2019 Medicaid and CHIP Premium Assistance Update

The Centers for Medicare & Medicaid Services (CMS) is issuing new guidance for states that choose to offer premium assistance for health insurance purchased through the individual market to eligible low-income people enrolled in Medicaid or the Children’s health insurance Program (CHIP).

CMS is committed to providing states with the necessary flexibilities to design and implement programs that best meet their needs and the needs of their beneficiaries. This new guidance builds on previous guidance issued in July 2017, and reflects CMS’ continued commitment to giving states maximum flexibility in administering their Medicaid and CHIP programs.

The new guidance provides additional information on:
· How states may use federal Medicaid funds to assist eligible individuals with paying premiums for health insurance plans purchased through the individual market;
· What types of plans are considered “qualified health plans” (QHPs), as well as how to determine if a QHP meets all other requirements under federal law;
· How CMS will calculate the federal medical assistance percentage (FMAP) for premium assistance payments;
· What cost-sharing arrangements are permissible under federal law; and
· How third-party payment arrangements can be used in connection with premium assistance payments.

Overview of Medicaid and CHIP Premium Assistance

Medicaid and the Children’s health insurance Program (CHIP) provide free or low-cost health insurance to millions of Americans, including children, pregnant women, parents, people with disabilities and seniors.

In most cases, Medicaid and CHIP cover families with very limited incomes and resources. However, some states have expanded Medicaid eligibility to include other groups of low-income adults without dependent children. These expansions vary by state.

If you have limited income and resources, you may be able to get help paying for your health insurance premiums. For instance, if you are eligible for Medicaid or CHIP but your income is too high to qualify for free or low-cost coverage through Medicaid or CHIP, you may be able to buy a private health insurance plan through the Marketplace and receive a premium tax credit that lowers your monthly premium payments.

How to Apply for Medicaid and CHIP Premium Assistance

If you or your family are eligible for Medicaid or Children’s Health Insurance Program (CHIP) coverage, you can apply for premium assistance to help pay your monthly premiums. To apply for premium assistance, visit the Healthcare.gov website and fill out an application. You will need to provide some basic information about your household income and size.

Eligibility for Medicaid and CHIP Premium Assistance

If you have Medicaid or CHIP coverage and are eligible for premium tax credits, you can use the Health Insurance Marketplace to buy a Marketplace plan. You can also use the Marketplace to renew your Medicaid or CHIP coverage. If you have questions about your coverage, call your state Medicaid or CHIP office or the Marketplace Call Center.

Coverage and Benefits of Medicaid and CHIP Premium Assistance

Coverage and Benefits of Medicaid and CHIP Premium Assistance:
Medicaid and the Children’s Health Insurance Program (CHIP) provide health coverage to eligible children, families, pregnant women, adults, seniors, and people with disabilities.

Medicaid is a joint federal and state program that:
– Helps with medical costs for some people with limited income and resources
– Offers benefits not normally covered by Medicare, like long-term care and personal care services.

In 2019, Medicaid is covering:
– More than 72 million low-income adults, children, pregnant women, seniors, and people with disabilities
– Roughly half of all births in the United States
– More than 60 percent of children in poverty

CHIP is a joint federal and state program that helps provide health coverage to eligible children up to age 19. In 2019:
– CHIP is covering more than 8 million kids nationwide

Some states have expanded their Medicaid programs to cover more low-income adults. The table below summarizes state expansions as of April 2019.

How Medicaid and CHIP Premium Assistance Works

Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to eligible children in families with incomes below a certain level. In some cases, Medicaid and CHIP also cover pregnant women, adults, and people with disabilities.

What to Do if You Have Questions about Medicaid and CHIP Premium Assistance

If you have questions about Medicaid or CHIP premium assistance, you can call your state Medicaid or CHIP office or visit www.insurekidsnow.gov for more information.

More Information about Medicaid and CHIP Premium Assistance

This document contains information about Medicaid and CHIP premium assistance, including how to find out if you or your family members are eligible for premium assistance and how to apply for it.

What is Medicaid?
Medicaid is a state and federal program that helps pay for medical care for low-income people of all ages. In some states, the program is called by a different name. For example, it may be called “Medi-Cal” in California, “MassHealth” in Massachusetts, or “TennCare” in Tennessee.

What is CHIP?
CHIP is the Children’s Health Insurance Program. It is a state and federal program that helps pay for health insurance for children up to age 19 who do not have health insurance. In some states, CHIP covers adults too.

Who can get premium assistance?
If you or your family members are eligible for Medicaid or CHIP and you’re having trouble paying your premiums, you might be able to get help paying them. This premium assistance is available in all 50 states and the District of Columbia.

You may be eligible for premium assistance if:
-Your income is below 400% of the federal poverty level (FPL) ($49,960 per year per family of four in 2019); and
-You’re not eligible for other affordable coverage, such as through an employer; and
-You’re either:
-A U.S. citizen; or
-A lawfully present noncitizen with qualifying immigrant status under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996; or
-An Indian tribe member as defined by Section 4(e) of the Indian Health Care Improvement Act

How do I apply?

If you want to see if you or your family members are eligible for premium assistance (or other help paying your premiums), visit healthcare.gov/lower-costs/eligible/. You’ll need to enter information about yourself (such as whether you have a job) and your family (such as how many people live with you), as well as information about your current health insurance coverage (if any).

State-by-State Medicaid and CHIP Premium Assistance

Keywords: Medicaid, CHIP, premium assistance

The following is a state-by-state update on Medicaid and CHIP premium assistance. If you have any questions about this information, please contact your state Medicaid or CHIP office.

