based on a per-applicant rate. 139
(f) Nothing in this section shall preclude the 140
department from continuing to conduct additional eligibility 141
verification processes, not detailed in this section, that are 142
currently in practice; and nothing in this section shall require 143
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the department or third-party vendor to violate the Fair Credit 144
Reporting Act. 145
(3) The department shall have the eligibility verification 146
service required by this section implemented and operational not 147
later than July 1, 2019. The department shall submit a report 148
every six (6) months on its progress on implementing the 149
eligibility verification service to the Chairmen of the House and 150
Senate Appropriations Committees, the House Public Health and 151
Human Services Committee and the Senate Public Health and Welfare 152
Committee, and the House and Senate Medicaid Committees. The 153
report also shall be provided to the other members of the 154
Legislature upon request. 155
(4) (a) As used in this subsection, the following terms 156
shall be defined as provided in this paragraph: 157
(i) "Abuse" includes any practice that is 158
inconsistent with acceptable fiscal, business or medical practices 159
that unnecessarily increase cost. 160
(ii) "Fraud" means misrepresenting the truth to 161
obtain an unauthorized benefit. 162
(b) The department shall enter or have entered into a 163
competitively-bid contract with a third-party vendor for the 164
purposes of identifying waste, abuse and fraud in the programs 165
administered by the department, focusing on detecting and 166
preventing abuse and fraud by providers of services in those 167
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programs, and recovering improper payments made to providers of 168
services in those programs. 169
SECTION 2. The following shall be codified as Section 170
43-12-6, Mississippi Code of 1972: 171
43-12-6. Required eligibility verification procedures using 172
federal data sources. (1) At least once a month, the department 173
shall assess continued eligibility and act on any changes that may 174
affect eligibility based on a review of data from the following 175
federal sources: 176
(a) From the United States Social Security 177
Administration, earned income information, death register 178
information, incarceration records, supplemental security income 179
information, beneficiary records, earnings information, and 180
pension information; 181
(b) From the United States Department of Health and 182
Human Services, income and employment information maintained in 183
the National Directory of New Hires database and child support 184
enforcement data; 185
(c) From the United States Department of Housing and 186
Urban Development, payment and earnings information; 187
(d) From the United States Federal Bureau of 188
Investigation, national fleeing felon information; and 189
(e) From the United States Postal Service, change of 190
address information. 191
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(2) Nothing in this section shall be construed to prohibit 192
or preclude the department from verifying eligibility or changes 193
in circumstances using additional data sources, including, but not 194
limited to, other federal, state, and commercial data sources. 195
SECTION 3. The following shall be codified as Section 196
43-12-10, Mississippi Code of 1972: 197
43-12-10. Eligible aliens for welfare and enhanced 198
verification of citizenship or immigration status. (1) No 199
individual who is not a United States citizen or national of the 200
United States shall be eligible for SNAP, unless that individual 201
meets the definition of an eligible alien under 7 USC Section 202
2015(f) and meets the definition of a qualified alien under 8 USC 203
Section 1641(b). 204
(2) No individual who is not a United States citizen or 205
national of the United States shall be eligible for Medicaid, 206
unless that individual meets the definition of an eligible alien 207
under 42 USC Section 1396b(v) and meets the definition of a 208
qualified alien under 8 USC Section 1641(b). 209
(3) The department shall be required to verify that an 210
individual is eligible pursuant to subsection (1) and subsection 211
(2) of this section during enrollment and eligibility 212
redetermination by verifying citizenship or eligible alien status 213
using the Systematic Alien Verification for Entitlements (SAVE) 214
service or requiring the individual to provide an acceptable form 215
of proof of citizenship or eligible alien status, including, but 216
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not limited to, certified birth certificates, United States 217
passports, and United States Customs and Immigration Services 218
documentation. 219
(4) The department shall submit to the appropriate law 220
