Medicaid; direct Division of Medicaid to apply for federal waivers to expand Medicaid eligibility.

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To: Medicaid; Appropriations
A
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Johnson

HOUSE BILL NO. 114

AN ACT TO BE KNOWN AS THE MISSISSIPPI HEALTH CARE SECURITY 1
AND PROMOTION ACT OF 2026; TO EXPRESS THE INTENT OF THE 2
LEGISLATURE REGARDING EXPANSION OF THE MEDICAID PROGRAM; TO 3
PROVIDE DEFINITIONS FOR THE PURPOSES OF THIS ACT; TO PROVIDE THAT 4
ANY EXPANSION OF THE MEDICAID PROGRAM AND ITS ELIGIBILITY CRITERIA 5
OR COVERED BENEFITS SHALL FALL INTO THE CATEGORIES OUTLINED IN 6
THIS ACT AND BE DEFINED BY THE SECTIONS OF THIS ACT; TO DIRECT THE 7
DIVISION OF MEDICAID TO SUBMIT TO THE CENTERS FOR MEDICARE AND 8
MEDICAID SERVICES (CMS) AN APPLICATION FOR A WAIVER OR STATE PLAN 9
AMENDMENT THAT WILL ALLOW THE DIVISION TO EXPAND COVERAGE TO 10
ELIGIBLE INDIVIDUALS WHOSE INCOME IS AT OR BELOW 100% OF THE 11
FEDERAL POVERTY LEVEL; TO DIRECT THE DIVISION TO SUBMIT TO CMS A 12
REQUEST FOR A SECTION 1115 WAIVER THAT WILL ALLOW THE DIVISION TO 13
EXPAND COVERAGE TO ELIGIBLE INDIVIDUALS WHO ARE UNINSURED AND 14
WHOSE INCOME IS NOT LESS THAN 101% OR MORE THAN 200% OF THE 15
FEDERAL POVERTY LEVEL; TO PROVIDE THAT UNINSURED INDIVIDUALS WITH 16
TOTAL HOUSEHOLD INCOME OF NOT LESS THAN 101% OR MORE THAN 200% OF 17
THE FEDERAL POVERTY LEVEL SHALL BE ELIGIBLE FOR EXPANDED COVERAGE 18
THROUGH AN INDIVIDUAL QUALIFIED HEALTH INSURANCE PLAN; TO PROVIDE 19
THAT INDIVIDUALS WITH CURRENT EMPLOYER HEALTH INSURANCE COVERAGE 20
AND UNINSURED INDIVIDUALS WHO ARE OFFERED EMPLOYER HEALTH 21
INSURANCE COVERAGE WITH TOTAL HOUSEHOLD INCOMES OF NOT LESS THAN 22
101% OR MORE THAN 200% OF THE FEDERAL POVERTY LEVEL SHALL BE 23
ELIGIBLE FOR PREMIUM ASSISTANCE FOR EMPLOYER HEALTH INSURANCE 24
COVERAGE; TO PROVIDE THAT UPON CMS APPROVAL OF REQUESTED WAIVERS 25
OR AMENDMENTS, THE DIVISION SHALL, IN CONJUNCTION AND CONSULTATION 26
WITH RELATED STATE AGENCIES, IMPLEMENT THE APPROVED WAIVER 27
COMPONENTS TO EXPAND ELIGIBILITY CRITERIA FOR THE MEDICAID PROGRAM 28
AS PROVIDED UNDER THE APPLICABLE WAIVER; TO PROVIDE THAT 29
ELIGIBILITY FOR MEDICAID AS DESCRIBED IN THIS ACT SHALL NOT BE 30
DELAYED IF CMS FAILS TO APPROVE ANY REQUESTED WAIVERS OF THE STATE 31
PLAN FOR WHICH THE DIVISION APPLIES, AND SUCH ELIGIBILITY SHALL 32
NOT BE DELAYED WHILE THE DIVISION IS CONSIDERING OR NEGOTIATING 33
ANY WAIVERS TO THE STATE PLAN; TO PROVIDE THAT IF CMS HAS NOT 34
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APPROVED A REQUESTED WAIVER OR STATE PLAN AMENDMENT SUBMITTED BY 35
THE DIVISION ON OR BEFORE DECEMBER 31, 2027, ELIGIBILITY FOR THE 36
MEDICAID PROGRAM SHALL BE EXPANDED TO INCLUDE ALL ELIGIBLE 37
POPULATIONS AND ESSENTIAL HEALTH BENEFITS AS PROVIDED IN THE 38
FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010; TO 39
AMEND SECTION 43-13-115, MISSISSIPPI CODE OF 1972, TO CONFORM TO 40
THE PRECEDING PROVISIONS; AND FOR RELATED PURPOSES. 41
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 42
SECTION 1. Short title. This act shall be known and may be 43
cited as the "Mississippi Health Care Security and Promotion Act 44
of 2026." 45
SECTION 2. Legislative Intent. Notwithstanding any general 46
or specific laws to the contrary, it is the intent of the 47
Legislature for the expansion of the Medicaid program to be a 48
fiscally sustainable, cost-effective, impactful, and an 49
opportunity-driven program that: 50
(a) Expands health insurance coverage opportunities for 51
the population of Mississippians who have not been previously 52
eligible or able to obtain coverage; 53
(b) Achieves comprehensive and innovative health care 54
reform that builds upon existing Medicaid, private insurance 55
market competition, and value-based insurance purchasing models in 56
providing health insurance coverage to low-income adults in 57
Mississippi; 58
(c) Reduces the maternal and infant mortality rates in 59
the state through initiatives that promote healthy outcomes for 60
eligible women with high-risk pregnancies; 61
(d) Promotes the health, welfare, and stability of 62
mothers and their infants before and after delivery; 63
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(e) Strengthens the financial stability of the critical 64
access hospitals and other small, rural hospitals; 65
(f) Fills gaps in the continuum of care for individuals 66
in target populations in need of services; 67
(g) Addresses health-related social needs of 68
Mississippians and reduces the additional risk for disease and 69
premature death associated with those needs; 70
(h) Strengthens the ability of individuals to improve 71
their economic security; 72
(i) Strengthens the ability of employers to recruit and 73
retain productive employees; 74
(j) Encourages personal responsibility for individuals 75
to understand their roles and obligations in maintaining private 76
insurance coverage; and 77
(k) Ensures state responsibility and accountability for 78
the administration of Medicaid health plans. 79
SECTION 3. Definitions. As used in this act, the following 80
terms shall be defined as provided in this section, unless the 81
context requires otherwise: 82
(a) "CMS" means the federal Centers for Medicare and 83
Medicaid Services. 84
(b) "Division" or "Division of Medicaid" means the 85
Division of Medicaid in the Office of the Governor. 86
(c) "Eligible individual" means an individual who is in 87
the eligibility category created by Section 1902(a)(10)(A)(i)(VII) 88
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of the Social Security Act, 42 USC Section 89
1396a(a)(10)(A)(i)(VII). 90
(d) "Employer health insurance coverage" means a health 91
insurance benefit plan offered by an employer or an employer 92
self-funded insurance plan governed by the Employee Retirement 93
Income Security Act of 1974, Pub. L. No. 93-406, as amended. 94
