Jane Dotson
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to some low-income people, families, and children. Each state has its own eligibility requirements for Medicaid and CHIP, and in most states, children up to the age of 19 with a family income of up to $80,000 per year may qualify for either Medicaid or CHIP. If your children are already covered by your HD insurance, you may still be able to apply for Medicaid or CHIP for them, depending on your state's eligibility requirements.
| Characteristics | Values |
|---|---|
| Who can apply for Medicaid or CHIP for a child? | A parent, grandparent, guardian or other authorized representative can apply on behalf of a child. |
| Who is eligible for Medicaid? | Low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI). |
| Who is eligible for CHIP? | Children in families that earn too much money to qualify for Medicaid. |
| What is the income eligibility for Medicaid? | States have different income eligibility rules, but in most states, children up to age 19 with family income up to $80,000 per year (for a family of four; income levels vary by state) may qualify for Medicaid or CHIP. |
| What is the income eligibility for CHIP? | Incomes vary by state. |
| What is the cost of CHIP? | Routine "well child" doctor and dental visits are free under CHIP. But there may be a fixed amount (e.g. $20) you pay for a covered health care service after you've paid your deductible. |
| When can I apply for Medicaid or CHIP? | You can apply for Medicaid or CHIP any time of year. There’s no limited enrollment period for either. |
| How can I apply for Medicaid or CHIP? | You can apply online, by phone, by mail, or in person. You can apply using the HealthCare.gov online application or directly at your state's Medicaid or CHIP agency. |
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What You'll Learn
Eligibility for Medicaid and CHIP
Medicaid and the Children's Health Insurance Program (CHIP) provide health coverage for children in families with low incomes. While each state has its own eligibility rules, in most states, children under 19 with a family income of up to $80,000 per year (for a family of four) may qualify for Medicaid or CHIP.
CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP also covers pregnant women. CHIP beneficiaries must be residents of the state in which they are receiving CHIP and meet certain financial and non-financial criteria.
Financial eligibility, or income eligibility, is based on Modified Adjusted Gross Income (MAGI). MAGI is used to determine financial eligibility for Medicaid, CHIP, and premium tax credits and cost-sharing reductions available through the health insurance marketplace. CHIP qualifications are different in every state, and eligibility is based on family income and any other state-specified rules in the CHIP state plan.
To be eligible for CHIP, children must be uninsured, US citizens, or meet immigration requirements. Generally, children who are eligible for health benefits through a state health benefits plan due to a family member's employment with a public agency cannot be eligible for CHIP (unless a state qualifies for either the maintenance of agency contribution or a hardship exception).
States have the flexibility to adopt their own eligibility standards. For example, some states have programs for specific geographic areas or for children with a disability status.
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Applying for Medicaid and CHIP
Medicaid and the Children's Health Insurance Program (CHIP) are health insurance programs for US citizens and certain lawfully present immigrants. They provide free or low-cost health coverage to eligible individuals. While Medicaid is aimed at people with low incomes, CHIP covers children in families that earn too much money to qualify for Medicaid. In some states, CHIP also covers pregnant women.
Each state has its own eligibility rules for Medicaid and CHIP, but in most states, children up to age 19 with a family income of up to $80,000 per year (for a family of four) may qualify for Medicaid or CHIP. Many children who are eligible for these programs are in families where one or both parents are working.
To apply for Medicaid and CHIP, you can use the HealthCare.gov online application or apply directly at your state's Medicaid or CHIP agency. You can also apply by phone, mail, or in person. If you apply for Medicaid coverage to your state agency, you'll also find out if your children qualify for CHIP.
When applying for Medicaid or CHIP, you may need to provide certain information or documentation, which may include:
- Social Security numbers for each person applying for benefits
- Citizenship documentation, such as a US passport, Certificate of Naturalization, US birth certificate, hospital record of birth, or Medicare card
- Immigration status documentation, such as a resident card, arrival/departure form, or other relevant papers
- Proof of income, such as pay stubs, tax returns, or a statement from your employer
- Documentation of any child support payments or other benefits you receive
It's important to note that the specific requirements and application process may vary depending on your state, so it's recommended to contact your state's Medicaid agency or call the confidential hotline at 1-877-KIDS-NOW (1-877-543-7669) for more information.