enforcement authorities, including, but not limited, to the United 221
States Department of Homeland Security, information concerning any 222
household member for whom it is determined to be an unlawfully 223
present alien, regardless of whether such household member is 224
applying to participate in the program as a member of such 225
household. 226
(5) The Department of Human Services shall submit to the 227
United States Department of Agriculture information concerning any 228
household member for whom it is unable to verify eligible alien 229
status, regardless of whether such household member is applying to 230
participate in SNAP as a member of such household. 231
(6) The Division of Medicaid shall submit to the United 232
States Department of Health and Human Services information 233
concerning any household member for whom it is unable to verify 234
eligible alien status, regardless of whether such household member 235
is applying for Medicaid as a member of such household. 236
(7) The entire income and financial resources of any 237
individual rendered ineligible for participation in SNAP under 7 238
USC Section 2015(f) shall be considered in determining the 239
eligibility and benefit allotment of the household of which such 240
individual is a member. 241
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(8) The Division of Medicaid shall adhere to the following 242
requirements regarding the reasonable opportunity period for 243
verification of United States citizenship or eligible alien status 244
for Medicaid: 245
(a) When an applicant's status cannot be verified 246
through available data sources, the division shall provide only a 247
single reasonable opportunity period, consistent with the minimum 248
period required under federal law, for the applicant to provide 249
verification. 250
(b) Medicaid coverage may only be provided 251
provisionally during the reasonable opportunity period. 252
(c) Failure to submit acceptable documentation within 253
the reasonable opportunity period required under federal law shall 254
result in denial or termination of Medicaid eligibility, subject 255
to required notice. 256
(d) No additional reasonable opportunity period shall 257
be granted to any applicant who has previously been denied 258
eligibility at any time due to a failure to verify citizenship or 259
eligible alien status. 260
(9) The Division of Medicaid shall require a field for 261
citizenship or eligible alien status on all presumptive 262
eligibility applications. The division shall require hospitals, 263
clinics, and other qualified entities authorized to conduct 264
presumptive eligibility determinations to collect and transmit 265
attestations of citizenship or eligible alien status to the 266
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division. No presumptive eligibility application shall be 267
approved unless the applicant certifies that they are a United 268
States citizen, United States national, or alien eligible for 269
Medicaid pursuant to 42 USC Section 1396b(v) and subsection (2) of 270
this section. 271
(10) The Division of Medicaid shall: 272
(a) Require each hospital that accepts Medicaid to 273
include a provision on its patient admission or registration forms 274
for the patient or the patient's representative to state or 275
indicate whether the patient is a United States citizen or 276
lawfully present in the United States or is not lawfully present 277
in the United States. 278
(b) Require each hospital that accepts Medicaid to 279
inform a patient, at the time this information is collected, that 280
any submission made on an admission or registration form will not 281
affect patient care, as required by federal law. 282
(c) Require that each hospital submits a quarterly 283
report to the division within thirty (30) days after the end of 284
each calendar quarter that reports the number of hospital 285
admissions or emergency department visits within the previous 286
quarter that were made by a patient who indicated that he or she 287
was a citizen of the United States or lawfully present in the 288
United States, was not lawfully present in the United States, or 289
declined to answer. 290
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(d) By April 1 of each year, submit a report to the 291
Governor, the Lieutenant Governor, and the Speaker of the House of 292
Representatives that includes the total number of hospital 293
admissions and emergency department visits for the previous 294
calendar year for which the patient or patient's representative 295
reported that the patient was a citizen of the United States or 296
lawfully present in the United States, was not lawfully present in 297
the United States, or declined to answer. The report must also 298
describe information relating to the costs of uncompensated care 299
for aliens who are not lawfully present in the United States, the 300
