Medicaid; require Governor and Division of Medicaid to negotiate to obtain federal waiver to expand Medicaid coverage.

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To: Medicaid; Appropriations
A
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Clark

HOUSE BILL NO. 256

AN ACT TO DIRECT THE GOVERNOR AND THE DIVISION OF MEDICAID TO 1
ENTER INTO NEGOTIATIONS WITH THE FEDERAL GOVERNMENT TO OBTAIN A 2
WAIVER OF APPLICABLE PROVISIONS OF THE MEDICAID LAWS AND 3
REGULATIONS TO CREATE A PLAN TO ALLOW THE EXPANSION OF MEDICAID 4
COVERAGE IN MISSISSIPPI; TO SPECIFY THE PROVISIONS THAT THE 5
GOVERNOR AND THE DIVISION SHALL SEEK TO HAVE INCLUDED IN THE 6
WAIVER PLAN; TO PROVIDE THAT IF A WAIVER IS OBTAINED TO ALLOW THE 7
EXPANSION OF MEDICAID COVERAGE, THE DIVISION SHALL AMEND THE STATE 8
PLAN TO INCLUDE THE PROVISIONS AUTHORIZED IN THE WAIVER AND SHALL 9
BEGIN IMPLEMENTING THE PLAN AUTHORIZED BY THE WAIVER; TO AMEND 10
SECTION 43-13-115, MISSISSIPPI CODE OF 1972, TO CONFORM TO THE 11
PRECEDING PROVISIONS; AND FOR RELATED PURPOSES. 12
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 13
SECTION 1. (1) The Governor and the Division of Medicaid 14
shall enter into negotiations with the Centers for Medicare and 15
Medicaid Services (CMS) to obtain a waiver of applicable 16
provisions of the Medicaid laws and regulations under Section 1115 17
of the federal Social Security Act to create a plan to allow the 18
expansion of Medicaid coverage in Mississippi, which contains the 19
following provisions: 20
(a) Overview. (i) Private market-based health 21
coverage will be provided to adults with incomes of not more than 22
one hundred thirty-eight percent (138%) of Federal Poverty Level 23
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(FPL). Most of these adults will be in working families who are 24
not offered affordable coverage options by their employer and earn 25
too much to qualify for Medicaid. 26
(ii) Newly eligible adults will have at least two 27
(2) Qualified Health Plans (QHP) offered by insurance carriers 28
contracting with the state. 29
(iii) Cost-sharing will be required for enrollees 30
with incomes of not less than fifty percent (50%) and not more 31
than one hundred thirty-eight percent (138%) of the FPL (not 32
greater than those allowable under current law), which can be 33
reduced by participating in specified healthy behavior activities. 34
(iv) The Mississippi Healthy Living Account will 35
be created, and enrollees with incomes of not less than fifty 36
percent (50%) and not more than one hundred thirty-eight percent 37
(138%) of the FPL will be required to make income-based 38
contributions to health savings accounts. Enrollees cannot lose 39
or be denied Medicaid eligibility, be denied health plan 40
enrollment, or be denied access to services, and providers may not 41
deny services for failure to pay copays or premiums. 42
(b) Duration. The plan will automatically end if the 43
federal contribution rate for this expanded Medicaid coverage 44
falls below ninety percent (90%). 45
(c) Coverage Groups. The groups that will be covered 46
are: 47
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(i) Newly eligible adults without dependent 48
children, who are nineteen (19) through sixty-four (64) years of 49
age with incomes of not more than one hundred thirty-eight percent 50
(138%) of the FPL; 51
(ii) Newly eligible parents who are nineteen (19) 52
through sixty-four (64) years of age with incomes more than 53
twenty-two percent (22%) and not more than one hundred 54
thirty-eight percent (138%) of the FPL; and 55
(iii) Parents with incomes of not more than 56
twenty-two percent (22%) of the FPL will be transitioned from 57
traditional Medicaid to the new plan. 58
(d) Premiums. The state will use Medicaid dollars to 59
pay monthly premiums directly to QHPs. Enrollees will not be 60
responsible for the premium but will be responsible to make 61
cost-sharing contributions. 62
(e) Qualified Health Plan Choice/Benefits. (i) 63
Enrollees will choose between at least two (2) silver level 64
marketplace QHPs. If enrollees do not choose a plan, they will be 65
automatically assigned to one (1) plan. The state must ensure 66
that beneficiaries authorize auto-assignment to a plan. 67
(ii) Enrollees will have access to at least one 68
(1) QHP that contracts with at least one (1) Federally Qualified 69
Health Center (FQHC). 70
(f) Health Savings Account/Cost-Sharing. (i) The 71
Mississippi Healthy Living Account will be established, which is a 72
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health savings account for individuals with incomes of not less 73
than fifty percent (50%) and not more than one hundred 74
thirty-eight percent (138%) of the FPL. Contributions to the 75
healthy living account will be used to pay individuals' copays and 76
to meet other cost-sharing requirements. Enrollees will make 77
quarterly contributions to their account. 78
(ii) Cost-sharing obligations will be based on the 79
enrollee's prior six (6) months of copays, billed at the end of 80
each quarter. No cost-sharing will be required for the first six 81
