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MANDATED NOTICES
To see if any other states have added a premium assistance program since July 31, 2015, or for more information
on special enrollment rights, contact either:
U.S. Department of Labor
Employee Benefits Security Administration
www.d o l.gov /e bsa1‐866‐444‐EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
ww w.c ms .hh s.g o v1‐877‐267‐2323, Menu Option 4, Ext. 61565
OMB Control Number 1210‐0137 (expires 10/31/2016)
SOUTH CAROLINA – Medicaid
VIRGINIA – Medicaid and CHIP
Website:
h ttp ://www.scdhhs.govPhone: 1‐888‐549‐0820
Medicaid Websit
e : ht tp ://w w w.coverva.org/programs_premium_assistance.cfm
Medicaid Phone: 1‐800‐432‐5924
CHIP Website:
htt p:// www.coverva.org/programs_premium_assistance.cfm
CHIP Phone: 1‐855‐242‐8282
SOUTH DAKOTA ‐ Medicaid
WASHINGTON – Medicaid
Website:
h ttp ://dss.sd.govPhone: 1‐888‐828‐0059
Website:
ht t p: //w ww.hca.wa.gov/ medi ca id/ premiumpymt/pages/ index.aspx
Phone: 1‐800‐562‐3022 ext. 15473
TEXAS – Medicaid
WEST VIRGINIA – Medicaid
Website:
h ttp : //ge th i pptexas .com/Phone: 1‐800‐440‐0493
Website:
http : //w ww.dhhr.w v.gov/ bms/Medicaid%20Expansion/Pages/default.aspx
UTAH – Medicaid and CHIP
WISCONSIN – Medicaid and CHIP
Website:
Medicaid:
ht tp : //heal th .uta h .g ov/medi c aidCHIP:
ht t p: / / health . ut ah . go v / ch i pWebsite:
https:/
/ www.dhs.wisconsin. go v /ba dgercareplus/p‐10095.htm
Phone: 1‐800‐362‐3002
VERMONT– Medicaid
WYOMING – Medicaid
Website:
h ttp : // www.greenmountaincare.org/Phone: 1‐800‐250‐8427
Website:
https://wyequalitycare.acs‐ inc.com/Phone: 307‐777‐7531