Medicaid; expand eligibility under federal Affordable Care Act and under CHIP.

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To: Medicaid; Appropriations
A
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Scott

HOUSE BILL NO. 224

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; TO PROVIDE MEDICAID COVERAGE 6
FOR CHILDREN WHO ARE UNDER 19 YEARS OF AGE AND WHOSE FAMILY INCOME 7
IS MORE THAN 133% BUT NOT MORE THAN 200% OF THE FEDERAL POVERTY 8
LEVEL, AS AUTHORIZED UNDER THE CHILDREN'S HEALTH INSURANCE 9
PROGRAM; TO REPEAL SECTIONS 41-86-1 AND 41-86-5 THROUGH 41-86-15, 10
MISSISSIPPI CODE OF 1972, WHICH ARE THE MISSISSIPPI CHILDREN'S 11
HEALTH INSURANCE PROGRAM ACT; AND FOR RELATED PURPOSES. 12
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 13
SECTION 1. Section 43-13-115, Mississippi Code of 1972, is 14
amended as follows: 15
43-13-115. Recipients of Medicaid shall be the following 16
persons only: 17
(1) Those who are qualified for public assistance 18
grants under provisions of Title IV-A and E of the federal Social 19
Security Act, as amended, including those statutorily deemed to be 20
IV-A and low income families and children under Section 1931 of 21
the federal Social Security Act. For the purposes of this 22
paragraph (1) and paragraphs (8), (17) and (18) of this section, 23
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any reference to Title IV-A or to Part A of Title IV of the 24
federal Social Security Act, as amended, or the state plan under 25
Title IV-A or Part A of Title IV, shall be considered as a 26
reference to Title IV-A of the federal Social Security Act, as 27
amended, and the state plan under Title IV-A, including the income 28
and resource standards and methodologies under Title IV-A and the 29
state plan, as they existed on July 16, 1996. The Department of 30
Human Services shall determine Medicaid eligibility for children 31
receiving public assistance grants under Title IV-E. The division 32
shall determine eligibility for low income families under Section 33
1931 of the federal Social Security Act and shall redetermine 34
eligibility for those continuing under Title IV-A grants. 35
(2) Those qualified for Supplemental Security Income 36
(SSI) benefits under Title XVI of the federal Social Security Act, 37
as amended, and those who are deemed SSI eligible as contained in 38
federal statute. The eligibility of individuals covered in this 39
paragraph shall be determined by the Social Security 40
Administration and certified to the Division of Medicaid. 41
(3) Qualified pregnant women who would be eligible for 42
Medicaid as a low income family member under Section 1931 of the 43
federal Social Security Act if her child were born. The 44
eligibility of the individuals covered under this paragraph shall 45
be determined by the division. 46
(4) [Deleted] 47
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(5) A child born on or after October 1, 1984, to a 48
woman eligible for and receiving Medicaid under the state plan on 49
the date of the child's birth shall be deemed to have applied for 50
Medicaid and to have been found eligible for Medicaid under the 51
plan on the date of that birth, and will remain eligible for 52
Medicaid for a period of one (1) year so long as the child is a 53
member of the woman's household and the woman remains eligible for 54
Medicaid or would be eligible for Medicaid if pregnant. The 55
eligibility of individuals covered in this paragraph shall be 56
determined by the Division of Medicaid. 57
(6) Children certified by the State Department of Human 58
Services to the Division of Medicaid of whom the state and county 59
departments of human services have custody and financial 60
responsibility, and children who are in adoptions subsidized in 61
full or part by the Department of Human Services, including 62
special needs children in non-Title IV-E adoption assistance, who 63
are approvable under Title XIX of the Medicaid program. The 64
eligibility of the children covered under this paragraph shall be 65
determined by the State Department of Human Services. 66
(7) Persons certified by the Division of Medicaid who 67
are patients in a medical facility (nursing home, hospital, 68
tuberculosis sanatorium or institution for treatment of mental 69
diseases), and who, except for the fact that they are patients in 70
that medical facility, would qualify for grants under Title IV, 71
Supplementary Security Income (SSI) benefits under Title XVI or 72
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state supplements, and those aged, blind and disabled persons who 73
would not be eligible for Supplemental Security Income (SSI) 74
benefits under Title XVI or state supplements if they were not 75
institutionalized in a medical facility but whose income is below 76
the maximum standard set by the Division of Medicaid, which 77
standard shall not exceed that prescribed by federal regulation. 78
(8) Children under eighteen (18) years of age and 79
pregnant women (including those in intact families) who meet the 80
financial standards of the state plan approved under Title IV-A of 81
the federal Social Security Act, as amended. The eligibility of 82
children covered under this paragraph shall be determined by the 83
Division of Medicaid. 84
