In Mississippi:
  • As of 2011, the state had 621,607 individuals enrolled in Medicaid.
    • 541,854 of these individuals received non-emergency transportation services through a Prepaid Ambulatory Health Plan (PAHP).
    • 51,626 of these individuals received services through Mississippi’s coordinated care program, Mississippi Coordinated Access Network (MississippiCAN) in 2011. Enrollment in MississippiCAN is limited to 45% of Medicaid beneficiaries and is available in all 82 counties. The state’s Division of Medicaid has contracted with two coordinated care organizations (CCOs), capitated health plans that provide the full range of Medicaid benefits to MississippiCan enrollees, excluding inpatient hospital services or transportation services to and from doctor visits. The program is mandatory for certain Medicaid groups, including individuals receiving SSI (ages 19-65), adults with disabilities, women with breast or cervical cancer, pregnant women and infants, families receiving Temporary Assistance for Needy Families, and children age 0-1. The program is voluntary for the following populations: children (ages 0-19) receiving SSI, children (ages 0-19) with disabilities, and foster children (ages 0-19). Voluntary enrollees have the option to opt-out and receive their Medicaid benefits on a fee-for-service basis.
  • The state provides 1915(c) waiver services to children with serious behavioral health needs through Mississippi Youth Programs Around the Clock (MYPAC). MYPAC provides services and supports including intensive case management, wraparound services, and respite services.
As of 2012, 429,897 individuals (aged 0 – 20) were eligible for Mississippi Cool Kids, Mississippi’s Medicaid benefit for children and adolescents (also known as the Early Periodic Screening, Diagnostic and Treatment benefit, or EPSDT). According to CMS data from 2012, Mississippi Cool Kids achieved a screening ratio of 65%. Additionally, 193,415 eligibles received dental services, with 176,016 receiving preventive dental services.
Last updated December 2013.
Medical Necessity
Mississippi’s Medicaid provider policy manual defines “medically necessary services” as those that are
  • Appropriate and consistent with the diagnosis of the treating provider and the omission of which could adversely affect the patient’s medical condition; and
  • Compatible with the standards of acceptable medical practice in the United States; and
  • Provided in a safe, appropriate and cost-effective setting given the nature of the diagnosis and the severity of the symptoms; and
  • Not provided solely for the convenience of the beneficiary or the family, or the convenience of any health care provider; and
  • Not primarily custodial care; and
  • There is no other effective and more conservative or substantially less costly treatment service and setting available; and
  • The service is not experimental, investigational or cosmetic in nature.
In the state’s Medicaid manual for EPSDT services, a “medically necessary service” is defined as “any service that is reasonably necessary to prevent, diagnose, correct, cure, alleviate or prevent the worsening of conditions that endanger life or cause suffering or pain, or result in illness or infirmity, or threaten to cause or aggravate a handicap or cause physical deformity or malfunction. There must also be no other equally effective, more conservative, or substantially less costly course of treatment available or suitable for the client requesting the service.”
Initiatives to Improve Access
The Department of Health (DOH) is a major provider of Mississippi Cool Kids (EPSDT) well-child services in the state. In partnership with Mississippi Medicaid, DOH has developed nurse-run clinics that provide well-child screens, and refer out to physicians for other services, referrals, and follow up. These nurses work with Head Start programs and visit daycare centers to expand access to Mississippi Cool Kids well-child services.
Mississippi works with schools to support a range of school-based health services designed to identify and assist children who have medical issues that interfere with learning. Nurses employed by the Department of Education may also perform Mississippi Cool Kids screens.
Reporting & Data Collection


Only enrolled Mississippi Cool Kids providers are permitted to bill for EPSDT screens, and these providers must use an EPSDT modifier when billing.
Reporting Requirements
Mississippi’s coordinated care program, MississippiCAN, includes EPSDT-specific contract language for participating coordinated care organizations (CCOs)—capitated health plans with specified care management responsibilities—on data and reporting. The state Medicaid agency evaluates EPSDT claims data and sample medical records to determine CCO compliance with EPSDT service provision requirements. CCOs are required to achieve a screening rate of 85% and an immunization rate of 90%; those who do not meet these rates are required to refund Mississippi Medicaid $10 per enrollee for all enrollees under age 12 months. Medicaid publishes the screening rates of CCOs that achieve rates of 85% or greater for the Medicaid population and the medical community in applicable service areas. CCOs are also required to make these screening rates known to potential enrollees in educational and marketing presentations.
