CHIP Eligibility Standards
The Children’s Health Insurance Program (CHIP) serves uninsured children up to age 19 in families with incomes too high to qualify them for Medicaid. States have broad discretion in setting their income eligibility standards, and eligibility varies across states. See upper income eligibility levels by state.
46 States and the District of Columbia cover children up to or above 200% of the Federal Poverty Level (FPL) ($44,700 for a family of four in 2011), and 24 of these states offer coverage to children in families with income at 250% of the FPL or higher. States may get the CHIP enhanced match for coverage up to 300% of the FPL ($67,050 for a family of four in 2011), which is higher than the Medicaid federal funding matching rate. See information on CHIP Financing.
States that expand coverage above 300% of the FPL get the Medicaid matching rate. See upper income eligibility levels by state. States have the option to provide continuous eligibility to children who remain eligible for CHIP.
New Medicaid & CHIP Coverage Options
Lawfully Residing Children and Pregnant Women
Many states have elected the option under CHIPRA to restore Medicaid and/or CHIP coverage to children and pregnant women who are lawfully residing in the United States. See related federal policy guidance.
CHIPRA created an explicit eligibility category for pregnant women to receive coverage through CHIP in certain circumstances. See related federal policy guidance. Some states have also chosen to provide prenatal care for pregnant women through the CHIP program through other available vehicles.
Children of Public Employees
The Affordable Care Act of 2010provides states the option to extend CHIP eligibility to state employees’ children. Before enactment of the Affordable Care Act children of public employees were not eligible for CHIP, regardless of their income. See related federal policy guidance.