(e) "Health insurance benefit plan" means a policy, 95
contract, certificate, or agreement offered or issued by a health 96
insurer to provide, deliver, arrange for, pay for, or reimburse 97
any of the costs of health care services, but not including 98
excepted benefits as defined under 42 USC Section 300gg-91(c), as 99
it existed on January 1, 2026. 100
(f) "Health insurance marketplace" means the applicable 101
entities that were designed to help individuals, families, and 102
businesses in Mississippi shop for and select health insurance 103
plans in a way that permits comparisons of available plans based 104
upon price, benefits, services, and quality. 105
(g) "Health insurer" means an insurer authorized by the 106
Department of Insurance to provide health insurance or a health 107
insurance benefit plan in the State of Mississippi, including, 108
without limitation: 109
(i) An insurance company; 110
(ii) A medical services plan; 111
(iii) A hospital plan; 112
(iv) A hospital medical service corporation; 113
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(v) A health maintenance organization; 114
(vi) A fraternal benefits society; 115
(vii) Employer health insurance coverage; 116
(viii) A managed care organization contracted with 117
the Mississippi Coordinated Access Network; and 118
(ix) Any other entity providing health insurance 119
or a health insurance benefit plan subject to state regulation. 120
(h) "Health care coverage" means coverage provided 121
through either an individual qualified health insurance plan, a 122
managed care organization, an employer health insurance coverage, 123
the Division of Medicaid's fee-for-service program, or the 124
Division of Medicaid's managed care program, the Mississippi 125
Coordinated Access Network. 126
(i) "Individual qualified health insurance plan" means 127
an individual health insurance benefit plan offered by a health 128
insurer that participates in the health insurance marketplace to 129
provide coverage in Mississippi that covers essential health 130
benefits as defined by the 45 CFR Section 156.110 and any federal 131
insurance regulations, as they existed on January 1, 2026. 132
SECTION 4. Medicaid expansion generally. (1) Any expansion 133
of the Medicaid program and its eligibility criteria or covered 134
benefits shall fall into the categories outlined in this act, and 135
be defined by the sections of this act. 136
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(2) Eligibility criteria for the Medicaid program shall be 137
expanded to cover additional low-income individuals, as defined in 138
Section 5 of this act. 139
(3) The Division of Medicaid, in coordination with the 140
Department of Insurance, the State Department of Health, and any 141
other state agencies, as necessary, shall seek approval from CMS 142
to implement the Medicaid waiver expansion program to increase 143
opportunities for low-income individuals to enroll in private or 144
employer sponsored coverage, as defined in Section 6, 7 and 8 of 145
this act. 146
SECTION 5. Medicaid program expansion. (1) The Division of 147
Medicaid shall develop an application for any federal waiver, 148
state plan amendment, or other authority necessary to expand 149
eligibility criteria for the Medicaid program. Before submitting 150
the application to CMS, the Division of Medicaid shall report the 151
application to the House and Senate Medicaid Committees for review 152
and recommendations. On or before December 31, 2026, the Division 153
of Medicaid shall submit to CMS an application for a waiver or 154
state plan amendment that will, upon approval, allow the division 155
to: 156
(a) Expand coverage to eligible individuals whose 157
income is at or below one hundred percent (100%) of the federal 158
poverty level; 159
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(b) Obtain maximum federal financial participation 160
under 42 USC Section 1396d(y), as allowed, for enrolling an 161
individual in the Medicaid program; 162
(c) Provide essential health benefits as defined under 163
45 CFR Section 156.110 through the state's Medicaid managed care 164
program, the Mississippi Coordinated Access Network; 165
(d) Provide for twelve (12) months of continuous 166
enrollment that shall not be terminated due to procedural reasons; 167
(e) Integrate the delivery of physical health services, 168
behavioral health services, and wraparound services with the 169
state's Medicaid managed care program; and 170
(f) Assist eligible individuals identified as target 171
populations who need a higher level of intervention with 172
wraparound services to improve their health outcomes. 173
(i) Wraparound services may be determined by the 174
division, in conjunction with the State Department of Health, but 175
shall, at minimum, include: 176
1. Benefits navigation; 177
2. Social and community resource navigation; 178
3. Community health workers. 179
(2) Upon CMS approval of requested waivers or amendments, 180
the division shall, in conjunction and consultation with related 181
state agencies, implement the approved waiver components to expand 182
eligibility criteria for the Medicaid program through the 183
Mississippi Coordinated Access Network. 184
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(3) If CMS does not approve the initially submitted waiver 185
or amendment, the division shall have ninety (90) days to submit 186
technical corrections or a revised application for approval. 187
SECTION 6. Expansion of the eligibility criteria for public 188
health insurance coverage with Section 1115 waiver program. (1) 189
The Division of Medicaid shall develop an application for any 190
federal waiver, state plan amendment, or other authority necessary 191
to create and establish the Employer Health Insurance Coverage 192
Premium Assistance Program. Before submission of the application 193
