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Demonstration Approval Period: October 1, 2024 through September 30, 2029 Page 1 of 43

CENTERS FOR MEDICARE & MEDICAID SERVICES EXPENDITURE AUTHORITY LIST

NUMBER: 11-W-00185/4

TITLE:

Healthier Mississippi Medicaid Section 1115 Demonstration

AWARDEE: Mississippi Division of Medicaid

Under the authority of section 1115(a)(2) of the Social Security Act (the Act), expenditures made by Mississippi for the items identified below, which are not otherwise included as expenditures under section 1903 of the Act, shall, from the date of the approval letter through September 30, 2029, be regarded as expenditures under the state’s title XIX plan.

The following expenditure authority shall enable Mississippi to implement its section 1115 Healthier Mississippi demonstration.

1. Demonstration Population 1. Expenditures for health care services provided to individuals with income at or below 135 percent of the federal poverty level who are aged, blind, or disabled, are not eligible for Medicare, and are not eligible under the Medicaid state plan.

Title XIX Requirements Not Applicable

1. Amount, Duration, and Scope

Section 1902(a)(10)(B)

To enable the state to provide a different benefit package to individuals covered under the demonstration.