(6) months of enrollment. Cost-sharing will be paid into health 82
accounts and can be reduced through compliance with healthy 83
behaviors. 84
(iii) Cost-sharing for enrollees with incomes of 85
not less than fifty percent (50%) and less than one hundred 86
percent (100%) of the FPL will be capped at two percent (2%) of 87
their income, and cost-sharing for enrollees with incomes of not 88
less than one hundred percent (100%) and not more than one hundred 89
thirty-eight percent (138%) of the FPL will be capped at five 90
percent (5%) of their income. 91
(iv) Cost-sharing will not be administered at the 92
point of service. Enrollees will make their required contribution 93
to their health savings account. The account administrator will 94
make required payments to the enrollee's provider. 95
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(v) Healthy living accounts and healthy behavior 96
protocols will be developed by the state and submitted to CMS for 97
approval. 98
(g) Enrollment Process. The Medicaid enrollment 99
process will be modernized by implementing a data-sharing 100
initiative commonly called "Fast-Track," which will transition 101
thousands of currently eligible parents off of traditional 102
Medicaid and to the private insurance market. 103
(2) If the Governor and the Division of Medicaid are 104
successful in obtaining a Section 1115 waiver to allow the 105
expansion of Medicaid coverage in Mississippi, the division shall 106
amend the state plan to include the provisions authorized in the 107
waiver, and shall begin implementing the plan authorized by the 108
waiver after receiving CMS approval of the state plan amendment. 109
SECTION 2. Section 43-13-115, Mississippi Code of 1972, is 110
amended as follows: 111
43-13-115. Recipients of Medicaid shall be the following 112
persons only: 113
(1) Those who are qualified for public assistance 114
grants under provisions of Title IV-A and E of the federal Social 115
Security Act, as amended, including those statutorily deemed to be 116
IV-A and low income families and children under Section 1931 of 117
the federal Social Security Act. For the purposes of this 118
paragraph (1) and paragraphs (8), (17) and (18) of this section, 119
any reference to Title IV-A or to Part A of Title IV of the 120
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federal Social Security Act, as amended, or the state plan under 121
Title IV-A or Part A of Title IV, shall be considered as a 122
reference to Title IV-A of the federal Social Security Act, as 123
amended, and the state plan under Title IV-A, including the income 124
and resource standards and methodologies under Title IV-A and the 125
state plan, as they existed on July 16, 1996. The Department of 126
Human Services shall determine Medicaid eligibility for children 127
receiving public assistance grants under Title IV-E. The division 128
shall determine eligibility for low income families under Section 129
1931 of the federal Social Security Act and shall redetermine 130
eligibility for those continuing under Title IV-A grants. 131
(2) Those qualified for Supplemental Security Income 132
(SSI) benefits under Title XVI of the federal Social Security Act, 133
as amended, and those who are deemed SSI eligible as contained in 134
federal statute. The eligibility of individuals covered in this 135
paragraph shall be determined by the Social Security 136
Administration and certified to the Division of Medicaid. 137
(3) Qualified pregnant women who would be eligible for 138
Medicaid as a low income family member under Section 1931 of the 139
federal Social Security Act if her child were born. The 140
eligibility of the individuals covered under this paragraph shall 141
be determined by the division. 142
(4) [Deleted] 143
(5) A child born on or after October 1, 1984, to a 144
woman eligible for and receiving Medicaid under the state plan on 145
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the date of the child's birth shall be deemed to have applied for 146
Medicaid and to have been found eligible for Medicaid under the 147
plan on the date of that birth, and will remain eligible for 148
Medicaid for a period of one (1) year so long as the child is a 149
member of the woman's household and the woman remains eligible for 150
Medicaid or would be eligible for Medicaid if pregnant. The 151
eligibility of individuals covered in this paragraph shall be 152
determined by the Division of Medicaid. 153
(6) Children certified by the State Department of Human 154
Services to the Division of Medicaid of whom the state and county 155
departments of human services have custody and financial 156
responsibility, and children who are in adoptions subsidized in 157
full or part by the Department of Human Services, including 158
special needs children in non-Title IV-E adoption assistance, who 159
are approvable under Title XIX of the Medicaid program. The 160
eligibility of the children covered under this paragraph shall be 161
determined by the State Department of Human Services. 162
(7) Persons certified by the Division of Medicaid who 163
