SB2681 Medicaid; seek federal waiver to provide for presumptive…

Plain English Breakdown

The bill did not pass and therefore has no legal effect as of now.

Medicaid Waiver for Children's Mental Health and Substance Use Services

This bill directs the Mississippi Division of Medicaid to seek a federal waiver to provide immediate mental health or substance use services to children who need them, even before their eligibility is fully confirmed.

What This Bill Does

Directs the Mississippi Division of Medicaid to negotiate with the federal government for a waiver under Section 1115 of the Social Security Act.
Allows children needing mental health or substance use disorder services to receive benefits during a presumptive eligibility period while their formal application is pending.
Limits the Medicaid benefits available during this period to only mental health and substance use disorder services.
Establishes requirements for qualified entities to determine presumptive eligibility and notify both the division and the child about the need to apply formally.
Requires children determined to be presumptively eligible to apply for full Medicaid benefits by the end of the month following their determination.

Who It Names or Affects

Children under 18 years old who need mental health or substance use disorder services
Qualified entities that can determine presumptive eligibility and provide these services

Terms To Know

Presumptive Eligibility Period: A temporary period during which children are allowed to receive Medicaid benefits for mental health or substance use disorder services before their formal application is processed.
Qualified Entities: Organizations approved by the Division of Medicaid that can determine if a child is presumptively eligible for Medicaid benefits and provide necessary services during this period.

Limits and Unknowns

The bill did not pass in its session, so it has no legal effect.
It requires the division to submit an application for the waiver by October 1, 2026, but does not specify what happens if the waiver is denied.

Official Summary Text

Medicaid; seek federal waiver to provide for presumptive eligibility for children who need mental health or substance use services.

Current Bill Text

Read the full stored bill text

S. B. No. 2681 *SS26/R347* ~ OFFICIAL ~ G1/2
26/SS26/R347
PAGE 1 (rdd\kr)

To: Medicaid; Appropriations
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Senator(s) Blackmon

SENATE BILL NO. 2681

AN ACT TO CODIFY SECTION 43-13-115.2, MISSISSIPPI CODE OF 1
1972, TO DIRECT THE DIVISION OF MEDICAID TO ENTER INTO 2
NEGOTIATIONS WITH THE FEDERAL GOVERNMENT TO OBTAIN A WAIVER OF 3
APPLICABLE PROVISIONS OF THE MEDICAID LAWS AND REGULATIONS TO 4
PROVIDE MEDICAID BENEFITS TO CHILDREN WHO ARE IN NEED OF MENTAL 5
HEALTH SERVICES OR SUBSTANCE USE DISORDER SERVICES DURING A 6
PRESUMPTIVE ELIGIBILITY PERIOD; TO PROVIDE THAT DURING THE 7
PRESUMPTIVE ELIGIBILITY PERIOD, THE MEDICAID BENEFITS AVAILABLE 8
FOR THOSE INDIVIDUALS WILL BE LIMITED TO MENTAL HEALTH SERVICES OR 9
SUBSTANCE USE DISORDER SERVICES, AS APPLICABLE; TO PROVIDE FOR THE 10
PRESUMPTIVE ELIGIBILITY PERIOD, QUALIFIED ENTITIES, NOTIFICATION 11
REQUIREMENTS, AND A REQUIREMENT TO APPLY FOR MEDICAID BENEFITS; 12
AND FOR RELATED PURPOSES. 13
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 14
SECTION 1. The following shall be codified as Section 15
43-13-115.2, Mississippi Code of 1972: 16
43-13-115.2. (1) The Office of the Governor, Division of 17
Medicaid, shall enter into negotiations with the Centers for 18
Medicare and Medicaid Services (CMS) to obtain a waiver of 19
applicable provisions of the Medicaid laws and regulations under 20
Section 1115 of the Social Security Act to provide Medicaid 21
benefits to children eighteen (18) years of age or less with 22
specific diagnosis, including complex medical conditions, severe 23
S. B. No. 2681 *SS26/R347* ~ OFFICIAL ~
26/SS26/R347
PAGE 2 (rdd\kr)

developmental disabilities, significant communication impairments, 24
or other conditions prescribed by the State Department of Health 25
during a presumptive eligibility period. During the presumptive 26
eligibility period, the Medicaid benefits available for those 27
children will be limited to mental health services or substance 28
use disorder services, as applicable. The presumptive eligibility 29
shall allow immediate access to services while formal 30
documentation is pending, subject to verification. 31
(2) Presumptive eligibility period. The presumptive 32
eligibility period for those children will be the period that (a) 33
begins with the date on which a qualified entity determines, on 34
the basis of preliminary information, that the child is otherwise 35
eligible for Medicaid benefits, and (b) ends with and includes the 36
earlier of (i) the day on which a determination is made with 37
respect to the eligibility of the child for Medicaid benefits, or 38
(ii) in the case of such a child who does not file an application 39
by the last day of the month following the month during which the 40
entity makes the determination that the child is otherwise 41
eligible for Medicaid benefits, such last day. 42
(3) Qualified entities. The determination of presumptive 43
eligibility for those children will be made qualified entities 44
approved by the division that are Medicaid providers and 45
determined by the division to be capable of making Medicaid 46
eligibility determinations for those types of children. 47
S. B. No. 2681 *SS26/R347* ~ OFFICIAL ~
26/SS26/R347
PAGE 3 (rdd\kr)
ST: Medicaid; seek federal waiver to provide
for presumptive eligibility for children who
need mental health or substance use services.
(4) Notification requirements. A qualified entity that 48
determines that a child is presumptively eligible for Medicaid 49
benefits shall (a) notify the division of the determination within 50
five (5) working days after the date on which determination is 51
made, and (b) inform the child at the time the determination is 52
made that an application for Medicaid benefits is required to be 53
made by not later than the last day of the month following the 54
month during which the determination is made. 55
(5) Requirement to apply Medicaid benefits. In the case of 56
a child who is determined by a qualified entity to be 57
presumptively eligible for Medicaid benefits, the child must apply 58
for Medicaid benefits by not later than the last day of the month 59
following the month during which the determination is made. 60
(6) The division shall submit the application for the waiver 61
described in this section not later than October 1, 2026. 62
SECTION 2. This act shall take effect and be in force from 63
and after July 1, 2026. 64