to CMS, the Division of Medicaid shall report the application to 194
the House and Senate Medicaid Committees for review and 195
recommendations. On or before December 31, 2026, the Division of 196
Medicaid shall submit to CMS an application for a Section 1115 197
waiver that will, upon approval, allow the division to: 198
(a) Expand coverage to eligible individuals who are 199
uninsured and whose income is not less than one hundred one 200
percent (101%) or more than two hundred percent (200%) of the 201
federal poverty level; 202
(b) Prevent further decline in population health 203
outcomes and deterioration of the health care system by: 204
(i) Reducing improper use of emergency 205
departments; 206
(ii) Increasing the utilization of primary and 207
preventive health services; 208
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(iii) Increasing the number of preventive health 209
screenings and wellness visits each year; 210
(iv) Promoting health literacy and proper 211
management of chronic conditions; and 212
(v) Incentivizing and assisting businesses in 213
providing employer health insurance coverage. 214
(c) Provide essential health benefits as defined under 215
45 CFR Section 156.110 through: 216
(i) An individual qualified health insurance plan; 217
or 218
(ii) Employer health insurance coverage. 219
(d) Provide for twelve (12) months of continuous 220
enrollment that shall not be terminated due to procedural reasons; 221
(e) Obtain maximum federal financial participation 222
under 42 USC Section 1396d(y) or 42 USC Section 1396d(ii), as 223
allowed, for enrolling an individual as a member of the Section 224
1115 waiver program; 225
(f) Administer federal funds for assistance in the 226
purchase of private health insurance coverage for newly eligible 227
individuals under the Section 1115 waiver program under this 228
section; and 229
(g) Demonstrate budget neutrality based on an aggregate 230
dollar cap that cannot exceed the cumulative target. 231
(3) Upon CMS approval of requested waivers or amendments, 232
the division shall, in conjunction and consultation with related 233
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state agencies, implement the waiver program to expand eligibility 234
criteria and covered services of the program. 235
(4) If CMS does not approve the initially submitted waiver 236
or amendment, the division shall have ninety (90) days to submit 237
technical corrections or a revised application for approval. 238
SECTION 7. Expanded coverage through an individual qualified 239
health plan. (1) Uninsured individuals with total household 240
incomes of not less than one hundred one percent (101%) or more 241
than two hundred percent (200%) of the federal poverty level 242
shall be eligible for expanded coverage through an individual 243
qualified health insurance plan. 244
(2) For members enrolled in an individual qualified health 245
insurance plan, the division shall provide for payment of 246
enrollment fees, premiums, deductions, cost sharing or other 247
similar charges on behalf of members, their spouses, and parents, 248
within the limitations of federal law and regulation. 249
(a) Premium assistance required of the division shall 250
be as follows: 251
(i) For individuals whose income is not less than 252
one hundred one percent (101%) or more than one hundred fifty 253
percent (150%) of the federal poverty level: the division pays 254
one hundred percent (100%) of the premium. 255
(ii) For individuals whose income is not less than 256
one hundred fifty-one percent (151%) or more than one hundred 257
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seventy-five percent (175%) of the federal poverty level: the 258
division pays seventy-five percent (75%) of the premium. 259
(iii) For individuals whose income is not less 260
than one hundred seventy-six percent (176%) or more than two 261
hundred percent (200%) of the federal poverty level: the division 262
pays fifty percent (50%) of the premium. 263
(b) Member contributions to copayments for services 264
provided shall be as follows: 265
(i) Individuals whose income is not less than one 266
hundred one percent (101%) or more than one hundred thirty-eight 267
percent (138%) of the federal poverty level: no member 268
contributions. 269
(ii) Individuals whose income is not less than one 270
hundred thirty-nine percent (139%) or more than two hundred 271
percent (200%) of the federal poverty level: an annual maximum of 272
the lesser of Four Hundred Dollars ($400.00) or two percent (2%) 273
of their income. 274
(c) For the division to provide for such charges, the 275
member shall: 276
(i) Receive a wellness visit from a qualifying 277
provider in an outpatient setting within one (1) year of 278
enrollment, and on an annual basis for each demonstration year. 279
1. Failure to meet this requirement shall 280
result in a decrease of no more than fifty percent (50%) in the 281
amount of premium assistance provided by the division. 282
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2. Failure to meet these requirements shall 283
not result in a loss of coverage. 284
(ii) Subparagraph (i)1 of this paragraph (c) shall 285
not apply to members residing in: 286
1. Provider Shortage Areas as defined by the 287
United States Department of Health and Human Services, Health 288
Resources and Services Administration; or 289
2. Medically Underserved Areas as defined by 290
the United States Department of Health and Human Services, Health 291
Resources and Services Administration. 292
(d) A member that is offered an employer health 293
insurance plan by an employer shall be required to enroll in the 294
employer's health insurance plan. 295
(3) Annually, the division, in conjunction and consultation 296
with related state agencies, shall develop purchasing guidelines 297
that: 298
