Mississippi
This data is meant to be used for educational purposes to inform providers, patients, insurers, and state Medicaid agencies what genetic services may or may not be written into each state’s Medicaid policy. The database is not meant to indicate or imply whether a certain program will cover a specific service, since many decisions are made on a case by case basis. If you have specific questions about whether a service is covered, you should reach out to your plan administrator. Please see this disclaimer below for more information.
Medicaid Coverage Information Published
State Contact Information
Drew Snyder,Executive Director of the Mississippi Division of Medicaid
Mississippi Division of Medicaid:
Toll-free: 800-421-2408
DOM main switchboard phone: 601-359-6050
DOM general fax: 601-359-6294
Office of Client Relations fax: 601-359-4185
Mailing address: 550 High Street, Suite 1000, Jackson, MS 39201
General Genetic Testing Criteria
The Division of Medicaid covers genetic testing when medically necessary to establish a diagnosis of an inheritable disease only when all of the following are met:
- The beneficiary displays clinical features, or is at direct risk of inheriting the mutation in question (pre-symptomatic),
- The result of the test will directly guide the treatment being delivered to the beneficiary,and
- After history, physical exam, pedigree analysis, genetic counseling, and completion of conventional diagnostic studies, a definitive diagnosis remains uncertain.
Genetic Testing Not Covered
The Division of Medicaid does not cover genetic testing:
- Of family members of a beneficiary
- If considered to be experimental, investigational or unproven,
- To determine the likelihood of passing on a trait,
- For the purpose of determining ancestry, or
- Other purposes not specifically defined that are not diagnostic in nature.
State Specific Definition
The Division of Medicaid defines genetic testing as a type of analysis that identifies changes in chromosomes, genes, or proteins that confirms or rules out a suspected genetic condition.
Genetic Services for Children
Genetic Counseling Requirement
No licensure requirement.
Required for genetic testing.
Metabolic Formula Coverage Legislation
No legislation.
Metabolic Formula Coverage & Criteria
DOM covers enteral nutrition when one of the following criteria is met:
- For beneficiaries with inborn errors of metabolism.
- For beneficiaries age 21 years or older, the requested enteral nutritional product must be the sole source of
nutrition or when there are special circumstances (such as chemotherapy and/or radiation therapy to the head
and neck region, etc.) that justify the need for enteral nutrition. - For EPSDT-eligible beneficiaries, specialized enteral feedings must constitute more than 50% of the nutritional
needs. A qualifying diagnosis is required.- EPSDT beneficiaries up to age 5 years must be registered with the federal program for women, infants, and
children (WIC) in order to receive WIC monthly nutritionals. If WIC eligible, DOM may allow up to a 30 day
transition period for NEW starts on WIC covered products. - Provide an estimate of initial coverage needs until WIC benefits start or if there is a gap in coverage of WIC
benefits (up to, but not more than, a 30-day supply). - Please attach and FAX to 877-537-0720 a copy of the WIC program formula request form when submitting
this PA form. Include the WIC Monthly Quantity Limit and the average amount needed after WIC benefits
are exhausted.
- EPSDT beneficiaries up to age 5 years must be registered with the federal program for women, infants, and
- The unique composition of the formula must contain nutrients the beneficiary is unable to obtain from food. The
composition of the formula must represent an integral part of the treatment of the specified diagnosis and/or
condition.
It must be documented that the beneficiary is either unable to take oral nutrition or unable to sufficiently maintain
life without an enteral nutritional replacement product.
Approval may be granted for up to 12 months. A prior authorization for enteral nutrition is for the nutritional
product only and does not include supplies necessary to administer the nutrient.
Prior Authorization Requirements
Prior authorization is required by the Utilization Management/Quality Improvement Organization (UM/QIO) for medical necessity and appropriateness
Prior Authorization Forms
Fee Schedule
BRCA Testing Coverage
Coverage is available.
Requirements for BRCA
Cystic Fibrosis Screening
Coverage is available.
Hereditary Cancer Testing Coverage
Coverage is available.
Lynch Syndrome Testing Coverage
Coverage is available.
Microarray Testing
Coverage is available.
Newborn Screening
The Division of Medicaid pays for all medically necessary services for EPSDT-eligible beneficiaries in accordance with Part 223 of Title 23, without regard to service limitations and with prior authorization
Panel Testing
Coverage is available.
Pharmacogenetic Testing
Coverage is available.
Prenatal Testing Offered
Coverage is available.
Whole Exome Sequencing
Coverage is available.
Other Tests Covered
Other Information
Resources
Newborn Screening Reimbursement
On this Page
Disclaimer: The information contained in the database has been obtained from sources believed to be reliable but NCC has not attempted to validate or confirm the information. The database may be updated periodically. However, the accuracy and completeness of the information contained in the database cannot be, and is not, guaranteed. NCC makes no warranty of the accuracy, completeness or timeliness of this information, and shall not be liable for any decision made in reliance on this information. It is the user’s responsibility to verify this information by contacting the state Medicaid agency directly.
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