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Demonstration Approval Period: October 1, 2024 through September 30, 2029 Page 3 of 43

II. PROGRAM DESCRIPTION AND OBJECTIVES

The Healthier Mississippi demonstration was approved in September 2004 and provides coverage for aged, blind, or disabled individuals with incomes at or below 135 percent of the federal poverty level (FPL) who are not eligible for Medicare and do not otherwise qualify for Medicaid.

In the 2004 legislative session, the Mississippi Legislature voted to discontinue Medicaid coverage for the optional Poverty Level Aged and Disabled (PLAD) group effective July 1, 2004. Concerned that this population was at risk for costly adverse events, including institutional placement, if medical regimens were not maintained, the state applied and received approval for a section 1115 demonstration to continue coverage for this population.

The demonstration was predicated on the assumption that continued access to medical care by the PLAD population will delay deterioration in health status which drives hospitalization and/or institutionalization in a nursing facility. Under the 2010 extension, the state requested, and CMS increased the enrollment cap from 5,000 to 5,500. Under the 2015 extension, CMS increased the enrollment limit from 5,500 to 6,000, and added to the benefit package the following previously excluded services: podiatry, eyeglasses, dental, and chiropractic services. In 2018, CMS extended the demonstration with no changes.

On September 24, 2024, the demonstration was extended for five years through September 30, 2029, with no programmatic changes. During the demonstration extension period, Mississippi expects to achieve the following goal and objectives:

Goal: To prevent hospitalizations and increase access to ambulatory and preventive healthcare by providing insurance coverage, for individuals who are aged, blind or disabled, not eligible for Medicare and do not qualify for Medicaid.

Objective 1: Decrease hospitalizations by two percent for the duration of the demonstration. Objective 2: Increase the utilization of ambulatory/preventive health visits by two percent each demonstration year. Objective 3: Increase the number of preventive health screenings by two percent each demonstration year. Objective 4: Increase the proportion of adults with diabetes who have a hemoglobin A1c (HbA1c) measurement at least once a year by three percent each demonstration year. Objective 5: Increase the proportion of adults with diabetes who have an annual dilated eye examination by three percent each demonstration year.

III. GENERAL PROGRAM REQUIREMENTS

1. Compliance with Federal Non-Discrimination Statutes. The state must comply with all applicable federal statutes relating to non-discrimination. These include, but are not limited