(a) Describe which individual qualified health 299
insurance plans are suitable for purchase in the next 300
demonstration year, including, without limitation: 301
(i) The level of the plan; 302
(ii) The amounts of allowable premiums; 303
(iii) Cost-sharing; and 304
(iv) Auto-assignment methodology. 305
(b) Ensure that: 306
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(i) The division shall pay premiums and 307
supplemental cost-sharing reductions directly to an individual 308
qualified health insurance plan; 309
(ii) Payments to an individual qualified health 310
insurance plan do not exceed budget neutrality limitations in each 311
demonstration year; 312
(iii) Total payments to all individual qualified 313
health insurance plans combined do not exceed budget targets for 314
the Section 1115 waiver program in each demonstration year; 315
(iv) Individual qualified health insurance plans 316
meet and report quality and performance measurement targets set by 317
the division; and 318
(v) At least two (2) health insurers offer 319
individual qualified health insurance plans in each county in the 320
state. 321
(4) Insurance coverage for a member enrolled in an 322
individual qualified health insurance plan shall be obtained, at a 323
minimum, through silver-level metallic plans as provided in 42 USC 324
Section 18022(d) and Section 18071, as they existed on January 1, 325
2026, that restrict out-of-pocket costs to amounts that do not 326
exceed applicable out-of-pocket cost limitations. 327
(5) The Division of Medicaid, Department of Insurance, and 328
each of the individual qualified health insurance plans shall 329
enter into a memorandum of understanding that shall specify the 330
duties and obligations of each party in the operation of the 331
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Section 1115 waiver program at least thirty (30) calendar days 332
before the annual open enrollment period. The memorandums of 333
understanding shall include provisions necessary to effectuate the 334
purchasing guidelines and reporting requirements including, 335
without limitation, that: 336
(a) Health insurers shall track the applicable premium 337
payments and cost-sharing collected from the members to ensure 338
that the total amount of an individual's payments for premiums and 339
cost-sharing does not exceed the aggregate cap imposed by 42 CFR 340
Section 447.56; 341
(b) Health insurer plans maintain a medical-loss ratio 342
of at least eighty percent (80%) as required under 45 CFR Section 343
158.210(c), as it existed on January 1, 2026, or rebate the 344
difference to the division for those enrolled; 345
(c) A health insurer that is providing an individual 346
qualified health insurance plan or employer health insurance 347
coverage for a member shall submit claims and enrollment data to 348
the division and Department of Insurance to facilitate such 349
reporting and guidelines; and 350
(d) A health insurer that is providing an individual 351
qualified health insurance plan or employer health insurance 352
coverage shall make reports to the division and Department of 353
Insurance regarding quality and performance metrics in a manner 354
and frequencies established. 355
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SECTION 8. Expanded coverage through employer health 356
insurance premium assistance. (1) Individuals with current 357
employer health insurance coverage and uninsured individuals who 358
are offered employer health insurance coverage with total 359
household incomes of not less than one hundred one percent (101%) 360
or more than two hundred percent (200%) of the federal poverty 361
level shall be eligible for premium assistance for employer health 362
insurance coverage. 363
(2) For members with employer health insurance coverage, the 364
division shall provide for payment of enrollment fees, premiums, 365
deductions, cost sharing or other similar charges on behalf of 366
members, their spouses, and parents, within the limitations of 367
federal law and regulation. 368
(a) Premium assistance required of the division shall 369
be as follows: 370
(i) For individuals whose income is not less than 371
one hundred one percent (101%) or more than one hundred fifty 372
percent (150%) of the federal poverty level: the division pays 373
one hundred percent (100%) of the premium. 374
(ii) For individuals whose income is not less than 375
one hundred fifty-one percent (151%) or more than one hundred 376
seventy-five percent (175%) of the federal poverty level: the 377
division pays seventy-five percent (75%) of the premium. 378
(iii) For individuals whose income is not less 379
than one hundred seventy-six percent (176%) or more than two 380
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hundred percent (200%) of the federal poverty level: the division 381
pays fifty percent (50%) of the premium. 382
(b) Member contributions to copayments for services 383
provided shall be as follows: 384
(i) Individuals whose income is not less than one 385
hundred one percent (101%) or more than one hundred thirty-eight 386
percent (138%) of the federal poverty level: no member 387
contributions. 388
(ii) Individuals whose income is not less than one 389
hundred thirty-nine percent (139%) or more than two hundred 390
percent (200%) of the federal poverty level: an annual maximum of 391
the lesser of Four Hundred Dollars ($400.00) or two percent (2%) 392
of their income. 393
(c) For the division to provide for such charges, the 394
member shall: 395
(i) Receive a wellness visit from a qualifying 396
provider in an outpatient setting within one (1) year of 397
enrollment, and on an annual basis for each demonstration year. 398
1. Failure to meet this requirement shall 399
result in a decrease of no more than fifty percent (50%) in the 400
amount of premium assistance provided by the division. 401
