Proof of income requirement concerns feds, Medicaid head says

The head of Mississippi Medicaid told lawmakers on Thursday that the agency is working with the federal government to get approval of a new law that allows uninsured, low-income women short-term Medicaid coverage while they wait for their application to be approved.

The program, called presumptive eligibility for pregnant women, has been hailed as a way to get pregnant women earlier access to prenatal care in states that have not expanded Medicaid and to mitigate bad health outcomes for mothers and babies.

Mississippi is one of 10 states in the nation not to expand Medicaid under the Affordable Care Act. 

Mississippi lawmakers wrote in the bill that women must provide proof of income before qualifying for presumptive eligibility, which is potentially at odds with federal regulations. 

“CMS (Centers for Medicare and Medicaid Services) does not like proof of income or proof of pregnancy,” Medicaid Executive Director Drew Snyder said Thursday in an annual legislative budget meeting. “To the current federal administration, a person’s word should be sufficient to get the temporary pregnancy coverage … I’m hopeful that we’ll be able to come to a resolution that is faithful to the state law and satisfies federal expectations.”

It’s not clear whether the state agency will be able to negotiate the details with the federal government or whether the Mississippi Legislature will need to rewrite the law during the 2025 legislative session.

Following the meeting, Snyder quickly left the building and refused to answer questions from a reporter about the status of the program. Mississippi Today has been allowed to communicate about pregnancy presumptive eligibility with the Division of Medicaid solely through email exchanges.

House Bill 539, spearheaded by Medicaid Chair Missy McGee, R-Hattiesburg, would allow low-income pregnant women to get prenatal care while waiting for an official Medicaid application to be approved. The way the bill is written, these women would need to bring proof of income, such as a paystub, to their doctor’s office. 

Federal guidelines, however, state that while the agency may require proof of citizenship or residency, it should not “require verification of the conditions for presumptive eligibility” – which are pregnancy and income. 

“It is my understanding that the Division of Medicaid is currently working with CMS for approval of our presumptive eligibility law, specifically with the language around proof of income,” McGee told Mississippi Today. “This is part of the process and I am optimistic that it will be approved.”

The Centers for Medicare and Medicaid Services, tasked with approving or denying the state’s plan for implementing presumptive eligibility, has until Oct. 9 to make a decision. 

CMS declined to comment on the status of Mississippi’s state plan amendment.

A spokesperson for Medicaid told Mississippi Today via email the agency is moving forward with implementation of the program despite the federal government’s concerns.

The Division is accepting applications from health care providers and conducting eligibility determination training sessions – the final requirement for providers before they can begin treating women under the new policy. Nine medical providers have had their applications approved so far, according to the Division of Medicaid. 

The Division hosted a training for participating Federally Qualified Health Centers Thursday and will be hosting a training for participating hospitals Oct. 10 and 11, according to a participating provider. 

In addition to the nine providers that have been accepted, the University of Mississippi Medical Center – the state’s largest public hospital and largest Medicaid provider – told Mississippi Today it submitted its application on Thursday. 

Below is a list of the nine providers that have been approved to participate as of Sept. 25: 

• Physicians & Surgeons Clinic – Amory
• Mississippi Department of Health, Dr. Renia Dotson – County Health Dept. (Family Planning Clinic)
• Family Health Center – Laurel
• Delta Health Center, Inc (Dr. H. Jack Geiger Medical Center) – Mound Bayou
• G.A. Carmichael Family Health Center Providers – Belzoni, Canton, Yazoo City
• Coastal Family Health Center, Inc. – Biloxi 
• Delta Health System – Greenville
• Delta Medical Group – Women’s Specialty Clinic – Greenville
• Southeast MS Rural Health Initiative Inc. – Women’s Health Center – Hattiesburg

Gwen Dilworth contributed to this report.