impact of uncompensated care on the cost or ability of hospitals 301
to provide services to the public, hospital funding needs, and 302
other related information. 303
(e) Adopt rules relating to the format and information 304
to be contained in quarterly reports and the acceptable formats 305
for hospitals to use in requesting information regarding a 306
patient's immigration status on hospital admission or registration 307
forms. 308
SECTION 4. The following shall be codified as Section 309
43-12-18, Mississippi Code of 1972: 310
43-12-18. Retroactive eligibility for Medicaid. The 311
Division of Medicaid shall limit retroactive eligibility for 312
Medicaid to no more than two (2) months before the month in which 313
the individual submits a completed Medicaid application. 314
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SECTION 5. The following shall be codified as Section 315
43-12-20, Mississippi Code of 1972: 316
43-12-20. Medicaid eligibility redeterminations. (1) 317
Unless prohibited by federal law, the Division of Medicaid shall 318
conduct eligibility redeterminations for all nonelderly adult 319
Medicaid recipients whose eligibility is determined based upon the 320
application of Modified Adjusted Gross Income standards under 42 321
CFR Section 435.603 at least once every six (6) months. 322
(2) The division shall conduct eligibility redeterminations 323
for all Medicaid recipients not described in subsection (1) of 324
this section at least once every twelve (12) months. 325
SECTION 6. The following shall be codified as Section 326
43-12-24, Mississippi Code of 1972: 327
43-12-24. SNAP eligibility recertification frequency. (1) 328
The Department of Human Services shall assign certification 329
periods for eligibility for the SNAP program no greater than four 330
(4) months to households with zero (0) net income, households that 331
include an able-bodied adult without dependents, or other 332
households whose circumstances are determined by the department to 333
be unstable, unless otherwise prohibited under federal law for 334
SNAP. 335
(2) The department shall assign certification periods of one 336
or two months to households that the department determines will 337
become ineligible for the SNAP program in the near future, unless 338
otherwise prohibited under federal law. 339
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SECTION 7. Section 43-12-29, Mississippi Code of 1972, is 340
amended as follows: 341
43-12-29. Verify identities and household composition, and 342
all expenses of welfare applicants. (1) The Department of Human 343
Services shall verify identity, household composition, expenses, 344
and any other factor affecting eligibility allowed under 7 CFR 345
Section 273.2(f)(3) before certification or recertification. 346
(2) The Department of Human Services shall not accept the 347
self-attestation or self-declaration of an applicant or enrollee 348
as verification of income, assets, or expenses unless such 349
verification is strictly unavailable due to circumstances beyond 350
an applicant or enrollee's control and federal regulations 351
explicitly require the acceptance of such statement to preserve 352
the applicant or enrollee's due process rights. 353
(3) For the purposes of this section, "verification" means 354
independent confirmation of the information provided by the 355
applicant or enrollee through: 356
(a) Third-party data matching sources; 357
(b) Documentary evidence provided by the source of the 358
income; or 359
(c) Direct contact with the income source. 360
(4) If a discrepancy exists between an applicant's or 361
enrollee's statement and third-party data sources, the Department 362
of Human Services shall investigate the discrepancy and may not 363
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certify the applicant or recertify the enrollee until the 364
discrepancy is resolved by independent documentary evidence. 365
(5) The Division of Medicaid shall not accept eligibility 366
determinations from an exchange established under 42 USC Section 367
18041(c). 368
(6) The Division of Medicaid may accept assessments from an 369
exchange established under 42 USC Section 18041(c), provided that 370
the division makes eligibility determinations. 371
(7) Except where required by federal law, the Division of 372
Medicaid shall not accept self-attestation of income, residency, 373
age, household composition, caretaker or relative status, or 374
receipt of other coverage without verifying that information 375
before enrollment. 376
SECTION 8. Section 43-12-39, Mississippi Code of 1972, is 377
amended as follows: 378
43-12-39. Out-of-state spending. (1) The Department of 379
Human Services shall post on its website and make available on an 380
annual basis to the chairmen of the House and Senate 381
Appropriations Committees, the House Public Health and Human 382