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Income requirements for Medicaid and CHIP
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.
Medicaid insures people with low incomes. The income eligibility rules vary by state, but in most states, children up to age 19 with a family income of up to $80,000 per year (for a family of four) may qualify for Medicaid or CHIP. In New York, for example, there is no monthly premium for families whose income is less than 2.2 times the poverty level, which is about $1,232 a week for a three-person family and $1,487 a week for a family of four. Families with somewhat higher incomes pay a small monthly premium per child per month, depending on their income and family size.
CHIP covers children in families with low to moderate incomes. CHIP qualifications are different in every state, and in most cases, they depend on income. If your income is too high for Medicaid, your child may still qualify for CHIP. If your children are eligible for CHIP, they won't be eligible for any savings on Marketplace insurance. CHIP coverage will probably be more affordable.
You can apply for Medicaid or CHIP at any time of the year, and if you qualify, your coverage can start immediately. You can apply online, by phone, by mail, or in person. To apply, you can use the HealthCare.gov online application or directly at your state's Medicaid or CHIP agency.
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Medicaid and CHIP coverage
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Each state has its own eligibility rules, but in most states, children up to age 19 with family incomes of up to $80,000 per year (for a family of four; income levels vary by state) may qualify for Medicaid or CHIP.
If your income is too high for Medicaid, your child may still qualify for CHIP. CHIP qualifications are different in every state and depend mostly on income. In general, CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. CHIP covers routine "well child" doctor and dental visits for free, but there may be a fixed amount you pay for covered health care services after you've paid your deductible.
Even if you don't qualify for Medicaid based on income, you should still apply. You may qualify for your state's program, especially if you have children, are pregnant, or have a disability. You can apply for Medicaid and CHIP at any time of the year, and if you qualify, your coverage can start immediately.
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Medicaid and CHIP during the COVID-19 pandemic
Medicaid and the Children's Health Insurance Program (CHIP) are health insurance options for children from low-income families in the United States. CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid.
During the COVID-19 pandemic, many families lost their sources of income and health insurance. In anticipation of the economic impact of the pandemic, Congress implemented incentives for states to maintain enrollment in Medicaid and CHIP. The Centers for Medicare & Medicaid Services (CMS) also temporarily waived certain Medicaid and CHIP requirements, preventing people from losing their health coverage during the pandemic.
The federal Families First Coronavirus Response Act (FFCRA), enacted on March 18, 2020, provided a 6.20 percentage point increase in the federal share of Medicaid spending, referred to as the Federal Medical Assistance Percentage (FMAP). This also indirectly provided a 4.34 percentage point increase in the enhanced FMAP for CHIP to states that met certain requirements. These requirements included applying Medicaid eligibility standards that were no more restrictive than those in effect on January 1, 2020.
The continuous enrollment provision, which was in place during the three years of the pandemic, allowed states to pause Medicaid disenrollments. This resulted in a record high of 94 million enrollees in March 2023, an 11% increase from February 2020, before the pandemic. However, by March 2024, national enrollment had decreased to 79 million people, a 16% decline from March 2023.
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Frequently asked questions
Yes, your children can be covered by both Medicaid and private insurance.
Eligibility for Medicaid depends on your state and your family income. In most states, children up to age 19 with a family income of up to $80,000 per year (for a family of four) may qualify.
You can apply online, by phone, by mail, or in person. You can apply using the HealthCare.gov online application or directly at your state's Medicaid agency.
If your income is too high for Medicaid, your child may still qualify for the Children's Health Insurance Program (CHIP). CHIP provides low-cost health coverage to children in families that earn too much to qualify for Medicaid.
During the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) temporarily waived certain Medicaid and CHIP requirements. This action prevented people with Medicaid and CHIP from losing their health coverage during the pandemic.
