MedicaidCoverageMedium impact
Special Enrollment Period for Managed Care Members
Mississippi Medicaid (DOM)·MS · Ophthalmology, Optometry, Pharmacy·Enrollment
Effective date
Jul 1, 2026
We identified it
Jun 21, 2026
Summary
Mississippi Medicaid has implemented multiple policy updates including drug formulary changes, hospital payment methodology updates, vision service fee corrections, and passive enrollment transitions. Key changes affect Farxiga prescriptions moving to non-preferred status, hospital inpatient payment calculations, and claims reprocessing for vision services with incorrect fees.
Action Required
By July 1, 2026: Billing team must transition Farxiga prescriptions from brand-name to generic dapagliflozin due to PDL status change. Update hospital billing systems to reflect new APR-DRG Version 43 parameters including new base payment of $5,608 and outlier threshold of $88,000. Monitor remittance advices for automatic reprocessing of vision service claims with corrected SFY 2021 fees. For passive enrollment transitions, submit recouped claims to Mississippi Medicaid within 365 days of service date or 90 days of CCO recoupment.