Medicaid; expand eligibility under federal Affordable Care Act.

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To: Medicaid; Appropriations
A
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Johnson

HOUSE BILL NO. 123

AN ACT TO AMEND SECTION 43-13-115, MISSISSIPPI CODE OF 1972, 1
TO PROVIDE MEDICAID COVERAGE FOR INDIVIDUALS WHO ARE UNDER 65 2
YEARS OF AGE, ARE NOT PREGNANT, ARE NOT ENTITLED TO OR ENROLLED 3
FOR MEDICARE BENEFITS AND WHOSE INCOME IS NOT MORE THAN 133% OF 4
THE FEDERAL POVERTY LEVEL, AS AUTHORIZED UNDER THE FEDERAL PATIENT 5
PROTECTION AND AFFORDABLE CARE ACT; AND FOR RELATED PURPOSES. 6
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 7
SECTION 1. Section 43-13-115, Mississippi Code of 1972, is 8
amended as follows: 9
43-13-115. Recipients of Medicaid shall be the following 10
persons only: 11
(1) Those who are qualified for public assistance 12
grants under provisions of Title IV-A and E of the federal Social 13
Security Act, as amended, including those statutorily deemed to be 14
IV-A and low income families and children under Section 1931 of 15
the federal Social Security Act. For the purposes of this 16
paragraph (1) and paragraphs (8), (17) and (18) of this section, 17
any reference to Title IV-A or to Part A of Title IV of the 18
federal Social Security Act, as amended, or the state plan under 19
Title IV-A or Part A of Title IV, shall be considered as a 20
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reference to Title IV-A of the federal Social Security Act, as 21
amended, and the state plan under Title IV-A, including the income 22
and resource standards and methodologies under Title IV-A and the 23
state plan, as they existed on July 16, 1996. The Department of 24
Human Services shall determine Medicaid eligibility for children 25
receiving public assistance grants under Title IV-E. The division 26
shall determine eligibility for low income families under Section 27
1931 of the federal Social Security Act and shall redetermine 28
eligibility for those continuing under Title IV-A grants. 29
(2) Those qualified for Supplemental Security Income 30
(SSI) benefits under Title XVI of the federal Social Security Act, 31
as amended, and those who are deemed SSI eligible as contained in 32
federal statute. The eligibility of individuals covered in this 33
paragraph shall be determined by the Social Security 34
Administration and certified to the Division of Medicaid. 35
(3) Qualified pregnant women who would be eligible for 36
Medicaid as a low income family member under Section 1931 of the 37
federal Social Security Act if her child were born. The 38
eligibility of the individuals covered under this paragraph shall 39
be determined by the division. 40
(4) [Deleted] 41
(5) A child born on or after October 1, 1984, to a 42
woman eligible for and receiving Medicaid under the state plan on 43
the date of the child's birth shall be deemed to have applied for 44
Medicaid and to have been found eligible for Medicaid under the 45
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plan on the date of that birth, and will remain eligible for 46
Medicaid for a period of one (1) year so long as the child is a 47
member of the woman's household and the woman remains eligible for 48
Medicaid or would be eligible for Medicaid if pregnant. The 49
eligibility of individuals covered in this paragraph shall be 50
determined by the Division of Medicaid. 51
(6) Children certified by the State Department of Human 52
Services to the Division of Medicaid of whom the state and county 53
departments of human services have custody and financial 54
responsibility, and children who are in adoptions subsidized in 55
full or part by the Department of Human Services, including 56
special needs children in non-Title IV-E adoption assistance, who 57
are approvable under Title XIX of the Medicaid program. The 58
eligibility of the children covered under this paragraph shall be 59
determined by the State Department of Human Services. 60
(7) Persons certified by the Division of Medicaid who 61
are patients in a medical facility (nursing home, hospital, 62
tuberculosis sanatorium or institution for treatment of mental 63
diseases), and who, except for the fact that they are patients in 64
that medical facility, would qualify for grants under Title IV, 65
Supplementary Security Income (SSI) benefits under Title XVI or 66
state supplements, and those aged, blind and disabled persons who 67
would not be eligible for Supplemental Security Income (SSI) 68
benefits under Title XVI or state supplements if they were not 69
institutionalized in a medical facility but whose income is below 70
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the maximum standard set by the Division of Medicaid, which 71
standard shall not exceed that prescribed by federal regulation. 72
(8) Children under eighteen (18) years of age and 73
pregnant women (including those in intact families) who meet the 74
financial standards of the state plan approved under Title IV-A of 75
