Insurance Affordability Programs
Effective Jan.1, 2014, the Affordable Care Act (ACA) creates insurance affordability programs as a way to get health coverage at no cost or lower cost than purchasing coverage on your own. In Mississippi, these programs include Mississippi Health Benefits (Medicaid and CHIP) and health coverage through a federal marketplace.
Individuals or families with income above the poverty level and below 400% of the Federal Poverty Level (FPL) can purchase insurance through the federal marketplace with premium tax credits that lower the cost of insurance. Certain households will also qualify for cost-sharing reductions for out-of-pocket expenses,for insurance through the marketplace. In order to qualify for insurance through the marketplace, an individual must not be eligible for Medicaid, CHIP or affordable job-based health coverage, as determined by the federal marketplace.
Individuals who apply for health coverage through the federal marketplace will be assessed for Medicaid and/or CHIP eligibility. If Medicaid or CHIP eligibility is a possibility for any family member, the marketplace will electronically transfer the individual’s account to the Division of Medicaid for a formal Medicaid decision. No separate application is needed to apply for Mississippi Health Benefits.
Mississippi Health Benefits
Mississippi Health Benefits includes the following Medicaid programs and the Children’s Health Insurance Program (CHIP). Individuals who may qualify are:
- Children up to age 19
- Low-income adults with children under age 18
- Pregnant women
- Medicaid for Infants from birth to age 1 – Infants to age 1 may qualify if family income does not exceed 194% of the FPL.
- Medicaid for Children age 1 to age 6 – Children age 1 to age 6 may qualify if family income does not exceed 143% of the FPL.
- Medicaid for Children age 6 to age 19 – Children age 6 to age 19 may qualify if family income does not exceed 133% of the FPL.
- Children’s Health Insurance Program (CHIP) – Uninsured children up to age 19 whose family income does not exceed 209% of the FPL may qualify for insurance coverage through CHIP. A child must be determined ineligible for Medicaid before eligibility for CHIP can be considered. Children with current health insurance coverage at the time of application are not eligible for CHIP. The child’s age and family income factor into when a child may qualify for CHIP.
- Infants from birth to age 1 may qualify for CHIP if family income is between 194% – 209% FPL.
- Children age 1 to age 6 may qualify for CHIP if family income is between 143% – 209% FPL.
- Children age 6 to age 19 may qualify for CHIP if family income is between 133% – 209% FPL.
- Medicaid for Pregnant Women of any age – Pregnant women of any age may qualify for Medicaid during pregnancy if family income does not exceed 194% of the FPL. The number of individuals within the family is increased by the number of babies expected when determining family size. Pregnant minors (under age 19) can qualify regardless of family income. Women age 21 and over are limited to pregnancy-related Medicaid benefits, which does not include eyeglasses and dental services, unless eligible for coverage as a low-income parent.
- Medicaid for Parent(s) and Caretaker Relatives – Low income parent(s) or caretaker relatives may qualify if there are children under age 18 living in the home who are deprived of the support of one or both parents due to the disability of a parent, the death or continued absence of a parent or have parent(s) who are unemployed or have very low income. Caretaker relatives must be within a certain degree of relationship to the children and have primary responsibility for children under age 18 in order to qualify. As a condition of eligibility, the adult must cooperate with child support enforcement requirements for each child deprived due to a parent’s continued absence from the home.
Single Streamline Application
The Mississippi Division of Medicaid and the federal marketplace have one single application for all insurance affordability programs. Application for any of the insurance affordability programs may be filed either through the federal marketplace or the Division of Medicaid.
- Medicaid Application Form – for benefits under the Affordable Care Act (ACA), effective Jan. 1, 2014
How to apply
- The fastest way to apply for this coverage which is effective on and after Jan. 1, 2014 is to complete and submit an application online at www.HealthCare.gov or www.medicaid.ms.gov . Only one application should be filed on one of the websites.
- The application form may also be printed at either website, filled out and submitted to the Division of Medicaid by one of the following. An original signature is not required for a faxed or e-mailed application.
- Fax to Enrollment: (601) 576-4164
- Email address: email@example.com
* It is advised that you do not email forms or submit online forms with protected health information or personally identifiable information, to protect your confidentiality in accordance with the Health Insurance Portability and Accountability Act of 1996.
- Mail to the regional office that serves your county of residence.
- If you want an application mailed to you or if you need telephone assistance, call the Division of Medicaid at 1-800-421-2408 or contact the regional office that serves your county of residence.
To fill out this application, you will need:
- Social Security Numbers or document numbers for legal immigrants who need insurance,
- Dates of birth for each person applying,
- Employer and income information for each person in the family with income. Use income from the most recent month’s paystubs or W-2 forms or any document that shows exactly what each person receives as income.
- Policy numbers for any current health insurance,
- Information about any job-related health insurance available to your family.
The Division of Medicaid and the federal marketplace will verify as much data as possible from electronic sources in order to verify what is reported on your application. You will only be asked to provide verification of needed eligibility information if eligibility factors cannot be verified through an available electronic source or if the information you give conflicts with data from electronic sources.
Medicaid and CHIP income limits are shown on the next page. There is no resource test for any insurance affordability program, including Medicaid and CHIP.