CHIP eligibility

CHIP

While Medicaid programs are required by federal law to cover certain populations up to specified income levels, there is no mandatory income level up to which CHIP programs must extend coverage.

States’ upper limits for children’s CHIP eligibility range from 170 percent of the federal poverty level (FPL) in North Dakota ($42,670 for a family of four in 2018) to 400 percent FPL in New York ($100,400 for a family of four in 2018). (Click here for CHIP income eligibility levels by state.) Although many states offer CHIP coverage at higher income levels (generally with higher premiums or cost sharing), 89 percent of the children enrolled in CHIP-financed coverage had incomes at or below 200 percent FPL in fiscal year (FY) 2013, and 97 percent were at or below 250 percent FPL (Table 1).

Under the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended), states must maintain their 2010 eligibility levels through FY 2019 for all children in separate CHIP programs and Medicaid (including Medicaid-expansion CHIP programs), a requirement referred to as maintenance of effort (MOE). Subsequent funding renewals that extended CHIP funding through FY 2027 also extended through the same year the CHIP MOE for children with incomes below 300 percent FPL.

Table 1. Children Enrollment in CHIP by Family Income, FY 2013

Family Income as a Percent of Federal Poverty Level (FPL) Percent of CHIP Child Enrollees
At or below 200 percent FPL 88.8%
Above 200 percent through 250 percent FPL 8.6%
Above 250 percent FPL 2.6%
Total 100.0%

Source: Child Enrollment in Medicaid-Financed Coverage by State, and CHIP-Financed Coverage by State and Family Income.

Pregnant Women and Unborn Children

States may also provide CHIP-funded coverage to pregnant women through a state plan option or a continuation of an existing Section 1115 waiver. Five states (Colorado, Missouri, New Jersey, Rhode Island, Virginia) enroll pregnant women in CHIP-funded coverage. (Click here for state-specific eligibility levels.)

States may also cover unborn children in separate CHIP. In FY 2015, 15 states provided separate CHIP coverage to approximately 327,000 unborn children. Unborn children accounted for the entirety of separate CHIP enrollment in Arkansas, Minnesota, Nebraska, and Rhode Island. The largest enrollment of unborn children in FY 2015 was in California and Texas. (Click here for state-specific enrollment data.)