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MississippiHB 5652026 Regular SessionHouseWALLET

Health benefit plans and Medicaid; require to offer coverage for biomarker testing.

Sponsored By: Samuel Creekmore IV (Republican)

Signed by Governor

Public Health and Human ServicesInsurance

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Bill Overview

Analyzed Economic Effects

7 provisions identified: 6 benefits, 1 costs, 0 mixed.

More biomarker testing coverage

Starting July 1, 2026, Mississippi health plans and Medicaid must cover biomarker tests supported by medical and scientific evidence. The tests must help diagnose, treat, manage, or monitor a condition. Plans must limit unnecessary repeat biopsies and samples. They must explain covered-test denials in writing, decide prior authorization requests within state timeframes, and offer an online process to request exceptions. Plans must post coverage policies within 60 days after enactment and post changes at least 30 days before they take effect. Medicaid must add required test codes to its fee schedule within 60 days after the law takes effect.

Medicaid coverage for birthing centers

From July 1, 2026, through July 1, 2028, Mississippi Medicaid must reimburse services for eligible patients at licensed birthing centers. The Division of Medicaid sets the payment method and must follow federal rules. The law does not set a payment amount.

More protections in Medicaid managed care

From July 1, 2026, through July 1, 2028, Medicaid managed-care plans cannot require you or your provider to use a pharmacy that ships or delivers prescriptions. Plans must pay network providers at least regular Medicaid rates. Contractors must use a uniform credentialing process, with temporary approval available to some qualified providers after a 60-day delay. Contractors must explain coverage denials, and a claim is approved and payable if they do not issue a final ruling within 60 days. State hearings or appeals must begin within 60 days after a final denial, with a decision within 30 days after the proceeding.

Clearer rules for health care reviews

Health insurance review rules include services that diagnose or screen for illness or injury. From July 1, 2026, through July 1, 2028, Medicaid managed-care contractors must follow professional care guidelines. They cannot add criteria that deny care those guidelines find appropriate and medically necessary.

Limits on cuts to Medicaid hospital payments

From July 1, 2026, through July 1, 2028, Mississippi Medicaid cannot cut hospital payments, allowed days, or service volumes while the hospital assessment is in effect. Exceptions include decreases from fewer admissions, audits or payment models, and managed-care or similar programs.

More oversight of Medicaid managed care

From July 1, 2026, through July 1, 2028, Medicaid managed-care programs must receive yearly reviews or audits. Each review must cover at least two topics listed in the law, and the full report must be posted online. The Division of Medicaid must study whether one vendor could manage dental benefits; the law does not require a single vendor or a pharmacy-benefit transition. The Division may also extend a qualifying managed-care contract once in an emergency, for no more than one year.

Limits on Medicaid managed-care expansion

From July 1, 2026, through July 1, 2028, Medicaid managed-care enrollment is limited to recipient groups eligible on January 1, 2021, CHIP, and certain federal waivers already in operation on that date. The Division of Medicaid cannot expand managed-care contracts without new state legislation. This does not change Medicaid eligibility.

Sponsors & Cosponsors

Sponsor

  • Samuel Creekmore IV

    Republican • House

Cosponsors

  • Christopher Bell

    Democratic • House

  • Becky Currie

    Republican • House

  • Casey Eure

    Republican • House

  • Kevin Felsher

    Republican • House

  • Jay McKnight

    Republican • House

  • Jansen T. Owen

    Republican • House

  • Omeria Scott

    Democratic • House

Roll Call Votes

All Roll Calls

Yes: 167 • No: 0

Senate vote • 3/4/2026

Passed

Yes: 51 • No: 0

House vote • 1/28/2026

Passed As Amended

Yes: 116 • No: 0

Actions Timeline

  1. Approved by Governor

    3/16/2026legislature

  2. Enrolled Bill Signed

    3/9/2026Senate

  3. Enrolled Bill Signed

    3/6/2026House

  4. Returned For Enrolling

    3/5/2026Senate

  5. Passed

    3/4/2026Senate

  6. Title Suff Do Pass

    2/26/2026Senate

  7. Referred To Insurance

    2/18/2026Senate

  8. Transmitted To Senate

    1/29/2026House

  9. Passed As Amended

    1/28/2026House

  10. Amended

    1/28/2026House

  11. Title Suff Do Pass

    1/22/2026House

  12. DR - TSDP: IN To PH

    1/22/2026House

  13. DR - TSDP: PH To IN

    1/22/2026House

  14. Referred To Public Health and Human Services;Insurance

    1/13/2026House

Bill Text

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