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Medicaid and the State Children’s Health Insurance Program (SCHIP/CHIP)* Offer Free or Low-Cost Health Coverage to Children and Families

If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid* or CHIP* programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.

If you or your dependents are already enrolled in Medicaid* or CHIP* and you live in a State listed below, you can 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, you can 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, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you and/or your dependents enroll in State Medicaid* or CHIP*, but subsequently lose eligibility, you and your dependents can be re-enrolled in the employer’s health plan. If you (or your dependent(s)) are already enrolled in your employer’s health plan, but become eligible for State Medicaid* or CHIP*, you have the right to dis-enroll yourself and/or your dependent(s) from the employer’s health plan**. These special enrollment/disenrollment requests must be submitted to the Benefits Office within 60 days after you or your dependent(s) is terminated from, or determined to be eligible for such assistance.

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 November 3, 2010. You should contact your State for further information on eligibility.

ALABAMA – Medicaid CALIFORNIA – Medicaid and CHIP*
Website: http://www.medicaid.alabama.gov Telephone:
1-800-362-1504 		Medicaid Website: http://www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont. aspx Telephone: 1-866-298-8443 CHIP (Healthy Families)* Website: http://www.healthyfamilies.ca.gov Telephone:
1-800-880-5305
ALASKA – Medicaid COLORADO – Medicaid and CHIP
Website: http://health.hss.state.ak.us/dpa/programs/medicaid/ Telephone (Outside of Anchorage): 1-888-318-8890 Telephone (Anchorage): 907-269-6529 Medicaid Website: http://www.colorado.gov/ Medicaid Telephone (In state): 1-800-866-3513 Medicaid Telephone (Out of state): 1-800-221-3943 CHIP
Website: http:// www.CHPplus.org CHIP
Telephone: 303-866-3243
ARIZONA – CHIP
Website: http://www.azahcccs.gov/applicants/default.aspx Telephone (In state): 1-877-764-5437
ARKANSAS – CHIP FLORIDA – Medicaid
Website: http://www.arkidsfirst.com/
Telephone: 1-888-474-8275 		Website: http://www.fdhc.state.fl.us/Medicaid/index.shtml Telephone: 1-866-762-2237
GEORGIA – Medicaid MONTANA – Medicaid
Website: http://dch.georgia.gov/ Click on Programs, then Medicaid Telephone: 1-800-869-1150 Website: http://medicaidprovider.hhs.mt.gov/clientpages/ clientindex.shtml TeleTelephone: 1-800-694-3084
IDAHO – Medicaid and CHIP NEBRASKA – Medicaid
Medicaid Website: www.accesstohealthinsurance.idaho.gov Medicaid Telephone: 1-800-926-2588 CHIP Website: www.medicaid.idaho.gov CHIP Telephone: 1-800-926-2588 Website: http://www.dhhs.ne.gov/med/medindex.htm Telephone: 1-877-255-3092
INDIANA – Medicaid NEVADA – Medicaid and CHIP
Website: http://www.in.gov/fssa/2408.htm
Telephone: 1-877-438-4479 		Medicaid Website: http://dwss.nv.gov/ Medicaid Telephone: 1-800-992-0900 CHIP
Website: http://www.nevadacheckup.nv.org/ CHIP
Telephone: 1-877-543-7669
IOWA – Medicaid
Website: www.dhs.state.ia.us/hipp/ Telephone: 1-888-346-9562
KANSAS – Medicaid NEW HAMPSHIRE – Medicaid
Website: https://www.khpa.ks.gov
Telephone: 800-766-9012 		Website: www.dhhs.nh.gov/ombp/index.htm
Telephone: 603-271-4238
KENTUCKY – Medicaid NEW JERSEY – Medicaid and CHIP
Website: http://chfs.ky.gov/dms/default.htm