Services Committee and the Senate Public Health and Welfare 383
Committee a report of SNAP and TANF benefit spending. The report 384
also shall be provided to the other members of the Legislature 385
upon request. 386
(2) The report required under subsection (1) of this section 387
shall include: 388
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(a) The dollar amount and number of transactions of 389
SNAP benefits that are accessed or spent out-of-state, 390
disaggregated by state; 391
(b) The dollar amount and number of transactions of 392
TANF benefits that are accessed or spent out-of-state, 393
disaggregated by state; 394
(c) The dollar amount, number of transactions, and 395
times of transactions of SNAP benefits that are accessed or spent 396
in-state, disaggregated by retailer, institution, or location, 397
unless expressly prohibited by federal law; * * * 398
(d) The dollar amount, number of transactions, and time 399
of transactions of TANF benefits that are accessed or spent 400
in-state, disaggregated by retailer, institution, or 401
location * * *; and 402
(e) The number of households in which transactions 403
occurred exclusively outside this state for a continuous period of 404
sixty (60) days or more during the reporting period. 405
(3) The report required under subsection (1) of this section 406
shall be de-identified to prevent identification of individual 407
recipients. 408
SECTION 9. Section 43-12-41, Mississippi Code of 1972, is 409
amended as follows: 410
43-12-41. Public reporting. (1) The Division of Medicaid 411
and the Department of Human Services shall provide on an annual 412
basis to the chairmen of the House and Senate Appropriations 413
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Committees, the House Public Health and Human Services Committee 414
and the Senate Public Health and Welfare Committee, and the House 415
and Senate Medicaid Committees, a report of characteristics of 416
recipients of Medicaid, SNAP and TANF benefits and efforts by the 417
Division of Medicaid and Department of Human Services to minimize 418
eligibility errors and fraud. The report also shall be provided 419
to the other members of the Legislature upon request. 420
(2) The report required under subsection (1) of this section 421
shall include: 422
(a) The length of enrollment, disaggregated by program 423
and eligibility group; 424
(b) The share of recipients concurrently enrolled in 425
one or more additional means-tested programs, disaggregated by 426
program and eligibility group; 427
(c) The number of means-tested programs recipients are 428
concurrently enrolled in, disaggregated by program and eligibility 429
group; 430
(d) The demographics and characteristics of recipients, 431
disaggregated by program and eligibility group; * * * 432
(e) The dollar amount spent on advertising and 433
marketing for TANF, SNAP, Medicaid, and other means-tested 434
programs, including both state and federal funds, disaggregated by 435
program * * *; 436
(f) The number of households investigated for 437
intentional program violations or fraud; 438
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(g) Total number of households referred to the Attorney 439
General's Office for prosecution; 440
(h) Improper payments and expenditures; 441
(i) Monies recovered; 442
(j) Aggregate data concerning improper payments and 443
ineligible recipients as a percentage of those investigated and 444
reviewed; 445
(k) A list of the databases and sources used to detect 446
eligibility errors and fraud; 447
(l) The number of households flagged by each database 448
as ineligible for the program; 449
(m) The number of cases in which benefits were adjusted 450
or terminated due to overpayments being made; 451
(n) Timeliness metrics, including, but not limited to: 452
(i) The median number of days from the date a data 453
source flags an eligibility error to the date the division or 454
department initiates verification of the flagged eligibility 455
error; 456
(ii) The median number of days from the date the 457
division or department initiates verification of an eligibility 458
error flagged by a data source to the date that verification is 459
completed; 460
(iii) The percentage of verifications of 461
eligibility errors flagged by a data source that were completed 462
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within thirty (30) days, within sixty (60) days, and within ninety 463
(90) days; and 464
(iv) The number of verifications of eligibility 465
errors flagged by a data source that remain pending for longer 466
than ninety (90) days as of the first day of February in the year 467
the report is due; 468
(o) A comparison of the data reported under this 469
subsection with the preceding year's report, highlighting trends 470
in match volumes, error rates, and recovery outcomes; 471
