MS HB1597

Directs Mississippi Division of Medicaid to seek a Section 1115 waiver from the Centers for Medicare and Medicaid Services (CMS) to create the Healthy Mississippi Works (HMW) program providing Medicaid coverage to individuals aged 19-64 with income at or below 138% of federal poverty level.

Requires HMW enrollees to work at least 80 hours per month, be full-time students, or participate in workforce training programs, with exemptions for caregivers, disabled individuals, and other specified categories.

Requires HMW enrollees to use managed care organizations (MCOs), coordinated care organizations (CCOs), or provider-sponsored health plans (PSHPs) for service delivery and imposes copayments for non-emergency emergency room use that may be waived if the patient calls a nurse hotline first.

Establishes funding through a combination of federal and state matching funds, including a 4% assessment on MCOs, CCOs, and PSHPs; if federal matching funds fall below 90%, the program must be discontinued.

If the waiver is not substantially approved by September 30, 2025, or if subsequently terminated, the Division of Medicaid shall instead implement HMW as a state plan amendment category with substantially similar terms; all provisions expire January 31, 2030.