Who is an individual certified by the local welfare department to receive benefits of Medicaid?

Depending on a number of factors an individual may qualify for full Mississippi Medicaid health benefits, reduced coverage or limited benefits (full coverage with some service limits) in a covered group briefly described below.

Full Medicaid Benefits

The following covered groups of people qualify for full Mississippi Medicaid health benefits if eligible under the appropriate income limits and other qualifications.

Infants and Children
Covered group: infants and children
Income limits: based on age, income, family size (refer to the MAGI income limit table) Age: up to 19 (0-18)

Qualifications: Household income, tax filing status and the relationships between household members must be considered in determining eligibility for each infant and child living in the home.

Children’s Health Insurance Program (CHIP)
Covered group: uninsured children
Income limits: based on age, insured status of each child, family size and family household income cannot exceed 209% of the federal poverty level (FPL) (refer to the MAGI income limit table) Age: up to 19 (0-18)

Qualifications: 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.

Parents/Caretakers of Minor Children Covered group: low-income parents, caretakers

Income limits: not based on the FPL, (refer to the MAGI income limit table)

Qualifications: Parents or caretakers must have 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.

Pregnant Women Covered group: pregnant women

Income limits: under 194% of the FPL, family size (refer to the MAGI income limit table)

Qualifications: Pregnant women receive benefits two months postpartum and are automatically put on the family planning waiver for one year. Any child born to Medicaid eligible mother automatically receives Medicaid benefits until the infant reaches the age of one. The number of individuals within the family is increased by the number of babies expected when determining family size for Medicaid. Pregnant minors (under age 19) can qualify regardless of family income.

Disabled Child Living at Home Covered group: disabled children who require a level of care typically provided in a hospital or long term care facility

Income limits: Only the child’s income and resources are considered. The limit is the current institutional maximum income limit and the resource limit is $2,000. For more information, view the Guidelines for Medicaid Eligibility for Disabled Child Living At Home brochure.

Qualifications: The child must be disabled and in need of an institutional level of care.

Working Disabled Covered group: working disabled

Income limits: income cannot exceed 250% of the federal poverty level and unearned income cannot exceed 135% of the federal poverty level. For more information, view the Guidelines for Persons Working and Disabled brochure.

Qualifications: The working disabled individual must work at least 40 hours per month. Those who earn more than 150% of the federal poverty level must pay a monthly premium to purchase Medicaid coverage.

Aged, Blind or Disabled Receiving Supplemental Security Income (SSI) Covered group: aged, blind or disabled (eligibility for this covered group is certified by the Social Security Administration

Income limits: income limits change annually and are determined by the Social Security Administration. For more information, view the Guidelines for the Aged, Blind and Disabled Receiving SSI or Former SSI Recipients brochure.

Qualifications: Individuals must be blind or disabled or age 65 or older. SSI recipients are automatically eligible for Medicaid.

Aged, Blind or Disabled Former Supplemental Security Income (SSI) Recipients
Covered group: Certain Former SSI Recipients who lose SSI due to a qualifying event that allows Medicaid to continue. This category includes certain disabled adult children, widow(er)s within a certain age limit who do not have Medicare and certain individuals who lose SSI due to a cost of living increase in their Social Security benefits.  For more information, view the Guidelines for the Aged, Blind and Disabled Receiving SSI or Former SSI Recipients brochure.

Aged, Blind or Disabled Residing in Nursing Facility or Participating in a Home and Community Based Services (HCBS) Waiver Program Covered group: Aged 65 or over or under age 65 who are blind or disabled. The individual must be determined to be in need of a level of care that is provided by the nursing facility or HCBS waiver program.