2. Failure to meet these requirements shall 402
not result in a loss of coverage. 403
(ii) Subparagraph (i)1 of this paragraph (c) shall 404
not apply to members residing in: 405
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1. Provider Shortage Areas as defined by the 406
United States Department of Health and Human Services, Health 407
Resources and Services Administration; or 408
2. Medically Underserved Areas as defined by 409
the United States Department of Health and Human Services, Health 410
Resources and Services Administration. 411
(d) The division shall pay premiums and supplemental 412
cost-sharing reductions directly to the employer or insurer. 413
(3) The division shall provide for a group health insurance 414
plan that businesses not currently offering employer health 415
insurance coverage may opt into. 416
(4) The division shall ensure that the group health 417
insurance plan being offered is, at minimum, through silver-level 418
metallic plans as provided in 42 USC Section 18022(d) and Section 419
18071, as they existed on January 1, 2026, that restrict 420
out-of-pocket costs to amounts that do not exceed applicable 421
out-of-pocket cost limitations. 422
(5) The Division of Medicaid, Department of Insurance, and 423
each of the employer health insurance plans shall enter into a 424
memorandum of understanding that shall specify the duties and 425
obligations of each party in the operation of the Section 1115 426
waiver program at least thirty (30) calendar days before the 427
annual open enrollment period. The memorandums of understanding 428
shall include provisions necessary to effectuate the purchasing 429
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guidelines and reporting requirements including, without 430
limitation, that: 431
(a) Health insurers shall track the applicable premium 432
payments and cost-sharing collected from the members to ensure 433
that the total amount of an individual's payments for premiums and 434
cost-sharing does not exceed the aggregate cap imposed by 42 CFR 435
Section 447.56; 436
(b) Health insurer plans maintain a medical-loss ratio 437
of at least eighty percent (80%) as required under 45 CFR Section 438
158.210(c), as it existed on January 1, 2026, or rebate the 439
difference to the division for those enrolled; 440
(c) A health insurer that is providing an individual 441
qualified health insurance plan or employer health insurance 442
coverage for a member shall submit claims and enrollment data to 443
the division and Department of Insurance to facilitate such 444
reporting and guidelines; 445
(d) A health insurer that is providing an individual 446
qualified health insurance plan or employer health insurance 447
coverage shall make reports to the division and Department of 448
Insurance regarding quality and performance metrics in a manner 449
and frequencies established. 450
SECTION 9. Implementation and enforcement of the act. (1) 451
Eligibility for Medicaid as described in this act shall not be 452
delayed if CMS fails to approve any requested waivers of the state 453
plan for which the division applies, and such eligibility shall 454
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not be delayed while the division is considering or negotiating 455
any waivers to the state plan. 456
(2) If CMS has not approved a requested waiver or state plan 457
amendment submitted by the division on or before December 31, 458
2027, eligibility for the Medicaid program shall be expanded to 459
include all eligible populations and essential health benefits as 460
provided in the Federal Patient Protection and Affordable Care Act 461
of 2010, as amended. 462
(3) If Section 1905(y) of the Social Security Act is held 463
unlawful or unconstitutional by the United States Supreme Court, 464
then the Legislature may declare this act and the sections in this 465
act to be null, void, and of no force and effect. 466
(4) If federal financial participation for the expanded, 467
newly eligible groups as established in this act is reduced below 468
the ninety percent (90%) commitment described in Section 1905(y) 469
of the Social Security Act, then the Appropriations Committees and 470
Medicaid Committees of the House of Representatives and the 471
Senate, the Public Health and Human Services Committee of the 472
House of Representatives and the Public Health and Welfare 473
Committee of the Senate shall, as soon as practicable, review the 474
effects of such reduction and make a recommendation to the 475
Legislature as to whether Medicaid eligibility expansion provided 476
for in this act should remain in effect. 477
SECTION 10. Section 43-13-115, Mississippi Code of 1972, is 478
amended as follows: 479
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43-13-115. Recipients of Medicaid shall be the following 480
persons only: 481
(1) Those who are qualified for public assistance 482
grants under provisions of Title IV-A and E of the federal Social 483
Security Act, as amended, including those statutorily deemed to be 484
IV-A and low income families and children under Section 1931 of 485
the federal Social Security Act. For the purposes of this 486
paragraph (1) and paragraphs (8), (17) and (18) of this section, 487
any reference to Title IV-A or to Part A of Title IV of the 488
federal Social Security Act, as amended, or the state plan under 489
Title IV-A or Part A of Title IV, shall be considered as a 490
reference to Title IV-A of the federal Social Security Act, as 491
amended, and the state plan under Title IV-A, including the income 492
and resource standards and methodologies under Title IV-A and the 493
state plan, as they existed on July 16, 1996. The Department of 494
Human Services shall determine Medicaid eligibility for children 495
receiving public assistance grants under Title IV-E. The division 496
shall determine eligibility for low income families under Section 497