Telephone: 1-800-635-2570 		Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid
Telephone: 1-800-356-1561 CHIP
Website: http://www.njfamilycare.org/index.html CHIP Telephone: 1-800-701-0710
LOUISIANA – Medicaid
Website: http://www.lahipp.dhh.louisiana.gov
Telephone: 1-888-342-6207
MAINE – Medicaid NEW MEXICO – Medicaid and CHIP
Website: http://www.maine.gov/dhhs/oms/ Telephone: 1-800-321-5557 Medicaid Website: http://www.hsd.state.nm.us/mad/index.html Medicaid Telephone: 1-888-997-2583 CHIP
Website: http://www.hsd.state.nm.us/mad/index.html Click on Insure New Mexico CHIP
Telephone: 1-888-997-2583
MASSACHUSETTS – Medicaid and CHIP
Medicaid & CHIP Website: http://www.mass.gov/MassHealth Medicaid & CHIP Telephone: 1-800-462-1120
MINNESOTA – Medicaid NEW YORK – Medicaid
Website: http://www.dhs.state.mn.us/ Click on Health Care, then Medical Assistance Telephone (Outside of Twin City area): 800-657-3739 Telephone (Twin City area): 651-431-2670 Website: http://www.nyhealth.gov/health_care/ medicaid/ Telephone: 1-800-541-2831
MISSOURI – Medicaid NORTH CAROLINA – Medicaid
Website: http://www.dss.mo.gov/mhd/index.htm
Telephone: 573-751-6944 		Website: http://www.nc.gov Telephone: 919-855-4100
NORTH DAKOTA – Medicaid UTAH – Medicaid
Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Telephone: 1-800-755-2604 Website: http://health.utah.gov/medicaid/
Telephone: 1-866-435-7414
OKLAHOMA – Medicaid VERMONT– Medicaid
Website: http://www.insureoklahoma.org
Telephone: 1-888-365-3742 		Website: http://ovha.vermont.gov/
Telephone: 1-800-250-8427
OREGON – Medicaid and CHIP VIRGINIA – Medicaid and CHIP
Medicaid & CHIP Website: http://www.oregonhealthykids.gov Medicaid & CHIP Telephone: 1-877-314-5678 Medicaid Website: http://www.dmas.virginia.gov/rcpHIPP.htm Medicaid Telephone: 1-800-432-5924 CHIP
Website: http://www.famis.org/ CHIP
Telephone: 1-866-873-2647
PENNSYLVANIA – Medicaid WASHINGTON – Medicaid
Website: http://www.dpw.state.pa.us/partnersproviders/medicalassista nce/doingbusiness/003670053.htm
Telephone: 1-800-644-7730 		Website: http://hrsa.dshs.wa.gov/premiumpymt/Apply.shtm Telephone: 1-800-562-3022 ext. 15473
RHODE ISLAND – Medicaid WEST VIRGINIA – Medicaid
Website: www.dhs.ri.gov
Telephone: 401-462-5300 		Website: http://www.wvrecovery.com/hipp.htm
Telephone: 304-342-1604
SOUTH CAROLINA – Medicaid WISCONSIN – Medicaid
Website: http://www.scdhhs.gov
Telephone: 1-888-549-0820 		Website: http://dhs.wisconsin.gov/medicaid/publications/p10095.htm Telephone: 1-800-362-3002
TEXAS – Medicaid WYOMING – Medicaid
Website: https://www.gethipptexas.com/
Telephone: 1-800-440-0493 		Website: http://www.health.wyo.gov/healthcarefin/index.html Telephone: 307-777-7531

To see if any more States have added a premium assistance program since November 3, 2010, or for more information on special enrollment rights, you can contact either:

U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services

*In the State of California, Healthy Families is the equivalent of the SCHIP/CHIP program and provides, health, dental and vision coverage to dependents up at age 19. The Medi-Cal Program is the equivalent of Medicaid. These programs are income-based and are available to individuals that may or may not qualify for health coverage through the employer.

**Please note: If you opt to enroll or re-enroll in your employer’s plan, you can opt to enroll yourself only or yourself and your dependents. Dependents cannot be enrolled in the employer’s plan without the employee being covered also.

OMB Control Number 1210-0137 (expires 09/30/2013)