the federal Social Security Act, as amended. The eligibility of 76
children covered under this paragraph shall be determined by the 77
Division of Medicaid. 78
(9) Individuals who are: 79
(a) Children born after September 30, 1983, who 80
have not attained the age of nineteen (19), with family income 81
that does not exceed one hundred percent (100%) of the nonfarm 82
official poverty level; 83
(b) Pregnant women, infants and children who have 84
not attained the age of six (6), with family income that does not 85
exceed one hundred thirty-three percent (133%) of the federal 86
poverty level; and 87
(c) Pregnant women and infants who have not 88
attained the age of one (1), with family income that does not 89
exceed one hundred eighty-five percent (185%) of the federal 90
poverty level. 91
The eligibility of individuals covered in (a), (b) and (c) of 92
this paragraph shall be determined by the division. 93
(10) Certain disabled children age eighteen (18) or 94
under who are living at home, who would be eligible, if in a 95
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medical institution, for SSI or a state supplemental payment under 96
Title XVI of the federal Social Security Act, as amended, and 97
therefore for Medicaid under the plan, and for whom the state has 98
made a determination as required under Section 1902(e)(3)(b) of 99
the federal Social Security Act, as amended. The eligibility of 100
individuals under this paragraph shall be determined by the 101
Division of Medicaid. 102
(11) Until the end of the day on December 31, 2005, 103
individuals who are sixty-five (65) years of age or older or are 104
disabled as determined under Section 1614(a)(3) of the federal 105
Social Security Act, as amended, and whose income does not exceed 106
one hundred thirty-five percent (135%) of the nonfarm official 107
poverty level as defined by the Office of Management and Budget 108
and revised annually, and whose resources do not exceed those 109
established by the Division of Medicaid. The eligibility of 110
individuals covered under this paragraph shall be determined by 111
the Division of Medicaid. After December 31, 2005, only those 112
individuals covered under the 1115(c) Healthier Mississippi waiver 113
will be covered under this category. 114
Any individual who applied for Medicaid during the period 115
from July 1, 2004, through March 31, 2005, who otherwise would 116
have been eligible for coverage under this paragraph (11) if it 117
had been in effect at the time the individual submitted his or her 118
application and is still eligible for coverage under this 119
paragraph (11) on March 31, 2005, shall be eligible for Medicaid 120
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coverage under this paragraph (11) from March 31, 2005, through 121
December 31, 2005. The division shall give priority in processing 122
the applications for those individuals to determine their 123
eligibility under this paragraph (11). 124
(12) Individuals who are qualified Medicare 125
beneficiaries (QMB) entitled to Part A Medicare as defined under 126
Section 301, Public Law 100-360, known as the Medicare 127
Catastrophic Coverage Act of 1988, and whose income does not 128
exceed one hundred percent (100%) of the nonfarm official poverty 129
level as defined by the Office of Management and Budget and 130
revised annually. 131
The eligibility of individuals covered under this paragraph 132
shall be determined by the Division of Medicaid, and those 133
individuals determined eligible shall receive Medicare 134
cost-sharing expenses only as more fully defined by the Medicare 135
Catastrophic Coverage Act of 1988 and the Balanced Budget Act of 136
1997. 137
(13) (a) Individuals who are entitled to Medicare Part 138
A as defined in Section 4501 of the Omnibus Budget Reconciliation 139
Act of 1990, and whose income does not exceed one hundred twenty 140
percent (120%) of the nonfarm official poverty level as defined by 141
the Office of Management and Budget and revised annually. 142
Eligibility for Medicaid benefits is limited to full payment of 143
Medicare Part B premiums. 144
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(b) Individuals entitled to Part A of Medicare, 145
with income above one hundred twenty percent (120%), but less than 146
one hundred thirty-five percent (135%) of the federal poverty 147
level, and not otherwise eligible for Medicaid. Eligibility for 148
Medicaid benefits is limited to full payment of Medicare Part B 149
premiums. The number of eligible individuals is limited by the 150
availability of the federal capped allocation at one hundred 151
percent (100%) of federal matching funds, as more fully defined in 152
the Balanced Budget Act of 1997. 153
The eligibility of individuals covered under this paragraph 154
shall be determined by the Division of Medicaid. 155
(14) [Deleted] 156
(15) Disabled workers who are eligible to enroll in 157
Part A Medicare as required by Public Law 101-239, known as the 158
