MS HB1356

Governor and Division of Medicaid directed to seek a Section 1115 federal waiver to expand Medicaid coverage under a plan called "One Mississippi" that includes health care delivery system and payment model reforms.

Eligible individuals are ages 19-64 with household income not exceeding 138% of federal poverty level; Regional Care Organizations (RCOs) will manage coverage with minimum 75% participation from hospitals, primary care providers, federally qualified health centers, and community mental health centers in each region.

RCOs may select either an upside-only shared savings model (with 2-3.9% minimum savings threshold) or a two-sided risk model (with 2% minimum savings threshold and downside loss-sharing obligations).

Members must opt in to RCO coverage and those with income above 50% of federal poverty level pay an annual membership fee of $25.

Amends Section 43-13-115 of Mississippi Code to add individuals eligible under the Section 1115 waiver as a new category of Medicaid recipients; effective July 1, 2019.