Social protection and healthcare in Mayotte

Mayotte became the 101^st French department on 31 March 2011 (CLEISS). The CSSM, headquartered in Mamoudzou, has run the general scheme since 1977 and has been the single social security body since 2015, under the authority of four national funds (ACOSS, CNAM, CNAF and CNAV); it covers sickness-maternity, invalidity-death, old age-widowhood, work accidents, unemployment and family benefits. Farm operators have come under the MSA since January 2015 (CLEISS). The Labour Code has applied since January 2018.

The order of 22 July 2026 on the extension and adaptation of the social security code to Mayotte provides that this code applies in Mayotte from 1 January 2028 and replaces the current specific orders. The Ministry of Labour and Solidarity specifies that the CSSM will then become a base body of the general scheme, keeping its organisation, its governance and its local roots. Until then, the scheme remains the one set by the orders applicable to Mayotte, in gradual convergence with the mainland.

For care, the Regional Health Agency (ARS) describes a Mayotte hospital centre (CHM) with more than 2,600 professionals, including more than 220 doctors and 170 midwives, with 411 beds and places across 5 sites, an emergency department open every day at any hour and a level 2b maternity unit. Four care and childbirth centres, thirteen consultation centres (dispensaries) and 21 structures awarded the "France Santé" label complete the primary care offering. The CHM website shows other figures (567 beds and places, 3,299 professionals) without specifying the period covered; they are therefore not used here.

Santé publique France monitors the health situation in a regional bulletin which regularly reports cases of malaria (acquired locally or imported, mainly from the Comoros), mpox and chikungunya; it also reports seasonal epidemics, such as acute gastroenteritis linked to rotavirus A and influenza, with vigilance recommended for young children and older people. The prefecture and the ARS also publish joint press releases on heightened vigilance in response to international alerts, such as Ebola. The health system in Mayotte guide details how care is organised.

• Local affiliation: article 19-1 of order no. 96-1122, as worded following law no. 2025-797 of 11 August 2025, affiliates to the Mayotte scheme anyone who carries on a professional activity or, with no activity, lives in Mayotte on a stable and lawful basis. The CSSM presents PUMa as personal and continuous cover of healthcare costs, in force since 1 July 2026. The stable residence criterion is proven to the CSSM.
• Residence criterion: decree no. 2026-581 of 30 June 2026 applies to Mayotte the rule that a person is deemed to have their main residence in Mayotte if they actually and personally live there for more than six months in the calendar year, without having transferred their residence outside Mayotte. The same decree extends from one to three months the time allowed to answer requests for information made to check the conditions (stability of residence and lawfulness of stay).
• Filing the application: the CSSM states that the basic condition is to live in Mayotte, that the affiliation application is filed with legible supporting documents and that the CSSM then issues the certificate of entitlement and the Vitale card; the certificate can also be downloaded from an ameli account and a temporary code can be provided at the reception desk. The page consulted contains no information specific to people arriving from mainland France.
• Continuation of rights: in the event of loss of activity, change of situation or end of validity of a residence permit, the CSSM indicates a temporary continuation of rights of 3 to 6 months depending on the case; the law refers to a decree to set the conditions under which rights are retained, for up to one year, by people who cease to meet the residence condition.
• Care pathway: since the law of 24 July 2019, the coordinated care pathway has applied in Mayotte; affiliated people over 16 declare a referring doctor (CLEISS). Young people aged 16 can apply for affiliation in their own right (CSSM).
• Dependants: minors are dependants up to age 18 according to the CSSM; article 19 of order no. 96-1122 covers people with no professional activity whose parentage is established.
• Student: the Assurance Maladie (the French national health insurance) states that a student's healthcare costs are reimbursed by the fund of their place of residence. For a student coming from the mainland, how this fits with their home fund is to be confirmed with the CSSM before departure.
• Seconded employee (see the glossary entry seconded employee) or civil servant transferred to Mayotte: the sources consulted describe no form for continuing mainland cover. The CSSM page on medical evacuation cites certificates of entitlement from the CSSM, the MGEN or the MSA, which indicates that several protection bodies coexist in the territory; the competent body is to be confirmed with the employer or administration and the CSSM.

The sources consulted mention no individual penalty linked to a lack of cover; the issue is financial. The Caisse des Français de l'Étranger (CFE), the French overseas social security fund offers generic plans (main plan, youth plan, retiree plan) intended for expatriates; its home page specifies no rule for a resident of Mayotte, who comes under the general scheme applicable to Mayotte: any eligibility is to be asked of the CFE.

This is not a social security agreement between two states: the framework is institutional. Mayotte is part of the Republic and its social protection comes under a specific scheme, set by orders, which is converging towards ordinary law. Law no. 2025-797 of 11 August 2025 on programming for the rebuilding of Mayotte authorised the government to legislate by order (article 23) and extended universal health protection to Mayotte (article 24). Decree no. 2026-581 of 30 June 2026 sets out the implementing rules from 1 July 2026, and order no. 2026-647 of 22 July 2026 provides for the social security code to apply on 1 January 2028.

• Convergence timetable (report to the President of the Republic): in 2028, application of the social security code and repeal of the four territorial orders; in 2029, current invalidity rules maintained; in 2031, alignment of favourable provisions; in 2035, end of the contribution-rate trajectories; on 31 March 2036, end of the transitional chapter. The ministry announces alignment of the SMIC, almost all family benefits, sickness benefits, minimum social benefits and the activity bonus by 2031, and full convergence by 2036.
• Supplementary cover: the generalisation of compulsory collective supplementary cover for employees in Mayotte is postponed to 31 March 2036 (report to the President of the Republic). Individual supplementary insurance therefore remains very relevant.
• Family benefits: the Mayotte CAF pays them on condition of actual residence in France, including on the mainland (CLEISS). The amounts of several benefits remain specific to Mayotte.
• Mainland forms: the Assurance Maladie specifies that the opening of rights is not always automatic and that form Cerfa S1106 must be completed and sent to the body of one's place of residence (CLEISS); for Mayotte, that body is the CSSM.
• Leaving Mayotte for the mainland: inform the CSSM, update your Vitale card and create your ameli account before leaving, as the CSSM recommends to students leaving to study on the mainland.

1. Before departure: inform your Assurance Maladie fund, your family allowance fund and your pension funds of the change of residence, and ask the CSSM about transferring your file.
2. On arrival: file the affiliation application with the CSSM (Centre Kinga, route nationale 1, Kaweni, Mamoudzou; telephone 02 69 61 91 91) with legible supporting documents, then collect the certificate of entitlement and the Vitale card.
3. Create your ameli account, declare a referring doctor (compulsory for over-16s) and update your Vitale card at least once a year.
4. Employee: the employer makes the pre-hire declaration within the eight days before the expected hiring date (CSSM). Self-employed: register and follow the Urssaf contribution calls.
5. Family: declare the children to the CSSM and the CAF; a 16-year-old can apply for personal affiliation.
6. Modest income: look into the complémentaire santé solidaire, to be requested from the CSSM or online depending on income level.
7. Plan for supplementary health insurance for the ticket modérateur and an assistance policy for travel outside national territory, as care abroad is only covered by the CSSM if it is urgent and unforeseen.
8. Scheduled medical evacuation: consult your doctor, file the application at the CSSM EVASAN one-stop desk at least 15 calendar days before the medical appointment.
9. On returning to the mainland: inform the CSSM and request the opening of rights with the fund of your new place of residence using form Cerfa S1106.