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Waiting Periods in CHIP

Section 2102(b)(3)(C) of the Social Security Act requires states to include in their state plan a description of how the state ensures that CHIP coverage does not substitute for coverage under group health plans. Prior to January 1, 2014, 36 states elected to institute a period of uninsurance (“waiting period”) ranging from one month to 12 months to address this requirement.

Effective January 1, 2014, CHIP regulations at 42 CFR 457.805 provide that a waiting period imposed under the state plan cannot exceed 90 days. Section 457.805(b)(3) of the regulations also requires states to adopt certain exemptions to any waiting period. States have the option to adopt additional exemptions. Regulations at 42 CFR 457.340(d)(3) and 457.350(i) require states to implement processes ensuring a smooth and seamless transition to other insurance affordability programs for which children may be eligible during a waiting period.

As of April 2021, only 14 states had a waiting period. The 22 states that eliminated their waiting period protect against substitution of coverage by using various procedures to monitor for substitution, including use of survey data, and private insurance database checks. Fourteen states have elected to continue to have a waiting period. Of these, 11 have a 90 day waiting period, 1 state has a two month waiting period, and 2 states have a one month waiting period.

The following table provides a summary of state policies in this area prior to, and subsequent to January 1, 2014.

Separate CHIP Waiting Periods National Snapshot

State

Waiting Period prior to January 1, 2014

Waiting Period as of April 2021

Exemptions to the Waiting Period (In Addition to Federally Mandated Exemptions under 42 CFR §457.805(b)(3))

Alabama

3 months

None

N/A

Arizona

3 months

90 days

  • Newborn children
  • Lifetime insurance limit reached
  • Enrolled in Children's Rehabilitative Services
  • Native American members receiving services from IHS or a 638 Tribal Facility

Arkansas

6 months

90 days

  • Unborn children

California

3 months

None

N/A

Colorado

3 months

None

N/A

Connecticut

2 months

None

N/A

Delaware

6 months

None

N/A

Florida

2 months

2 months

  • Domestic violence led to the loss of coverage
  • The child has exhausted coverage under COBRA continuation provision
  • The health benefits coverage does not cover the child's health care needs
  • Lifetime insurance limit reached

Georgia

60 days

None

N/A

Idaho

6 months

None

N/A

Illinois

12 months

90 days

  • Children in families with incomes at or above 209% FPL
  • Newborn under age 1

Indiana

3 months

90 days

  • Children in families with incomes at or below 158% FPL

Iowa

1 month

1 month

  • Children in families with incomes at or below 181% FPL
  • Children eligible for dental only supplemental coverage
  • Child lost coverage due to: domestic violence, lifetime insurance limit reached, expiration of coverage under COBRA, or due to reason beyond control of parent such as serious illness of the parent, flood, fire, or natural disaster
  • Health insurance was through an individual plan

Kansas

8 months

90 days

  • Children in families with incomes below 219% FPL
  • Lifetime insurance limit reached

Kentucky

6 months

None

N/A

Louisiana

12 months

90 days

  • Unborn children
  • Lifetime insurance limit reached
  • Long-term disability or other medical condition

Maine

3 months

90 days

None

Massachusetts

6 months

None

N/A

Michigan

6 months

None

N/A

Minnesota

None

None

N/A

Mississippi

None

None

N/A

Missouri

6 months

None

N/A

Montana

3 months

None

N/A

Nevada

6 months

None

N/A

New Jersey

3 months

90 days

  • Children in families with incomes at or below 200% FPL
  • Pregnant women
  • Physical or emotional abuse led to loss of coverage
  • Child was previously covered under an individual health benefits plan or COBRA plan preceding application for NJ FamilyCare
  • Child covered under a plan where the defined network is not accessible with 45 minutes travel time of the child's residency
  • The employer ceased operations in this state, and the succeeding employer has altered the terms of a noncontributory group health plan to require a premium contribution (for a class of employee to which the child's household member belongs)

New York

6 months

None

N/A

North Carolina

None

None

N/A

Oklahoma

None

None

N/A

Oregon

2 months

None

N/A

Pennsylvania

6 months

None

N/A

Rhode Island

None

None

N/A

South Dakota

3 months

90 days

None

Tennessee

3 months

None

N/A

Texas

90 days

90 days

  • Unborn children
  • Expiration of COBRA period of coverage
  • HHSC determines good cause exists
  • Loss of coverage in the Texas Employee Retirement System

Utah

90 days

90 days

  • Voluntary termination of COBRA coverage
  • Voluntary termination of coverage by a non-custodial parent
  • Voluntary termination of insurance that does not provide coverage in Utah
  • Voluntary termination of a limited health insurance plan

Virginia

4 months

None

N/A

Washington

4 months

None

N/A

West Virginia

3 months

None

N/A

Wisconsin

3 months

None

N/A

Wyoming

1 month

1 month

None

Totals

36 states

14 states

N/A