Medicaid; expand eligibility to include certain disabled children living at home based on functional need.

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To: Medicaid
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Senator(s) Blackmon

SENATE BILL NO. 2122

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