(9) Individuals who are: 85
(a) Children born after September 30, 1983, who 86
have not attained the age of nineteen (19), with family income 87
that does not exceed one hundred percent (100%) of the nonfarm 88
official poverty level; 89
(b) Pregnant women, infants and children who have 90
not attained the age of six (6), with family income that does not 91
exceed one hundred thirty-three percent (133%) of the federal 92
poverty level; and 93
(c) Pregnant women and infants who have not 94
attained the age of one (1), with family income that does not 95
exceed one hundred eighty-five percent (185%) of the federal 96
poverty level. 97
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The eligibility of individuals covered in (a), (b) and (c) of 98
this paragraph shall be determined by the division. 99
(10) Certain disabled children age eighteen (18) or 100
under who are living at home, who would be eligible, if in a 101
medical institution, for SSI or a state supplemental payment under 102
Title XVI of the federal Social Security Act, as amended, and 103
therefore for Medicaid under the plan, and for whom the state has 104
made a determination as required under Section 1902(e)(3)(b) of 105
the federal Social Security Act, as amended. The eligibility of 106
individuals under this paragraph shall be determined by the 107
Division of Medicaid. 108
(11) Until the end of the day on December 31, 2005, 109
individuals who are sixty-five (65) years of age or older or are 110
disabled as determined under Section 1614(a)(3) of the federal 111
Social Security Act, as amended, and whose income does not exceed 112
one hundred thirty-five percent (135%) of the nonfarm official 113
poverty level as defined by the Office of Management and Budget 114
and revised annually, and whose resources do not exceed those 115
established by the Division of Medicaid. The eligibility of 116
individuals covered under this paragraph shall be determined by 117
the Division of Medicaid. After December 31, 2005, only those 118
individuals covered under the 1115(c) Healthier Mississippi waiver 119
will be covered under this category. 120
Any individual who applied for Medicaid during the period 121
from July 1, 2004, through March 31, 2005, who otherwise would 122
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have been eligible for coverage under this paragraph (11) if it 123
had been in effect at the time the individual submitted his or her 124
application and is still eligible for coverage under this 125
paragraph (11) on March 31, 2005, shall be eligible for Medicaid 126
coverage under this paragraph (11) from March 31, 2005, through 127
December 31, 2005. The division shall give priority in processing 128
the applications for those individuals to determine their 129
eligibility under this paragraph (11). 130
(12) Individuals who are qualified Medicare 131
beneficiaries (QMB) entitled to Part A Medicare as defined under 132
Section 301, Public Law 100-360, known as the Medicare 133
Catastrophic Coverage Act of 1988, and whose income does not 134
exceed one hundred percent (100%) of the nonfarm official poverty 135
level as defined by the Office of Management and Budget and 136
revised annually. 137
The eligibility of individuals covered under this paragraph 138
shall be determined by the Division of Medicaid, and those 139
individuals determined eligible shall receive Medicare 140
cost-sharing expenses only as more fully defined by the Medicare 141
Catastrophic Coverage Act of 1988 and the Balanced Budget Act of 142
1997. 143
(13) (a) Individuals who are entitled to Medicare Part 144
A as defined in Section 4501 of the Omnibus Budget Reconciliation 145
Act of 1990, and whose income does not exceed one hundred twenty 146
percent (120%) of the nonfarm official poverty level as defined by 147
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the Office of Management and Budget and revised annually. 148
Eligibility for Medicaid benefits is limited to full payment of 149
Medicare Part B premiums. 150
(b) Individuals entitled to Part A of Medicare, 151
with income above one hundred twenty percent (120%), but less than 152
one hundred thirty-five percent (135%) of the federal poverty 153
level, and not otherwise eligible for Medicaid. Eligibility for 154
Medicaid benefits is limited to full payment of Medicare Part B 155
premiums. The number of eligible individuals is limited by the 156
availability of the federal capped allocation at one hundred 157
percent (100%) of federal matching funds, as more fully defined in 158
the Balanced Budget Act of 1997. 159
The eligibility of individuals covered under this paragraph 160
shall be determined by the Division of Medicaid. 161
(14) [Deleted] 162
(15) Disabled workers who are eligible to enroll in 163
Part A Medicare as required by Public Law 101-239, known as the 164
Omnibus Budget Reconciliation Act of 1989, and whose income does 165
not exceed two hundred percent (200%) of the federal poverty level 166
as determined in accordance with the Supplemental Security Income 167
(SSI) program. The eligibility of individuals covered under this 168
paragraph shall be determined by the Division of Medicaid and 169
those individuals shall be entitled to buy-in coverage of Medicare 170
Part A premiums only under the provisions of this paragraph (15). 171