(p) A summary of corrective actions identified in the 472
prior annual report and the status of their implementation; 473
(q) A brief narrative describing material delays, 474
impediments, or systemic data quality issues encountered during 475
the past twelve months, corrective actions taken to address such 476
issues, interagency or multi-state cooperative activities 477
undertaken, and recommendations for statutory, regulatory, or 478
operational changes to improve program integrity and timeliness. 479
(3) The report required under subsection (1) of this section 480
shall be de-identified to prevent identification of individual 481
recipients. 482
SECTION 10. Section 43-13-115.1, Mississippi Code of 1972, 483
is amended as follows: 484
43-13-115.1. (1) Ambulatory prenatal care shall be 485
available to a pregnant woman under this article during a 486
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presumptive eligibility period in accordance with the provisions 487
of this section. 488
(2) For purposes of this section, the following terms shall 489
be defined as provided in this subsection: 490
(a) "Presumptive eligibility" means a reasonable 491
determination of Medicaid eligibility of a pregnant woman made by 492
a qualified provider based only on the countable family income of 493
the woman, which allows the woman to receive ambulatory prenatal 494
care under this article during a presumptive eligibility period 495
while the Division of Medicaid makes a determination with respect 496
to the eligibility of the woman for Medicaid. 497
(b) "Presumptive eligibility period" means, with 498
respect to a pregnant woman, the period that: 499
(i) Begins with the date on which a qualified 500
provider determines, on the basis of preliminary information, that 501
the total countable net family income of the woman does not exceed 502
the income limits for eligibility of pregnant women in the 503
Medicaid state plan; and 504
(ii) Ends with, and includes, the earlier of: 505
1. The day on which a determination is made 506
with respect to the eligibility of the woman for Medicaid; or 507
2. In the case of a woman who does not file 508
an application by the last day of the month following the month 509
during which the provider makes the determination referred to in 510
subparagraph (i) of this paragraph, such last day. 511
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(c) "Qualified provider" means any provider that meets 512
the definition of "qualified provider" under 42 USC Section 513
1396r-1. The term includes, but is not limited to, county health 514
departments, federally qualified health centers (FQHCs), and other 515
entities approved and designated by the Division of Medicaid to 516
conduct presumptive eligibility determinations for pregnant women. 517
(3) A pregnant woman shall be deemed to be presumptively 518
eligible for ambulatory prenatal care under this article if a 519
qualified provider determines, on the basis of preliminary 520
information, that the total countable net family income of the 521
woman does not exceed the income limits for eligibility of 522
pregnant women in the Medicaid state plan. A pregnant woman who 523
is determined to be presumptively eligible may receive no more 524
than one (1) presumptive eligibility period per pregnancy. 525
(4) A qualified provider that determines that a pregnant 526
woman is presumptively eligible for Medicaid shall: 527
(a) Notify the Division of Medicaid of the 528
determination within five (5) working days after the date on which 529
determination is made; and 530
(b) Inform the woman at the time the determination is 531
made that she is required to make application for Medicaid by not 532
later than the last day of the month following the month during 533
which the determination is made. 534
(5) A pregnant woman who is determined by a qualified 535
provider to be presumptively eligible for Medicaid shall make 536
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ST: Division of Medicaid and Dept. of Human
Services; revise provisions under the
Transparency and Fraud Prevention Act.
application for Medicaid by not later than the last day of the 537
month following the month during which the determination is made. 538
(6) The Division of Medicaid shall provide qualified 539
providers with such forms as are necessary for a pregnant woman to 540
make application for Medicaid and information on how to assist 541
such women in completing and filing such forms. The division 542
shall make those application forms and the application process 543
itself as simple as possible. 544
(7) The Division of Medicaid shall be subject to the 545
provisions of Section 43-12-10(9) in accepting and processing 546
applications for presumptive eligibility for Medicaid under this 547
section. 548
SECTION 11. This act shall take effect and be in force from 549
and after July 1, 2026. 550