1931 of the federal Social Security Act and shall redetermine 498
eligibility for those continuing under Title IV-A grants. 499
(2) Those qualified for Supplemental Security Income 500
(SSI) benefits under Title XVI of the federal Social Security Act, 501
as amended, and those who are deemed SSI eligible as contained in 502
federal statute. The eligibility of individuals covered in this 503
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paragraph shall be determined by the Social Security 504
Administration and certified to the Division of Medicaid. 505
(3) Qualified pregnant women who would be eligible for 506
Medicaid as a low income family member under Section 1931 of the 507
federal Social Security Act if her child were born. The 508
eligibility of the individuals covered under this paragraph shall 509
be determined by the division. 510
(4) [Deleted] 511
(5) A child born on or after October 1, 1984, to a 512
woman eligible for and receiving Medicaid under the state plan on 513
the date of the child's birth shall be deemed to have applied for 514
Medicaid and to have been found eligible for Medicaid under the 515
plan on the date of that birth, and will remain eligible for 516
Medicaid for a period of one (1) year so long as the child is a 517
member of the woman's household and the woman remains eligible for 518
Medicaid or would be eligible for Medicaid if pregnant. The 519
eligibility of individuals covered in this paragraph shall be 520
determined by the Division of Medicaid. 521
(6) Children certified by the State Department of Human 522
Services to the Division of Medicaid of whom the state and county 523
departments of human services have custody and financial 524
responsibility, and children who are in adoptions subsidized in 525
full or part by the Department of Human Services, including 526
special needs children in non-Title IV-E adoption assistance, who 527
are approvable under Title XIX of the Medicaid program. The 528
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eligibility of the children covered under this paragraph shall be 529
determined by the State Department of Human Services. 530
(7) Persons certified by the Division of Medicaid who 531
are patients in a medical facility (nursing home, hospital, 532
tuberculosis sanatorium or institution for treatment of mental 533
diseases), and who, except for the fact that they are patients in 534
that medical facility, would qualify for grants under Title IV, 535
Supplementary Security Income (SSI) benefits under Title XVI or 536
state supplements, and those aged, blind and disabled persons who 537
would not be eligible for Supplemental Security Income (SSI) 538
benefits under Title XVI or state supplements if they were not 539
institutionalized in a medical facility but whose income is below 540
the maximum standard set by the Division of Medicaid, which 541
standard shall not exceed that prescribed by federal regulation. 542
(8) Children under eighteen (18) years of age and 543
pregnant women (including those in intact families) who meet the 544
financial standards of the state plan approved under Title IV-A of 545
the federal Social Security Act, as amended. The eligibility of 546
children covered under this paragraph shall be determined by the 547
Division of Medicaid. 548
(9) Individuals who are: 549
(a) Children born after September 30, 1983, who 550
have not attained the age of nineteen (19), with family income 551
that does not exceed one hundred percent (100%) of the nonfarm 552
official poverty level; 553
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(b) Pregnant women, infants and children who have 554
not attained the age of six (6), with family income that does not 555
exceed one hundred thirty-three percent (133%) of the federal 556
poverty level; and 557
(c) Pregnant women and infants who have not 558
attained the age of one (1), with family income that does not 559
exceed one hundred eighty-five percent (185%) of the federal 560
poverty level. 561
The eligibility of individuals covered in (a), (b) and (c) of 562
this paragraph shall be determined by the division. 563
(10) Certain disabled children age eighteen (18) or 564
under who are living at home, who would be eligible, if in a 565
medical institution, for SSI or a state supplemental payment under 566
Title XVI of the federal Social Security Act, as amended, and 567
therefore for Medicaid under the plan, and for whom the state has 568
made a determination as required under Section 1902(e)(3)(b) of 569
the federal Social Security Act, as amended. The eligibility of 570
individuals under this paragraph shall be determined by the 571
Division of Medicaid. 572
(11) Until the end of the day on December 31, 2005, 573
individuals who are sixty-five (65) years of age or older or are 574
disabled as determined under Section 1614(a)(3) of the federal 575
Social Security Act, as amended, and whose income does not exceed 576
one hundred thirty-five percent (135%) of the nonfarm official 577
poverty level as defined by the Office of Management and Budget 578
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and revised annually, and whose resources do not exceed those 579
established by the Division of Medicaid. The eligibility of 580
individuals covered under this paragraph shall be determined by 581
the Division of Medicaid. After December 31, 2005, only those 582
individuals covered under the 1115(c) Healthier Mississippi waiver 583
will be covered under this category. 584
Any individual who applied for Medicaid during the period 585
from July 1, 2004, through March 31, 2005, who otherwise would 586
have been eligible for coverage under this paragraph (11) if it 587
had been in effect at the time the individual submitted his or her 588
application and is still eligible for coverage under this 589
paragraph (11) on March 31, 2005, shall be eligible for Medicaid 590
