PENNSYLVANIA Medical Assistance (Medicaid) Premium Assistance http://www.dhs.state.pa.us 1-800-644-7730. Medicaid Website: http://www.colorado.



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Information about Help in Paying for Your Health Insurance Coverage Medicaid and the Children s Health Insurance Program (CHIP) Offer Free or Low-Cost Health Coverage to Children and Families If you or your children are eligible for Medicaid or CHIP and you re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren t eligible for Medicaid or CHIP, you won t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.pennsylvania uses funds from its Medicaid program to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. (Pennsylvania does not have a premium assistance program for its Children s Health Insurance Program (CHIP), but offers CHIP coverage to eligible children on a free, low-cost, or at-cost basis.) If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. Please note that most children of Commonwealth of Pennsylvania employees are not eligible for CHIP. Children of commonwealth employees who are eligible for health insurance through the Pennsylvania Employees Benefit Trust Fund (PEBTF) are not eligible for the Children s Health Insurance Program (CHIP) administered by the Pennsylvania Insurance Department s Office of CHIP. There are a few exceptions for children of: Employees in their first six months of employment Employees who are not eligible to receive PEBTF family full coverage benefits Part time employees who are eligible to purchase the PEBTF benefits, but meet the hardship exception (PEBTF premiums and cost-sharing are more than 5% of the family s income during the year the child would be enrolled in CHIP) Commonwealth employees who have children who are eligible for PEBTF coverage and are currently enrolled in CHIP should immediately contact the HR Service Center at 1-866-377-2672 to enroll their children in PEBTF, then immediately contact their CHIP insurer to end CHIP coverage. Employees of agencies not supported by the HR Service Center should contact their HR office. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren t already enrolled. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

Pennsylvania offers an assistance program only for Medical Assistance (Medicaid). For a list of the other states assistance information, please review the information below. PENNSYLVANIA Medical Assistance (Medicaid) Premium Assistance http://www.dhs.state.pa.us 1-800-644-7730 If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2014. Contact your State for more information on eligibility ALABAMA Medicaid http://www.medicaid.alabama.gov Phone: 1-855-692-5447 ALASKA Medicaid COLORADO Medicaid Medicaid http://www.colorado.gov/ Medicaid Phone (In state): 1-800-866-3513 Medicaid Phone (Out of state): 1-800-221-3943 http://health.hss.state.ak.us/dpa/programs/medicaid/ Phone (Outside of Anchorage): 1-888-318-8890 Phone (Anchorage): 907-269-6529 ARIZONA CHIP http://www.azahcccs.gov/applicants Phone (Outside of Maricopa County): 1-877-764-5437 Phone (Maricopa County): 602-417-5437 FLORIDA Medicaid https://www.flmedicaidtplrecovery.com/ Phone: 1-877-357-3268 GEORGIA Medicaid http://dch.georgia.gov/ - Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP) IDAHO Medicaid Medicaid http://healthandwelfare.idaho.gov/medical/medicaid/ PremiumAssistance/tabid/1510/Default.aspx Medicaid Phone: 1-800-926-2588 Phone: 1-800-869-1150 MONTANA Medicaid http://medicaidprovider.hhs.mt.gov/clientpages/ clientindex.shtml Phone: 1-800-694-3084

INDIANA Medicaid http://www.in.gov/fssa Phone: 1-800-889-9949 NEBRASKA Medicaid www.accessnebraska.ne.gov Phone: 1-800-383-4278 IOWA Medicaid www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562 NEVADA Medicaid Medicaid http://dwss.nv.gov/ Medicaid Phone: 1-800-992-0900 KANSAS Medicaid http://www.kdheks.gov/hcf/ Phone: 1-800-792-4884 KENTUCKY Medicaid http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570 LOUISIANA Medicaid http://www.lahipp.dhh.louisiana.gov Phone: 1-888-695-2447 MAINE Medicaid http://www.maine.gov/dhhs/ofi/publicassistance/index.html Phone: 1-800-977-6740 TTY 1-800-977-6741 MASSACHUSETTS Medicaid and CHIP http://www.mass.gov/masshealth Phone: 1-800-462-1120 NEW HAMPSHIRE Medicaid http://www.dhhs.nh.gov/oii/documents/hippapp. pdf Phone: 603-271-5218 NEW JERSEY Medicaid and CHIP Medicaid http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 NEW YORK Medicaid http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831

MINNESOTA Medicaid http://www.dhs.state.mn.us/ Click on Health Care, then Medical Assistance NORTH CAROLINA Medicaid http://www.ncdhhs.gov/dma Phone: 919-855-4100 Phone: 1-800-657-3629 MISSOURI Medicaid http://www.dss.mo.gov/mhd/participants/pages/hipp. htm Phone: 573-751-2005 NORTH DAKOTA Medicaid http://www.nd.gov/dhs/services/medicalserv/me dicaid/ Phone: 1-800-755-2604 OKLAHOMA Medicaid and CHIP http://www.insureoklahoma.org Phone: 1-888-365-3742 OREGON Medicaid http://www.oregonhealthykids.gov http://www.hijossaludablesoregon.gov Phone: 1-800-699-9075 PENNSYLVANIA Medicaid http://www.dhs.state.pa.us/hipp Phone: 1-800-692-7462 UTAH Medicaid and CHIP http://health.utah.gov/upp Phone: 1-866-435-7414 VERMONT Medicaid http://www.greenmountaincare.org/ Phone: 1-800-250-8427 VIRGINIA Medicaid and CHIP Medicaid http://www.dmas.virginia.gov/rcp-hipp.htm Medicaid Phone: 1-800-432-5924 CHIP http://www.famis.org/ CHIP Phone: 1-866-873-2647 RHODE ISLAND Medicaid www.ohhs.ri.gov Phone: 401-462-5300 WASHINGTON Medicaid http://www.hca.wa.gov/medicaid/premiumpymt/ pages/index.aspx Phone: 1-800-562-3022 ext. 15473

SOUTH CAROLINA Medicaid WEST VIRGINIA Medicaid http://www.scdhhs.gov Phone: 1-888-549-0820 SOUTH DAKOTA - Medicaid http://dss.sd.gov Phone: 1-888-828-0059 TEXAS Medicaid https://www.gethipptexas.com/ Phone: 1-800-440-0493 www.dhhr.wv.gov/bms/ Phone: 1-877-598-5820, HMS Third Party Liability WISCONSIN Medicaid http://www.badgercareplus.org/pubs/p- 10095.htm Phone: 1-800-362-3002 WYOMING Medicaid http://health.wyo.gov/healthcarefin/equalitycare Phone: 307-777-7531 To see if any other states have added a premium assistance program since January 31, 2014, or for more information on special enrollment rights, contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565 OMB Control Number 1210-0137 (expires 10/31/2016)