are patients in a medical facility (nursing home, hospital, 164
tuberculosis sanatorium or institution for treatment of mental 165
diseases), and who, except for the fact that they are patients in 166
that medical facility, would qualify for grants under Title IV, 167
Supplementary Security Income (SSI) benefits under Title XVI or 168
state supplements, and those aged, blind and disabled persons who 169
would not be eligible for Supplemental Security Income (SSI) 170
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benefits under Title XVI or state supplements if they were not 171
institutionalized in a medical facility but whose income is below 172
the maximum standard set by the Division of Medicaid, which 173
standard shall not exceed that prescribed by federal regulation. 174
(8) Children under eighteen (18) years of age and 175
pregnant women (including those in intact families) who meet the 176
financial standards of the state plan approved under Title IV-A of 177
the federal Social Security Act, as amended. The eligibility of 178
children covered under this paragraph shall be determined by the 179
Division of Medicaid. 180
(9) Individuals who are: 181
(a) Children born after September 30, 1983, who 182
have not attained the age of nineteen (19), with family income 183
that does not exceed one hundred percent (100%) of the nonfarm 184
official poverty level; 185
(b) Pregnant women, infants and children who have 186
not attained the age of six (6), with family income that does not 187
exceed one hundred thirty-three percent (133%) of the federal 188
poverty level; and 189
(c) Pregnant women and infants who have not 190
attained the age of one (1), with family income that does not 191
exceed one hundred eighty-five percent (185%) of the federal 192
poverty level. 193
The eligibility of individuals covered in (a), (b) and (c) of 194
this paragraph shall be determined by the division. 195
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(10) Certain disabled children age eighteen (18) or 196
under who are living at home, who would be eligible, if in a 197
medical institution, for SSI or a state supplemental payment under 198
Title XVI of the federal Social Security Act, as amended, and 199
therefore for Medicaid under the plan, and for whom the state has 200
made a determination as required under Section 1902(e)(3)(b) of 201
the federal Social Security Act, as amended. The eligibility of 202
individuals under this paragraph shall be determined by the 203
Division of Medicaid. 204
(11) Until the end of the day on December 31, 2005, 205
individuals who are sixty-five (65) years of age or older or are 206
disabled as determined under Section 1614(a)(3) of the federal 207
Social Security Act, as amended, and whose income does not exceed 208
one hundred thirty-five percent (135%) of the nonfarm official 209
poverty level as defined by the Office of Management and Budget 210
and revised annually, and whose resources do not exceed those 211
established by the Division of Medicaid. The eligibility of 212
individuals covered under this paragraph shall be determined by 213
the Division of Medicaid. After December 31, 2005, only those 214
individuals covered under the 1115(c) Healthier Mississippi waiver 215
will be covered under this category. 216
Any individual who applied for Medicaid during the period 217
from July 1, 2004, through March 31, 2005, who otherwise would 218
have been eligible for coverage under this paragraph (11) if it 219
had been in effect at the time the individual submitted his or her 220
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application and is still eligible for coverage under this 221
paragraph (11) on March 31, 2005, shall be eligible for Medicaid 222
coverage under this paragraph (11) from March 31, 2005, through 223
December 31, 2005. The division shall give priority in processing 224
the applications for those individuals to determine their 225
eligibility under this paragraph (11). 226
(12) Individuals who are qualified Medicare 227
beneficiaries (QMB) entitled to Part A Medicare as defined under 228
Section 301, Public Law 100-360, known as the Medicare 229
Catastrophic Coverage Act of 1988, and whose income does not 230
exceed one hundred percent (100%) of the nonfarm official poverty 231
level as defined by the Office of Management and Budget and 232
revised annually. 233
The eligibility of individuals covered under this paragraph 234
shall be determined by the Division of Medicaid, and those 235
individuals determined eligible shall receive Medicare 236
cost-sharing expenses only as more fully defined by the Medicare 237
Catastrophic Coverage Act of 1988 and the Balanced Budget Act of 238
1997. 239
(13) (a) Individuals who are entitled to Medicare Part 240
A as defined in Section 4501 of the Omnibus Budget Reconciliation 241
Act of 1990, and whose income does not exceed one hundred twenty 242
percent (120%) of the nonfarm official poverty level as defined by 243
the Office of Management and Budget and revised annually. 244
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Eligibility for Medicaid benefits is limited to full payment of 245