Omnibus Budget Reconciliation Act of 1989, and whose income does 159
not exceed two hundred percent (200%) of the federal poverty level 160
as determined in accordance with the Supplemental Security Income 161
(SSI) program. The eligibility of individuals covered under this 162
paragraph shall be determined by the Division of Medicaid and 163
those individuals shall be entitled to buy-in coverage of Medicare 164
Part A premiums only under the provisions of this paragraph (15). 165
(16) In accordance with the terms and conditions of 166
approved Title XIX waiver from the United States Department of 167
Health and Human Services, persons provided home- and 168
community-based services who are physically disabled and certified 169
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by the Division of Medicaid as eligible due to applying the income 170
and deeming requirements as if they were institutionalized. 171
(17) In accordance with the terms of the federal 172
Personal Responsibility and Work Opportunity Reconciliation Act of 173
1996 (Public Law 104-193), persons who become ineligible for 174
assistance under Title IV-A of the federal Social Security Act, as 175
amended, because of increased income from or hours of employment 176
of the caretaker relative or because of the expiration of the 177
applicable earned income disregards, who were eligible for 178
Medicaid for at least three (3) of the six (6) months preceding 179
the month in which the ineligibility begins, shall be eligible for 180
Medicaid for up to twelve (12) months. The eligibility of the 181
individuals covered under this paragraph shall be determined by 182
the division. 183
(18) Persons who become ineligible for assistance under 184
Title IV-A of the federal Social Security Act, as amended, as a 185
result, in whole or in part, of the collection or increased 186
collection of child or spousal support under Title IV-D of the 187
federal Social Security Act, as amended, who were eligible for 188
Medicaid for at least three (3) of the six (6) months immediately 189
preceding the month in which the ineligibility begins, shall be 190
eligible for Medicaid for an additional four (4) months beginning 191
with the month in which the ineligibility begins. The eligibility 192
of the individuals covered under this paragraph shall be 193
determined by the division. 194
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(19) Disabled workers, whose incomes are above the 195
Medicaid eligibility limits, but below two hundred fifty percent 196
(250%) of the federal poverty level, shall be allowed to purchase 197
Medicaid coverage on a sliding fee scale developed by the Division 198
of Medicaid. 199
(20) Medicaid eligible children under age eighteen (18) 200
shall remain eligible for Medicaid benefits until the end of a 201
period of twelve (12) months following an eligibility 202
determination, or until such time that the individual exceeds age 203
eighteen (18). 204
(21) Women of childbearing age whose family income does 205
not exceed one hundred eighty-five percent (185%) of the federal 206
poverty level. The eligibility of individuals covered under this 207
paragraph (21) shall be determined by the Division of Medicaid, 208
and those individuals determined eligible shall only receive 209
family planning services covered under Section 43-13-117(13) and 210
not any other services covered under Medicaid. However, any 211
individual eligible under this paragraph (21) who is also eligible 212
under any other provision of this section shall receive the 213
benefits to which he or she is entitled under that other 214
provision, in addition to family planning services covered under 215
Section 43-13-117(13). 216
The Division of Medicaid shall apply to the United States 217
Secretary of Health and Human Services for a federal waiver of the 218
applicable provisions of Title XIX of the federal Social Security 219
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Act, as amended, and any other applicable provisions of federal 220
law as necessary to allow for the implementation of this paragraph 221
(21). The provisions of this paragraph (21) shall be implemented 222
from and after the date that the Division of Medicaid receives the 223
federal waiver. 224
(22) Persons who are workers with a potentially severe 225
disability, as determined by the division, shall be allowed to 226
purchase Medicaid coverage. The term "worker with a potentially 227
severe disability" means a person who is at least sixteen (16) 228
years of age but under sixty-five (65) years of age, who has a 229
physical or mental impairment that is reasonably expected to cause 230
the person to become blind or disabled as defined under Section 231
1614(a) of the federal Social Security Act, as amended, if the 232
person does not receive items and services provided under 233
Medicaid. 234
The eligibility of persons under this paragraph (22) shall be 235
conducted as a demonstration project that is consistent with 236
Section 204 of the Ticket to Work and Work Incentives Improvement 237
