CurrentMississippi Division of MedicaidPolicy N/A

Family Planning Medicaid Waiver (Section 1115) — Annual Monitoring Report (DY21)

Customize your policy alerts

Sign up for all Mississippi Division of Medicaid policy alerts

Know when Mississippi Division of Medicaid releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Annual monitoring report for Mississippi's Family Planning Section 1115 demonstration covering program operations, utilization, outreach, and program integrity for January 1–December 31, 2024; affects individuals eligible for the FPW demonstration (reproductive-age men and women meeting income and coverage criteria) and program administrators.

Policy Summary

PayerMississippi Division of Medicaid

PolicyFamily Planning Medicaid Waiver (Section 1115) — Annual Monitoring Report (DY21)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2024

Next Review DateN/A

Key ActionLimit participants to individuals age 13–44 with income ≤194% FPL (post-MAGI) who are not enrolled in Medicaid, Medicare, CHIP, or other creditable coverage including family planning services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

22,508FPW enrollees at Q4

33,766Total FPW enrollees (DY21)

5,008STD tests (DY21)

1,563

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

CurrentMississippi Division of MedicaidPolicy N/A

Family Planning Medicaid Waiver (Section 1115) — Annual Monitoring Report (DY21)

Customize your policy alerts

Sign up for all Mississippi Division of Medicaid policy alerts

Know when Mississippi Division of Medicaid releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerMississippi Division of Medicaid

PolicyFamily Planning Medicaid Waiver (Section 1115) — Annual Monitoring Report (DY21)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2024

Next Review DateN/A

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

22,508FPW enrollees at Q4

33,766Total FPW enrollees (DY21)

5,008STD tests (DY21)

1,563

1,795Clinical breast exams

40.1%3-month injection users

Family Planning Waiver Coverage and DY21 Utilization

inv-01: FPW coverage and monitoring summary

Program goals, coverage scope, monitoring focus, and operational notes for the FPW demonstration during DY21.

ALL of the following

Ensure access to and utilization of family planning services and family planning-related services for individuals not otherwise eligible for Medicaid (improve access and use, increase child spacing, reduce unintended and repeat teen pregnancies, improve birth outcomes, and increase cost savings).

ALL of the following

Individuals age 13–44 capable of reproducing with income at or below 194% FPL (post-MAGI) who are not enrolled in Medicaid, Medicare, CHIP, or other creditable coverage that includes family planning services.

ALL of the following

Family planning services and family planning-related services provided to eligible participants (note: breast cancer screening is not covered under FPW).

ALL of the following

Monthly/quarterly monitoring of enrollment, claims, service by method, STD testing, cervical cancer screening, and clinical breast exams for program oversight and reporting.

ALL of the following

Enrollment declined across DY21 (Q1 26,346; Q2 25,636; Q3 22,875; Q4 22,508) due to eligibility unwinding that continued through May 2024.
No administrative or operational changes impacting delivery, benefits, quality of care, or payment rates during DY21; no audits, investigations, or lawsuits affecting the FPW were reported.
DOM coordinates outreach with MSDH; DY21 outreach events reached approximately 2,537 clients and distributed 3,760 brochures.

ALL of the following

Desk audits are performed by registered nurses to ensure provider documentation supports services reimbursed under the FPW program.

ALL of the following

No administrative or operational changes affecting service utilization or provider participation were noted during DY21.

inv-02: DY21 coverage and utilization metrics

Reported coverage, utilization, service counts, and selected health outcomes for DY21 (Jan 1–Dec 31, 2024).

ALL of the following

Total FPW enrollees during DY21: 33,766.
Enrollees with at least one FPW service encounter: 10,508.
Percent of enrollees utilizing services in DY21: 31.1%.

ALL of the following

Female beneficiaries who utilized a contraceptive method in DY21: 6,945.
Female beneficiaries who used a LARC method in DY21: 336.

Utilization Measures, Methods, and Cost Metrics

Contraceptive method utilization (by method)mixed

Diaphragm	Diaphragm, Total Users = 8 (Percent of All Users = 0.1%)
Sponge	Sponge, Total Users = 0 (Percent of All Users = 0%)
Female Condom	Female Condom, Total Users = 14 (Percent of All Users = 0.2%)
Male Condom	Male Condom, Total Users = 128 (Percent of All Users = 1.4%)

Utilization measures (procedures/drugs aggregated)mixed

LARC	Number of female beneficiaries who utilized a long-acting reversible contraceptive (LARC) method = 336 (DY21)
STD Testing	Number of beneficiaries tested for any sexually transmitted disease (STD) = 5,008 (DY21); of these, 1,648 (32.9%) had a claim for a STD-related drug/treatment
Cervical Cancer Screening (Pap Smear)	Female beneficiaries who obtained a cervical cancer screening = 1,563 (DY21)
Clinical Breast Exam	Female beneficiaries who received a clinical breast exam = 1,795 (DY21)

Paid deliveries and cost metricsmixed

FPW Medicaid Deliveries - DY21: Total Cost	$7,651,060.68
FPW Births - DY21	428
Average Cost per Medicaid-funded Birth - DY21	$17,876.31

inv-06: STD testing coverage rate

STD testing coverage rate (DY21)14.6% of enrolled beneficiaries obtained an STD test

Unduplicated beneficiaries tested (total)5,008 beneficiaries tested for STDs in DY21

Female beneficiaries tested (DY21)4,509 female beneficiaries (15.7% of enrolled females)

Male beneficiaries tested (DY21)499 male beneficiaries (8.8% of enrolled males)

inv-07: utilization rate

Utilization rate (DY21)31.1% of FPW enrollees utilized family planning services in DY21

Eligibility, Documentation, and Appeals

Documentation Required

Eligibility and enrollment condition

Participants eligible for the FPW demonstration must be age 13–44, have income no more than 194% of the federal poverty level (post‑MAGI), and must not be enrolled in Medicaid, Medicare, CHIP, or any other creditable coverage that includes family planning services.