Medicare Part B premiums. 246
(b) Individuals entitled to Part A of Medicare, 247
with income above one hundred twenty percent (120%), but less than 248
one hundred thirty-five percent (135%) of the federal poverty 249
level, and not otherwise eligible for Medicaid. Eligibility for 250
Medicaid benefits is limited to full payment of Medicare Part B 251
premiums. The number of eligible individuals is limited by the 252
availability of the federal capped allocation at one hundred 253
percent (100%) of federal matching funds, as more fully defined in 254
the Balanced Budget Act of 1997. 255
The eligibility of individuals covered under this paragraph 256
shall be determined by the Division of Medicaid. 257
(14) [Deleted] 258
(15) Disabled workers who are eligible to enroll in 259
Part A Medicare as required by Public Law 101-239, known as the 260
Omnibus Budget Reconciliation Act of 1989, and whose income does 261
not exceed two hundred percent (200%) of the federal poverty level 262
as determined in accordance with the Supplemental Security Income 263
(SSI) program. The eligibility of individuals covered under this 264
paragraph shall be determined by the Division of Medicaid and 265
those individuals shall be entitled to buy-in coverage of Medicare 266
Part A premiums only under the provisions of this paragraph (15). 267
(16) In accordance with the terms and conditions of 268
approved Title XIX waiver from the United States Department of 269
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Health and Human Services, persons provided home- and 270
community-based services who are physically disabled and certified 271
by the Division of Medicaid as eligible due to applying the income 272
and deeming requirements as if they were institutionalized. 273
(17) In accordance with the terms of the federal 274
Personal Responsibility and Work Opportunity Reconciliation Act of 275
1996 (Public Law 104-193), persons who become ineligible for 276
assistance under Title IV-A of the federal Social Security Act, as 277
amended, because of increased income from or hours of employment 278
of the caretaker relative or because of the expiration of the 279
applicable earned income disregards, who were eligible for 280
Medicaid for at least three (3) of the six (6) months preceding 281
the month in which the ineligibility begins, shall be eligible for 282
Medicaid for up to twelve (12) months. The eligibility of the 283
individuals covered under this paragraph shall be determined by 284
the division. 285
(18) Persons who become ineligible for assistance under 286
Title IV-A of the federal Social Security Act, as amended, as a 287
result, in whole or in part, of the collection or increased 288
collection of child or spousal support under Title IV-D of the 289
federal Social Security Act, as amended, who were eligible for 290
Medicaid for at least three (3) of the six (6) months immediately 291
preceding the month in which the ineligibility begins, shall be 292
eligible for Medicaid for an additional four (4) months beginning 293
with the month in which the ineligibility begins. The eligibility 294
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of the individuals covered under this paragraph shall be 295
determined by the division. 296
(19) Disabled workers, whose incomes are above the 297
Medicaid eligibility limits, but below two hundred fifty percent 298
(250%) of the federal poverty level, shall be allowed to purchase 299
Medicaid coverage on a sliding fee scale developed by the Division 300
of Medicaid. 301
(20) Medicaid eligible children under age eighteen (18) 302
shall remain eligible for Medicaid benefits until the end of a 303
period of twelve (12) months following an eligibility 304
determination, or until such time that the individual exceeds age 305
eighteen (18). 306
(21) Women of childbearing age whose family income does 307
not exceed one hundred eighty-five percent (185%) of the federal 308
poverty level. The eligibility of individuals covered under this 309
paragraph (21) shall be determined by the Division of Medicaid, 310
and those individuals determined eligible shall only receive 311
family planning services covered under Section 43-13-117(13) and 312
not any other services covered under Medicaid. However, any 313
individual eligible under this paragraph (21) who is also eligible 314
under any other provision of this section shall receive the 315
benefits to which he or she is entitled under that other 316
provision, in addition to family planning services covered under 317
Section 43-13-117(13). 318
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The Division of Medicaid shall apply to the United States 319
Secretary of Health and Human Services for a federal waiver of the 320
applicable provisions of Title XIX of the federal Social Security 321
Act, as amended, and any other applicable provisions of federal 322
law as necessary to allow for the implementation of this paragraph 323
(21). The provisions of this paragraph (21) shall be implemented 324
from and after the date that the Division of Medicaid receives the 325
federal waiver. 326