coverage under this paragraph (11) from March 31, 2005, through 591
December 31, 2005. The division shall give priority in processing 592
the applications for those individuals to determine their 593
eligibility under this paragraph (11). 594
(12) Individuals who are qualified Medicare 595
beneficiaries (QMB) entitled to Part A Medicare as defined under 596
Section 301, Public Law 100-360, known as the Medicare 597
Catastrophic Coverage Act of 1988, and whose income does not 598
exceed one hundred percent (100%) of the nonfarm official poverty 599
level as defined by the Office of Management and Budget and 600
revised annually. 601
The eligibility of individuals covered under this paragraph 602
shall be determined by the Division of Medicaid, and those 603
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individuals determined eligible shall receive Medicare 604
cost-sharing expenses only as more fully defined by the Medicare 605
Catastrophic Coverage Act of 1988 and the Balanced Budget Act of 606
1997. 607
(13) (a) Individuals who are entitled to Medicare Part 608
A as defined in Section 4501 of the Omnibus Budget Reconciliation 609
Act of 1990, and whose income does not exceed one hundred twenty 610
percent (120%) of the nonfarm official poverty level as defined by 611
the Office of Management and Budget and revised annually. 612
Eligibility for Medicaid benefits is limited to full payment of 613
Medicare Part B premiums. 614
(b) Individuals entitled to Part A of Medicare, 615
with income above one hundred twenty percent (120%), but less than 616
one hundred thirty-five percent (135%) of the federal poverty 617
level, and not otherwise eligible for Medicaid. Eligibility for 618
Medicaid benefits is limited to full payment of Medicare Part B 619
premiums. The number of eligible individuals is limited by the 620
availability of the federal capped allocation at one hundred 621
percent (100%) of federal matching funds, as more fully defined in 622
the Balanced Budget Act of 1997. 623
The eligibility of individuals covered under this paragraph 624
shall be determined by the Division of Medicaid. 625
(14) [Deleted] 626
(15) Disabled workers who are eligible to enroll in 627
Part A Medicare as required by Public Law 101-239, known as the 628
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Omnibus Budget Reconciliation Act of 1989, and whose income does 629
not exceed two hundred percent (200%) of the federal poverty level 630
as determined in accordance with the Supplemental Security Income 631
(SSI) program. The eligibility of individuals covered under this 632
paragraph shall be determined by the Division of Medicaid and 633
those individuals shall be entitled to buy-in coverage of Medicare 634
Part A premiums only under the provisions of this paragraph (15). 635
(16) In accordance with the terms and conditions of 636
approved Title XIX waiver from the United States Department of 637
Health and Human Services, persons provided home- and 638
community-based services who are physically disabled and certified 639
by the Division of Medicaid as eligible due to applying the income 640
and deeming requirements as if they were institutionalized. 641
(17) In accordance with the terms of the federal 642
Personal Responsibility and Work Opportunity Reconciliation Act of 643
1996 (Public Law 104-193), persons who become ineligible for 644
assistance under Title IV-A of the federal Social Security Act, as 645
amended, because of increased income from or hours of employment 646
of the caretaker relative or because of the expiration of the 647
applicable earned income disregards, who were eligible for 648
Medicaid for at least three (3) of the six (6) months preceding 649
the month in which the ineligibility begins, shall be eligible for 650
Medicaid for up to twelve (12) months. The eligibility of the 651
individuals covered under this paragraph shall be determined by 652
the division. 653
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(18) Persons who become ineligible for assistance under 654
Title IV-A of the federal Social Security Act, as amended, as a 655
result, in whole or in part, of the collection or increased 656
collection of child or spousal support under Title IV-D of the 657
federal Social Security Act, as amended, who were eligible for 658
Medicaid for at least three (3) of the six (6) months immediately 659
preceding the month in which the ineligibility begins, shall be 660
eligible for Medicaid for an additional four (4) months beginning 661
with the month in which the ineligibility begins. The eligibility 662
of the individuals covered under this paragraph shall be 663
determined by the division. 664
(19) Disabled workers, whose incomes are above the 665
Medicaid eligibility limits, but below two hundred fifty percent 666
(250%) of the federal poverty level, shall be allowed to purchase 667
Medicaid coverage on a sliding fee scale developed by the Division 668
of Medicaid. 669
(20) Medicaid eligible children under age eighteen (18) 670
shall remain eligible for Medicaid benefits until the end of a 671
period of twelve (12) months following an eligibility 672
determination, or until such time that the individual exceeds age 673
eighteen (18). 674
(21) Women of childbearing age whose family income does 675
not exceed one hundred eighty-five percent (185%) of the federal 676
poverty level. The eligibility of individuals covered under this 677
paragraph (21) shall be determined by the Division of Medicaid, 678
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and those individuals determined eligible shall only receive 679
family planning services covered under Section 43-13-117(13) and 680
not any other services covered under Medicaid. However, any 681
individual eligible under this paragraph (21) who is also eligible 682
under any other provision of this section shall receive the 683