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(16) In accordance with the terms and conditions of 172
approved Title XIX waiver from the United States Department of 173
Health and Human Services, persons provided home- and 174
community-based services who are physically disabled and certified 175
by the Division of Medicaid as eligible due to applying the income 176
and deeming requirements as if they were institutionalized. 177
(17) In accordance with the terms of the federal 178
Personal Responsibility and Work Opportunity Reconciliation Act of 179
1996 (Public Law 104-193), persons who become ineligible for 180
assistance under Title IV-A of the federal Social Security Act, as 181
amended, because of increased income from or hours of employment 182
of the caretaker relative or because of the expiration of the 183
applicable earned income disregards, who were eligible for 184
Medicaid for at least three (3) of the six (6) months preceding 185
the month in which the ineligibility begins, shall be eligible for 186
Medicaid for up to twelve (12) months. The eligibility of the 187
individuals covered under this paragraph shall be determined by 188
the division. 189
(18) Persons who become ineligible for assistance under 190
Title IV-A of the federal Social Security Act, as amended, as a 191
result, in whole or in part, of the collection or increased 192
collection of child or spousal support under Title IV-D of the 193
federal Social Security Act, as amended, who were eligible for 194
Medicaid for at least three (3) of the six (6) months immediately 195
preceding the month in which the ineligibility begins, shall be 196
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eligible for Medicaid for an additional four (4) months beginning 197
with the month in which the ineligibility begins. The eligibility 198
of the individuals covered under this paragraph shall be 199
determined by the division. 200
(19) Disabled workers, whose incomes are above the 201
Medicaid eligibility limits, but below two hundred fifty percent 202
(250%) of the federal poverty level, shall be allowed to purchase 203
Medicaid coverage on a sliding fee scale developed by the Division 204
of Medicaid. 205
(20) Medicaid eligible children under age eighteen (18) 206
shall remain eligible for Medicaid benefits until the end of a 207
period of twelve (12) months following an eligibility 208
determination, or until such time that the individual exceeds age 209
eighteen (18). 210
(21) Women of childbearing age whose family income does 211
not exceed one hundred eighty-five percent (185%) of the federal 212
poverty level. The eligibility of individuals covered under this 213
paragraph (21) shall be determined by the Division of Medicaid, 214
and those individuals determined eligible shall only receive 215
family planning services covered under Section 43-13-117(13) and 216
not any other services covered under Medicaid. However, any 217
individual eligible under this paragraph (21) who is also eligible 218
under any other provision of this section shall receive the 219
benefits to which he or she is entitled under that other 220
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provision, in addition to family planning services covered under 221
Section 43-13-117(13). 222
The Division of Medicaid shall apply to the United States 223
Secretary of Health and Human Services for a federal waiver of the 224
applicable provisions of Title XIX of the federal Social Security 225
Act, as amended, and any other applicable provisions of federal 226
law as necessary to allow for the implementation of this paragraph 227
(21). The provisions of this paragraph (21) shall be implemented 228
from and after the date that the Division of Medicaid receives the 229
federal waiver. 230
(22) Persons who are workers with a potentially severe 231
disability, as determined by the division, shall be allowed to 232
purchase Medicaid coverage. The term "worker with a potentially 233
severe disability" means a person who is at least sixteen (16) 234
years of age but under sixty-five (65) years of age, who has a 235
physical or mental impairment that is reasonably expected to cause 236
the person to become blind or disabled as defined under Section 237
1614(a) of the federal Social Security Act, as amended, if the 238
person does not receive items and services provided under 239
Medicaid. 240
The eligibility of persons under this paragraph (22) shall be 241
conducted as a demonstration project that is consistent with 242
Section 204 of the Ticket to Work and Work Incentives Improvement 243
Act of 1999, Public Law 106-170, for a certain number of persons 244
as specified by the division. The eligibility of individuals 245
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covered under this paragraph (22) shall be determined by the 246
Division of Medicaid. 247
(23) Children certified by the Mississippi Department 248
of Human Services for whom the state and county departments of 249
human services have custody and financial responsibility who are 250
in foster care on their eighteenth birthday as reported by the 251
Mississippi Department of Human Services shall be certified 252
Medicaid eligible by the Division of Medicaid until their 253
twenty-first birthday. 254