(22) Persons who are workers with a potentially severe 327
disability, as determined by the division, shall be allowed to 328
purchase Medicaid coverage. The term "worker with a potentially 329
severe disability" means a person who is at least sixteen (16) 330
years of age but under sixty-five (65) years of age, who has a 331
physical or mental impairment that is reasonably expected to cause 332
the person to become blind or disabled as defined under Section 333
1614(a) of the federal Social Security Act, as amended, if the 334
person does not receive items and services provided under 335
Medicaid. 336
The eligibility of persons under this paragraph (22) shall be 337
conducted as a demonstration project that is consistent with 338
Section 204 of the Ticket to Work and Work Incentives Improvement 339
Act of 1999, Public Law 106-170, for a certain number of persons 340
as specified by the division. The eligibility of individuals 341
covered under this paragraph (22) shall be determined by the 342
Division of Medicaid. 343
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(23) Children certified by the Mississippi Department 344
of Human Services for whom the state and county departments of 345
human services have custody and financial responsibility who are 346
in foster care on their eighteenth birthday as reported by the 347
Mississippi Department of Human Services shall be certified 348
Medicaid eligible by the Division of Medicaid until their 349
twenty-first birthday. 350
(24) Individuals who have not attained age sixty-five 351
(65), are not otherwise covered by creditable coverage as defined 352
in the Public Health Services Act, and have been screened for 353
breast and cervical cancer under the Centers for Disease Control 354
and Prevention Breast and Cervical Cancer Early Detection Program 355
established under Title XV of the Public Health Service Act in 356
accordance with the requirements of that act and who need 357
treatment for breast or cervical cancer. Eligibility of 358
individuals under this paragraph (24) shall be determined by the 359
Division of Medicaid. 360
(25) The division shall apply to the Centers for 361
Medicare and Medicaid Services (CMS) for any necessary waivers to 362
provide services to individuals who are sixty-five (65) years of 363
age or older or are disabled as determined under Section 364
1614(a)(3) of the federal Social Security Act, as amended, and 365
whose income does not exceed one hundred thirty-five percent 366
(135%) of the nonfarm official poverty level as defined by the 367
Office of Management and Budget and revised annually, and whose 368
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resources do not exceed those established by the Division of 369
Medicaid, and who are not otherwise covered by Medicare. Nothing 370
contained in this paragraph (25) shall entitle an individual to 371
benefits. The eligibility of individuals covered under this 372
paragraph shall be determined by the Division of Medicaid. 373
(26) The division shall apply to the Centers for 374
Medicare and Medicaid Services (CMS) for any necessary waivers to 375
provide services to individuals who are sixty-five (65) years of 376
age or older or are disabled as determined under Section 377
1614(a)(3) of the federal Social Security Act, as amended, who are 378
end stage renal disease patients on dialysis, cancer patients on 379
chemotherapy or organ transplant recipients on antirejection 380
drugs, whose income does not exceed one hundred thirty-five 381
percent (135%) of the nonfarm official poverty level as defined by 382
the Office of Management and Budget and revised annually, and 383
whose resources do not exceed those established by the division. 384
Nothing contained in this paragraph (26) shall entitle an 385
individual to benefits. The eligibility of individuals covered 386
under this paragraph shall be determined by the Division of 387
Medicaid. 388
(27) Individuals who are entitled to Medicare Part D 389
and whose income does not exceed one hundred fifty percent (150%) 390
of the nonfarm official poverty level as defined by the Office of 391
Management and Budget and revised annually. Eligibility for 392
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ST: Medicaid; require Governor and Division of
Medicaid to negotiate to obtain federal waiver
to expand Medicaid coverage.
payment of the Medicare Part D subsidy under this paragraph shall 393
be determined by the division. 394
(28) The division is authorized and directed to provide 395
up to twelve (12) months of continuous coverage postpartum for any 396
individual who qualifies for Medicaid coverage under this section 397
as a pregnant woman, to the extent allowable under federal law and 398
as determined by the division. 399
(29) Individuals who are eligible under the Section 400
1115 waiver obtained under Section 1 of this act. 401
The division shall redetermine eligibility for all categories 402
of recipients described in each paragraph of this section not less 403
frequently than required by federal law. 404
SECTION 3. This act shall take effect and be in force from 405
and after July 1, 2026. 406