Alaska
The Alaska Department of Health and Social Services (DHSS) has approved premium assistance for children enrolled in private health plans through the Alaska Premera Blue Cross Blue Shield Children’s Trust. For more information, please call 907-269-3680 or visit http://dhss.alaska.gov/omp/CHAMP/.

Arizona
The Arizona Health Care Cost Containment System (AHCCCS) offers premium assistance for children enrolled in private health plans. For more information, please call the AHCCCS Premium Assistance line at 602-417-5687 or visit https://www.azahcccs.gov/applicants/howtoapply/Pages/PremiumAssistancePrograms.aspx#child.

Arkansas
The Arkansas Department of Human Services (DHS) offers premium assistance for children enrolled in private health plans through Arkansas Blue Cross and Blue Shield, Arkans Choice, and QualChoice of Arkansas. For more information, please call 501-683-5947 or visit http://www.arkansasbluecrossblueshield4kids2enrollnowcom/.

California
California Children’s Services (CCS) offers premium assistance for children enrolled in private health plans through 10 CCS contracted managed care plans. For more information on the CCS Premium Assistance Program, please call 800-288-4584 or visit https://www.dhcs.ca.gov/services/ccs/pages/premiumassistprogdescriphowtorequestpaauthorizatnfromccsmpgpcontractedplanproviderair ambulancemedicaidmanagedcareorgnmbrsbycountyandccscontractedmanagedcareplansandserviceareasandpremiumratesupdated81518pdflinkopensanexternaldocumentinnewwindowmedicaidinfolineemaildhcsinfofilter@dhcscagovwebsitefeedbackformlinkopensanexternaldocumentinnewwindowcontactuslinkopensanexternaldocumentinnewwindowreportreimbursementfraudlinkopensanexternaldocumentinnewwindowfrequentlyaskedquestionsaboutpaymentreimbursementpracticespdfwasreviewedbytheofficeofthemangdcareombudsmanpriortobepostingpleasecontactcmoinquiry@dhcscagovwithanycommentsorquestionsthisinformationisavailabletothepublicpursuantto cal gov code 1251910 general administration5 public notice122 internet postingcalifornia code of regulations title 22 590782 public noticeatleastthreetimesayearcontractorsmustmakeallcurrentandpreviouslyissuedproviderdirectoriesandcurrentandpreviouslyissuedrateinformationavailablefreepublicon their website pursuant toGovernment Code 12572107 thesection furtherrequires the contractor post a list of the most common complaintsreceived bythe departmentinthe contractor’spubliclyaccessible website 122 internetposting contracting entities inthe ccs program must maintain a listofthemostcommoncomplaintsreceivedoftheircontractorentity which maybe made availabletopotentialproviderssection57107 asamendedbysection3ofchapter699statutesof2012requires that every california child withspecialhealth careneedswhose family’s income doesnot exceed300percentofthe federal poverty levelshouldhave access to Wraparound services CCS arranges careforchildrenwith chronic physical mental emotional or developmental conditions that require health and related services of a type or amountbeyondthatrequiredfor thenormalgrowthanddevelopmentofchildrenofsimilarage The department is requiredtoprovideeach countywith total funding that is not less than what was provided during fiscal year 2007 08No Child shall be denied eligibility to participate inAgency programsnorwill any Agency client be discriminated against on the basis of race creed color national origin ancestry religion sex marital status sexual orientation gender identity age disability medical condition genetic informationor any other basis protected by federal state local law In compliance with44 CFRparts6 13 29 30 Title IX prohibition against sex discrimination as amended 20 USC 1681 et seq 34 CFR 100 et seq Florida Statute section 1006 37 Part B ofthe Individuals with Disabilities Education Act 20 USC 1401et seq Section 504 33 USC 1631 et seq Title VI civil rights protectionsbased on race color national origin found at42 USC 2000d 49 CFR 21 1050 65 as amended by49 CFR 26 1152 Americans with Disabilities Act found at42 USC 12101et seq without regard to whether those services would bedefinedass medically necessary if provided to a nondisabled child 22 Ca Code Regs 59110a

Frequently Asked Questions about Medicaid and CHIP Premium Assistance

Q1: What is Medicaid and CHIP premium assistance?
A: Medicaid and CHIP premium assistance are programs that help eligible low-income families pay for private health insurance premiums.

Q2: Who is eligible for Medicaid and CHIP premium assistance?
A: Families with incomes at or below 150% of the federal poverty level (FPL) may be eligible for Medicaid. Children in families with incomes at or below 133% of the FPL are also eligible for CHIP.
Families with higher incomes may be eligible for premium assistance through Medicaid or CHIP if they meet certain other requirements.

Q3: How much premium assistance can I receive?
A: The amount of premium assistance you can receive depends on your income and the number of family members you have.

Q4: How do I apply for Medicaid and CHIP premium assistance?
A: You can apply for Medicaid or CHIP through your state’s Medicaid office or your state’s CHIP office. You can also apply through the Health Insurance Marketplace at Healthcare.gov. If you qualify, you will be referred to your state’s Medicaid office or your state’s CHIP office to complete the enrollment process.

Q5: I think I qualify for premium assistance, but I’m not sure. How can I find out?
A: You can call your state’s Medicaid office or your state’s CHIP office to find out if you qualify for premium assistance, or you can apply through the Health Insurance Marketplace at Healthcare.gov.

2019 Medicaid and CHIP Premium Assistance Update