(24) Individuals who have not attained age sixty-five 255
(65), are not otherwise covered by creditable coverage as defined 256
in the Public Health Services Act, and have been screened for 257
breast and cervical cancer under the Centers for Disease Control 258
and Prevention Breast and Cervical Cancer Early Detection Program 259
established under Title XV of the Public Health Service Act in 260
accordance with the requirements of that act and who need 261
treatment for breast or cervical cancer. Eligibility of 262
individuals under this paragraph (24) shall be determined by the 263
Division of Medicaid. 264
(25) The division shall apply to the Centers for 265
Medicare and Medicaid Services (CMS) for any necessary waivers to 266
provide services to individuals who are sixty-five (65) years of 267
age or older or are disabled as determined under Section 268
1614(a)(3) of the federal Social Security Act, as amended, and 269
whose income does not exceed one hundred thirty-five percent 270
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(135%) of the nonfarm official poverty level as defined by the 271
Office of Management and Budget and revised annually, and whose 272
resources do not exceed those established by the Division of 273
Medicaid, and who are not otherwise covered by Medicare. Nothing 274
contained in this paragraph (25) shall entitle an individual to 275
benefits. The eligibility of individuals covered under this 276
paragraph shall be determined by the Division of Medicaid. 277
(26) The division shall apply to the Centers for 278
Medicare and Medicaid Services (CMS) for any necessary waivers to 279
provide services to individuals who are sixty-five (65) years of 280
age or older or are disabled as determined under Section 281
1614(a)(3) of the federal Social Security Act, as amended, who are 282
end stage renal disease patients on dialysis, cancer patients on 283
chemotherapy or organ transplant recipients on antirejection 284
drugs, whose income does not exceed one hundred thirty-five 285
percent (135%) of the nonfarm official poverty level as defined by 286
the Office of Management and Budget and revised annually, and 287
whose resources do not exceed those established by the division. 288
Nothing contained in this paragraph (26) shall entitle an 289
individual to benefits. The eligibility of individuals covered 290
under this paragraph shall be determined by the Division of 291
Medicaid. 292
(27) Individuals who are entitled to Medicare Part D 293
and whose income does not exceed one hundred fifty percent (150%) 294
of the nonfarm official poverty level as defined by the Office of 295
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Management and Budget and revised annually. Eligibility for 296
payment of the Medicare Part D subsidy under this paragraph shall 297
be determined by the division. 298
(28) The division is authorized and directed to provide 299
up to twelve (12) months of continuous coverage postpartum for any 300
individual who qualifies for Medicaid coverage under this section 301
as a pregnant woman, to the extent allowable under federal law and 302
as determined by the division. 303
(29) Individuals who are under sixty-five (65) years of 304
age, are not pregnant, are not entitled to or enrolled for 305
benefits under Part A or Part B of Medicare, are not eligible for 306
Medicaid under any other paragraph of this section, and whose 307
income is not more than one hundred thirty-three percent (133%) of 308
the federal poverty level applicable to a family of the size 309
involved. Individuals eligible under this paragraph (28) shall 310
receive benchmark coverage described in Section 1937(b)(1) of the 311
federal Social Security Act, as amended, or benchmark equivalent 312
coverage described in Section 1937(b)(2) of the federal Social 313
Security Act, as amended. The eligibility of individuals covered 314
under this paragraph shall be determined by the Division of 315
Medicaid. 316
(30) Children who are under nineteen (19) years of age, 317
are not eligible for Medicaid under any other paragraph of this 318
section, and whose family income is more than one hundred 319
thirty-three percent (133%) but not more than two hundred percent 320
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ST: Medicaid; expand eligibility under federal
Affordable Care Act and under CHIP.
(200%) of the federal poverty level applicable to a family of the 321
size involved. The eligibility of individuals covered under this 322
paragraph shall be determined by the Division of Medicaid. The 323
coverage of children under this paragraph is an expansion of 324
Medicaid coverage as allowed under the Children's Health Insurance 325
Program (CHIP) established by Title XXI of the federal Social 326
Security Act, as amended. 327
The division shall redetermine eligibility for all categories 328
of recipients described in each paragraph of this section not less 329
frequently than required by federal law. 330
SECTION 2. Sections 41-86-1, 41-86-5, 41-86-7, 41-86-9, 331
41-86-11, 41-86-13 and 41-86-15, Mississippi Code of 1972, which 332
are the Mississippi Children's Health Insurance Program Act, are 333
repealed. 334
SECTION 3. This act shall take effect and be in force from 335
and after July 1, 2026. 336