Documentation Required

Provider documentation monitoring (desk audits by RNs)

DOM conducts desk audits of provider medical records performed by registered nurses to verify that provider documentation supports services reimbursed under the FPW program and to confirm appropriate care and referrals for non‑family‑planning needs.

Desk audits validate documentation that supports billed family planning and family‑planning‑related services.
RNs review records to ensure participants receive appropriate medical care and that referrals are made for primary care or services not covered by FPW.

Population, Processes, and Key Terms

inv-13: Demonstration population

Covered populationIndividuals ages 13–44 capable of reproducing

Income eligibilityIncome ≤194% FPL (post-MAGI)

Exclusion for other coverageNot enrolled in Medicaid, Medicare, CHIP, or any other creditable coverage that includes family planning services

Program scopeFamily planning and family planning-related services for eligible individuals

inv-14: Public Forum

RequirementAnnual Public Forum required under 42 C.F.R. §431.420(c)

Purpose

Policy Summary

PayerMississippi Division of Medicaid

PolicyFamily Planning Medicaid Waiver (Section 1115) — Annual Monitoring Report (DY21)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2024

Next Review DateN/A

SourceLink

On This Page

Number of sterilizations during DY21: 8 females and 1 male selected sterilization as permanent contraception.

ALL of the following

Beneficiaries tested for STDs in DY21: 5,008 (of whom 1,648 [32.9%] had a claim for an STD-related drug/treatment).
Female beneficiaries screened for cervical cancer in DY21: 1,563.
Female beneficiaries receiving a clinical breast exam in DY21: 1,795.

ALL of the following

Beneficiaries who completed one 12-month coverage spell in DY21: 24,003.
Beneficiaries re-enrolled for at least a second spell in DY21: 16,209.

ALL of the following

DY21 showed a small increase in females accessing family planning services compared to DY20 (4,338 in DY21 vs. 4,202 in DY20) but overall declines when compared to earlier years; utilization and enrollment trended downward overall versus prior demonstration years.

Enrollees with ≥1 service encounter10,508 enrollees had at least one FPW service encounter in DY21

Total FPW enrollees (DY21)33,766 enrollees enrolled in DY21

Change from DY20Utilization decreased from 35.5% in DY20 to 31.1% in DY21

inv-08: Average cost per Medicaid-funded birth (DY21)

Average cost per Medicaid-funded birth (DY21)$17,876.31 average cost per Medicaid-funded birth in DY21

Total FPW-paid deliveries (DY21)428 FPW births in DY21

Total cost of FPW Medicaid deliveries (DY21)$7,651,060.68 total expenditures for FPW Medicaid deliveries in DY21

Denial Risk

Appeals handled by DOM's Office of Appeals (example)

Appeals of denied services are processed by DOM's Office of Appeals; during DY21 one appeal was received for a denied inpatient psychiatric stay and the denial was upheld because the services billed were not family planning related.

Example: Provider requested review of denied inpatient psychiatric treatment; Office of Appeals upheld the denial as not family planning related.

Documentation Required

Beneficiary satisfaction survey reporting (annual metrics)

DOM administers a beneficiary satisfaction survey each demonstration year and reports the survey metrics (number mailed, undeliverable, returned, and response rate) as part of program monitoring.

DY21 survey metrics: mailed = 3,815; undeliverable = 305; returned = 168; response rate = 4.4%.
Survey outcomes reported include measures such as respondents who accessed services in the past six months and percent pleased with care.

Provide stakeholders opportunity to provide meaningful comments on waiver progress

DY21 forum datePublic Forum held July 11, 2024 (notice posted June 10, 2024)

Participation detailsIn-person forum with teleconference option (dial-in information provided)

inv-15: Desk audit

Desk audit definitionReview of provider medical records by registered nurses (RNs) to validate documentation supporting reimbursed family planning services

Responsible officeDOM's Office of Medical Services conducts desk audits

DY21 activity372 medical records audited across 17 FPW providers during DY21

Audit objectivesEnsure documentation supports reimbursed services, appropriate medical care, and referrals for non-family-planning services

inv-16: 12-month coverage spell

12-month coverage spellCompletion of one spell of 12-month coverage (one full 12-month period)

DY21 completions24,003 enrolled beneficiaries completed one 12-month coverage spell in DY21

Comparison to prior yearDown from 25,817 completions in DY20 (7.0% decrease)

inv-17: FPW Medicaid deliveries and costs

DefinitionFPW Medicaid deliveries: births paid for by Medicaid among Family Planning Waiver enrollees

DY21 FPW births and cost428 FPW-paid deliveries in DY21 with total FPW delivery expenditures of $7,651,060.68

Average cost per Medicaid-funded birth (DY21)$17,876.31 average cost per Medicaid-funded birth in DY21

Related metricDuring DY21, 9,201 postpartum women were enrolled in FPW; cost savings from non-repeat pregnancy claims estimated at $137,236,431.87