benefits to which he or she is entitled under that other 684
provision, in addition to family planning services covered under 685
Section 43-13-117(13). 686
The Division of Medicaid shall apply to the United States 687
Secretary of Health and Human Services for a federal waiver of the 688
applicable provisions of Title XIX of the federal Social Security 689
Act, as amended, and any other applicable provisions of federal 690
law as necessary to allow for the implementation of this paragraph 691
(21). The provisions of this paragraph (21) shall be implemented 692
from and after the date that the Division of Medicaid receives the 693
federal waiver. 694
(22) Persons who are workers with a potentially severe 695
disability, as determined by the division, shall be allowed to 696
purchase Medicaid coverage. The term "worker with a potentially 697
severe disability" means a person who is at least sixteen (16) 698
years of age but under sixty-five (65) years of age, who has a 699
physical or mental impairment that is reasonably expected to cause 700
the person to become blind or disabled as defined under Section 701
1614(a) of the federal Social Security Act, as amended, if the 702
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person does not receive items and services provided under 703
Medicaid. 704
The eligibility of persons under this paragraph (22) shall be 705
conducted as a demonstration project that is consistent with 706
Section 204 of the Ticket to Work and Work Incentives Improvement 707
Act of 1999, Public Law 106-170, for a certain number of persons 708
as specified by the division. The eligibility of individuals 709
covered under this paragraph (22) shall be determined by the 710
Division of Medicaid. 711
(23) Children certified by the Mississippi Department 712
of Human Services for whom the state and county departments of 713
human services have custody and financial responsibility who are 714
in foster care on their eighteenth birthday as reported by the 715
Mississippi Department of Human Services shall be certified 716
Medicaid eligible by the Division of Medicaid until their 717
twenty-first birthday. 718
(24) Individuals who have not attained age sixty-five 719
(65), are not otherwise covered by creditable coverage as defined 720
in the Public Health Services Act, and have been screened for 721
breast and cervical cancer under the Centers for Disease Control 722
and Prevention Breast and Cervical Cancer Early Detection Program 723
established under Title XV of the Public Health Service Act in 724
accordance with the requirements of that act and who need 725
treatment for breast or cervical cancer. Eligibility of 726
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individuals under this paragraph (24) shall be determined by the 727
Division of Medicaid. 728
(25) The division shall apply to the Centers for 729
Medicare and Medicaid Services (CMS) for any necessary waivers to 730
provide services to individuals who are sixty-five (65) years of 731
age or older or are disabled as determined under Section 732
1614(a)(3) of the federal Social Security Act, as amended, and 733
whose income does not exceed one hundred thirty-five percent 734
(135%) of the nonfarm official poverty level as defined by the 735
Office of Management and Budget and revised annually, and whose 736
resources do not exceed those established by the Division of 737
Medicaid, and who are not otherwise covered by Medicare. Nothing 738
contained in this paragraph (25) shall entitle an individual to 739
benefits. The eligibility of individuals covered under this 740
paragraph shall be determined by the Division of Medicaid. 741
(26) The division shall apply to the Centers for 742
Medicare and Medicaid Services (CMS) for any necessary waivers to 743
provide services to individuals who are sixty-five (65) years of 744
age or older or are disabled as determined under Section 745
1614(a)(3) of the federal Social Security Act, as amended, who are 746
end stage renal disease patients on dialysis, cancer patients on 747
chemotherapy or organ transplant recipients on antirejection 748
drugs, whose income does not exceed one hundred thirty-five 749
percent (135%) of the nonfarm official poverty level as defined by 750
the Office of Management and Budget and revised annually, and 751
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ST: Medicaid; direct Division of Medicaid to
apply for federal waivers to expand Medicaid
eligibility.
whose resources do not exceed those established by the division. 752
Nothing contained in this paragraph (26) shall entitle an 753
individual to benefits. The eligibility of individuals covered 754
under this paragraph shall be determined by the Division of 755
Medicaid. 756
(27) Individuals who are entitled to Medicare Part D 757
and whose income does not exceed one hundred fifty percent (150%) 758
of the nonfarm official poverty level as defined by the Office of 759
Management and Budget and revised annually. Eligibility for 760
payment of the Medicare Part D subsidy under this paragraph shall 761
be determined by the division. 762
(28) The division is authorized and directed to provide 763
up to twelve (12) months of continuous coverage postpartum for any 764
individual who qualifies for Medicaid coverage under this section 765
as a pregnant woman, to the extent allowable under federal law and 766
as determined by the division. 767
(29) Individuals who are eligible under any waivers 768
applied for under Sections 1 through 8 of this act that are 769
approved by the Centers for Medicare and Medicaid Services. 770
The division shall redetermine eligibility for all categories 771
of recipients described in each paragraph of this section not less 772
frequently than required by federal law. 773
SECTION 11. This act shall take effect and be in force from 774
and after July 1, 2026. 775