MississippiCan CCOs also supply the Department of Medicaid with encounter data that includes claims payment for EPSDT services. In addition to the encounter data, the CCOs must submit quarterly 416 reports that indicate whether the CCOs have met the screening and immunization standards described above.
Behavioral Health
Mississippi Medicaid delivers behavioral health services on a fee-for-service basis  through Mississippi’s private mental health providers and community mental health centers.
The state provides 1915(c) waiver services to children with Serious Emotional Disturbance (SED) through Mississippi Youth Programs Around the Clock (MYPAC). MYPAC provides services and supports including intensive case management, wraparound services, and respite services. On the MYPAC website, Mississippi provides the MYPAC Initial Screening Form to determine if a child meets criteria for the waiver services, and a Freedom of Choice Form for the families to ensure they have made an informed choice between treatment in a Psychiatric Residential Treatment Facility and participation the MYPAC community-based demonstration.
Mississippi Medicaid has developed an Adolescent Counseling Form for use by physicians during the EPSDT screen for children aged nine and above. The form facilitates a structured interview with adolescents on issues such as substance use, coping skills, and relationships. Providers can bill Medicaid for an EPSDT adolescent screen separately from other EPSDT services using screening code 99401-EP.
Support to Providers and Families
The Mississippi Department of Health (DOH) operates an EPSDT website that provides information on the benefit and how to determine eligibility for these services.
Managed care organizations participating in the Mississippi Coordinated Access Network (MississippiCAN) are required to provide “instructions advising enrollees about EPSDT and how to access such services.” Families of children with special health care needs enrolled in managed care may also request that their specialist be the primary care provider for their child, and “the Contractor shall have in place procedures for ensuring access to needed services for these enrollees or shall grant these PCP requests, as is reasonably feasible and in accordance with Contractor’s credentialing policies and procedures.”
Mississippi Youth Programs Around the Clock (MYPAC)
Youth enrolled in MYPAC, the state’s 1915(c) waiver for children with serious behavioral health needs, are assigned a Family Support Specialist (FSS), who acts as their personal advisor to answer questions about the program. An FSS is someone who has experience as a parent/guardian of a child with Serious Emotional Disturbance (SED).
Support to Providers
Mississippi Medicaid produced a provider manual for EPSDT services, which outlines topics such as provider requirements, covered services, and reimbursement.
Medicaid providers in Mississippi also receive pamphlets and books describing the Medicaid benefit for children and adolescents. The state has developed Screening Documentation Forms for all ages, from 1 month to 15 – 20 years. These forms include a checklist for the providers when performing a screen under the benefit. The forms, and the periodicity, schedule follow Bright Futures guidelines.
Care Coordination
The Mississippi administrative code requires the Medicaid agency to pay for an EPSDT case manager for families of children with developmental disabilities. Case managers must have experience in service coordination for children with disabilities up to age 18 or two years of experience in service provision to children under 6 years of age. Case managers carry out Early Intervention/Targeted Case Management (EI/TCM) activities to assist and enable a child with developmental disabilities receiving the Mississippi Cool Kids benefit to gain access to needed medical and other services, provide service coordination for the child and his or her family, and assist in the development of the Individualized Family Services Plan (IFSP). Case Managers are required to make a minimum of one (1) face-to-face contact quarterly and documented successful contacts monthly.
Coordinated Care Organizations under the state’s MississippiCAN program are required to “be responsible for the management and continuity of medical care for all Enrollees.” In particular, contract language establishes their responsibility for child-specific care coordination such as:
  • “Appropriate referral and scheduling assistance for Enrollees needing specialty health care services, including those identified through EPSDT,” and
  • “Coordination with other health and social programs such as Individuals with Disabilities Education Act (IDEA), Part B and Part C; the Special Supplemental Food Program for Women, Infants, and Children (WIC); Head Start; school health services, and other programs for children with special health care needs, such as the Title V Maternal and Child Health Program.”
Oral Health
Mississippi Cool Kids (EPSDT) providers are encouraged to perform an oral health assessment and apply fluoride varnish at the same time as the child’s regularly scheduled Mississippi Cool Kids Screening.
Medicaid also reimburses dental providers for an oral evaluation and counseling with each child’s primary caregiver for children under the age of three.