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SB 2867

Medicaid; make various amendments to the provisions of the program.

2025 Regular Session Introduced by Sarita Simmons

Mississippi Medicaid would streamline redeterminations for some chronically ill children by pursuing a CMS waiver and broaden advisory committees while tightening leadership rules.

Veto Referred To Medicaid
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Bill Summary · SB 2867

Summary — SB 2867 (2025): Medicaid — various amendments

Status and timeline
- Bill No.: SB 2867 (companion: HB 5428)
- Introduced: March 14, 2025
- Latest status: Vetoed March 27, 2025; Veto referred to the Medicaid committee March 28, 2025. (Legislative history shows committee/subcommittee amendments, concurrence actions, and enrollment steps prior to the veto.)

Purpose / intent
SB 2867 makes multiple statutory changes to Mississippi’s Medicaid law (Miss. Code § 43-13-100 et seq.), clarifying organizational authority, modifying eligibility categories and redetermination procedures, revising advisory committee structures, and changing administrative appeals procedures. It also directs the Division of Medicaid to pursue a federal waiver to alter redetermination frequency for certain children.

Key provisions (high-level)
- Administration and leadership
- Confirms the Division of Medicaid as an Office of the Governor entity.
- Sets qualifications for the full‑time Executive Director (physician with admin experience, or graduate degree in health administration/public health, or bachelor’s plus 3 years Medicaid management/policy experience).
- Prohibits appointment of anyone who has been a member of the Mississippi Legislature in the previous three years.
- Requires a $100,000 fidelity bond for the Executive Director and specifies employment/compensation authority and State Personnel Board involvement.
- Designates Division staff as part of the Governor’s immediate office for certain personnel rules (with specified statutory exceptions).

  • Advisory committee structure and duties

    • Reconstitutes the Medical Care Advisory Committee required by federal regulation, specifying appointment authorities and composition:
    • Governor: 5 appointments (one per congressional district + at-large)
    • Lieutenant Governor: 3 appointments (one per Supreme Court district)
    • Speaker of the House: 3 appointments (one per Supreme Court district)
    • Several legislative committee chairmen (or designees) serve ex officio, nonvoting.
    • Adds a Medicaid Advisory Committee and Beneficiary Advisory Committee per federal rules, effective July 9, 2025.
    • Increases the maximum membership of the (beneficiary/advisory) committee from “no more than 20” to “no more than 40” and makes that change effective July 1, 2025 (Amendment 5).
    • Requires the Executive Director to submit proposed state plan amendments/modifications to the advisory committee for review before implementation.
    • Enumerates advisory duties (advice on state plan amendments, funding/eligibility, service quantity/quality, provider participation) and requires an annual written report by November 30.

  • Eligibility and redetermination changes (Section 43-13-115)

    • Clarifies which agencies determine eligibility for specified categories (e.g., Dept. of Human Services to determine Title IV-E child eligibility; Division of Medicaid to handle others).
    • Restates child/pregnancy income eligibility levels:
    • Children ages 6–19: ≤ 133% of Federal Poverty Level (FPL)
    • Children ages 1–5: ≤ 143% FPL
    • Infants <1 year: ≤ 194% FPL
    • Aged/disabled category: persons 65+ or disabled under SSA §1614(a)(3) with income ≤ 135% FPL (and resource limits set by the Division).
    • Explicitly includes individuals covered under the Section 1115(c) “Healthier Mississippi” waiver in the aged/disabled category.
    • Directs the Division to submit a waiver to CMS by July 1, 2025, to permit less frequent medical redeterminations for certain children with long‑term or chronic conditions (i.e., streamline renewal frequency).

  • Administrative hearings and appeals

    • Removes or limits certain hearing options and modifies appeals procedures (including eliminating appeals to the Chancery Court of the First Judicial District of Hinds County following an administrative appeal).
    • Deletes statutory language authorizing the Division to tax administrative hearing costs (court reporter/transcript) to providers who lose their defense.
    • Makes related procedural edits to notice and appeal timing.

Who is affected / likely impacts
- Medicaid beneficiaries: clarifications of eligibility categories and the directive to seek a waiver to reduce redetermination frequency for some children could reduce renewal burden for qualifying children with chronic conditions.
- Providers: changes to hearing/appeal procedures and removal of cost-taxing language reduce certain liability/risk associated with administrative appeals; other procedural changes may affect provider appeal routes.
- Division of Medicaid and Dept. of Human Services: specified responsibilities for eligibility determinations and new procedural requirements (advisory reviews; waiver submission by July 1, 2025).
- Governor’s office/personnel: strengthened appointment/organizational controls over Division leadership and staff alignment with the Governor’s office.

Notable deadlines and effective dates
- Waiver submission to CMS required by July 1, 2025.
- Creation of Medicaid Advisory Committee and Beneficiary Advisory Committee effective July 9, 2025.
- Certain committee composition/size changes effective July 1, 2025.

Notes
- The bill is a committee substitute with multiple adopted amendments that adjust committee sizes, clarify language, add procedural limits on appeals, and impose specific deadlines.
- Status: vetoed by the Governor (3/27/2025) and referred back to the Medicaid committee for further action.

Compiled from official sources — confirm details with the bill’s official record.

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