Act of 1999, Public Law 106-170, for a certain number of persons 238
as specified by the division. The eligibility of individuals 239
covered under this paragraph (22) shall be determined by the 240
Division of Medicaid. 241
(23) Children certified by the Mississippi Department 242
of Human Services for whom the state and county departments of 243
human services have custody and financial responsibility who are 244
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in foster care on their eighteenth birthday as reported by the 245
Mississippi Department of Human Services shall be certified 246
Medicaid eligible by the Division of Medicaid until their 247
twenty-first birthday. 248
(24) Individuals who have not attained age sixty-five 249
(65), are not otherwise covered by creditable coverage as defined 250
in the Public Health Services Act, and have been screened for 251
breast and cervical cancer under the Centers for Disease Control 252
and Prevention Breast and Cervical Cancer Early Detection Program 253
established under Title XV of the Public Health Service Act in 254
accordance with the requirements of that act and who need 255
treatment for breast or cervical cancer. Eligibility of 256
individuals under this paragraph (24) shall be determined by the 257
Division of Medicaid. 258
(25) The division shall apply to the Centers for 259
Medicare and Medicaid Services (CMS) for any necessary waivers to 260
provide services to individuals who are sixty-five (65) years of 261
age or older or are disabled as determined under Section 262
1614(a)(3) of the federal Social Security Act, as amended, and 263
whose income does not exceed one hundred thirty-five percent 264
(135%) of the nonfarm official poverty level as defined by the 265
Office of Management and Budget and revised annually, and whose 266
resources do not exceed those established by the Division of 267
Medicaid, and who are not otherwise covered by Medicare. Nothing 268
contained in this paragraph (25) shall entitle an individual to 269
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benefits. The eligibility of individuals covered under this 270
paragraph shall be determined by the Division of Medicaid. 271
(26) The division shall apply to the Centers for 272
Medicare and Medicaid Services (CMS) for any necessary waivers to 273
provide services to individuals who are sixty-five (65) years of 274
age or older or are disabled as determined under Section 275
1614(a)(3) of the federal Social Security Act, as amended, who are 276
end stage renal disease patients on dialysis, cancer patients on 277
chemotherapy or organ transplant recipients on antirejection 278
drugs, whose income does not exceed one hundred thirty-five 279
percent (135%) of the nonfarm official poverty level as defined by 280
the Office of Management and Budget and revised annually, and 281
whose resources do not exceed those established by the division. 282
Nothing contained in this paragraph (26) shall entitle an 283
individual to benefits. The eligibility of individuals covered 284
under this paragraph shall be determined by the Division of 285
Medicaid. 286
(27) Individuals who are entitled to Medicare Part D 287
and whose income does not exceed one hundred fifty percent (150%) 288
of the nonfarm official poverty level as defined by the Office of 289
Management and Budget and revised annually. Eligibility for 290
payment of the Medicare Part D subsidy under this paragraph shall 291
be determined by the division. 292
(28) The division is authorized and directed to provide 293
up to twelve (12) months of continuous coverage postpartum for any 294
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ST: Medicaid; expand eligibility under federal
Affordable Care Act.
individual who qualifies for Medicaid coverage under this section 295
as a pregnant woman, to the extent allowable under federal law and 296
as determined by the division. 297
(29) Individuals who are under sixty-five (65) years of age, 298
are not pregnant, are not entitled to or enrolled for benefits 299
under Part A or Part B of Medicare, are not eligible for Medicaid 300
under any other paragraph of this section, and whose income is not 301
more than one hundred thirty-three percent (133%) of the federal 302
poverty level applicable to a family of the size involved. 303
Individuals eligible under this paragraph (29) shall receive 304
benchmark coverage described in Section 1937(b)(1) of the federal 305
Social Security Act, as amended, or benchmark equivalent coverage 306
described in Section 1937(b)(2) of the federal Social Security 307
Act, as amended. The eligibility of individuals covered under 308
this paragraph shall be determined by the Division of Medicaid. 309
The division shall redetermine eligibility for all categories 310
of recipients described in each paragraph of this section not less 311
frequently than required by federal law. 312
SECTION 2. This act shall take effect and be in force from 313
and after July 1, 2026. 314