Income limits: monthly income that does not exceed 300% of the SSI Federal Benefit Rate. Individuals whose income exceeds the institutional limit may qualify based on an Income Trust that obligates all income to the facility or to the Division of Medicaid. For HCBS waiver participants, income over the Medicaid limit is payable to the Division of Medicaid under the terms of an Income Trust. For more information, view the Guidelines for Medicaid Eligibility for Aged, Blind and Disabled Living in Nursing Facilities or Participating in a Home and Community Based Services Waiver Program brochure.

Emergency Services for Immigrants (who do not otherwise qualify for Medicaid) Covered group: non-qualified or undocumented immigrants Income limits: An immigrant must qualify for a covered group on all factors other than citizenship and immigration status. The income (and resource) limit for the covered group applies. Age: The age limit for the applicable covered group applies.

Qualifications: Immigrants who have had an emergency medical service and who are determined eligible for a covered group, are covered solely for the date of service of the emergency.

Reduced Coverage / Medicare Cost Sharing or Premium Payment

Qualified Medicare Beneficiaries Covered group: individuals covered by Medicare

Income limits: Income cannot exceed 100% of the federal poverty level. For more information, view the Guidelines for Medicare Cost-Sharing Programs brochure.

Qualifications: Individuals must be eligible for Medicare Part A hospital insurance.

Specified Low-Income Medicare Beneficiaries Covered group: individuals covered by Medicare

Income limits: Income cannot exceed 135% of the federal poverty level. For more information, view the Guidelines for Medicare Cost-Sharing Programs brochure.

Qualifications: Individuals must have Medicare Part A (hospital insurance)

Qualified Individuals Covered group: individuals covered by Medicare

Income limits: Income cannot exceed 135% of the federal poverty level. For more information, view the Guidelines for Medicare Cost-Sharing Programs brochure.

Qualifications: Individuals must have Medicare Part A (hospital insurance)

Limited Benefits

Family Planning Waiver Covered group: women and men Income limits: family income at or below 194% FPL Age: 13-44 years old

Qualifications: This Waiver will cover women and men who have not had any type of procedure that would prevent them from reproducing, and does not have any other type of health insurance.

Healthier Mississippi Waiver
Covered group: aged, blind or disabled who are not Medicare eligible
Income limits: Monthly income cannot exceed 135% of the federal poverty level. For more information, view the Healthier Mississippi Waiver brochure. Age: 65 or older, blind or disabled

Qualifications: This waiver covers individuals who are not eligible for Medicare. Once Medicare starts, eligibility for the Healthier MS Waiver ends.

How to Apply?

Good health is important to everyone. If you can't afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy and stay healthy.

Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. Depending on your state's rules, you may also be asked to pay a small part of the cost (co-payment) for some medical services. In general, you should apply for Medicaid if you have limited income and resources. You must match one of the descriptions below:

Pregnant Women

Apply for Medicaid if you think you are pregnant. You may be eligible if you are married or single. If you are on Medicaid when your child is born, both you and your child will be covered.

Children and Teenagers

Apply for Medicaid if you are the parent or guardian of a child who is 18 years old or younger and your family's income is limited, or if your child is sick enough to need nursing home care, but could stay home with good quality care at home. If you are a teenager living on your own, the state may allow you to apply for Medicaid on your own behalf or any adult may apply for you. Many states also cover children up to age 21.

Person who is Aged, Blind, and/or Disabled

Apply if you are aged (65 years old or older), blind, or disabled and have limited income and resources. Apply if you are terminally ill and want to get hospice services. Apply if you are aged, blind, or disabled; live in a nursing home; and have limited income and resources. Apply if you are aged, blind, or disabled and need nursing home care, but can stay at home with special community care services. Apply if you are eligible for Medicare and have limited income and resources.

Other Situations

Apply if you are leaving welfare and need health coverage. Apply if you are a family with children under age 18 and have limited income and resources. (You do not need to be receiving a welfare check.) Apply if you have very high medical bills, which you cannot pay (and you are pregnant, under age 18 or over age 65, blind, or disabled).

Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services. To learn more, see: http://www.medicaid.gov/.