The Center for Medicaid and CHIP Services (CMCS) works with states to identify and enroll people who are eligible for Medicaid or the Children's Health Insurance Program (CHIP). States may use these and other strategies to make it easier for people to enroll in Medicaid and CHIP coverage.
In May 2013, the Centers for Medicare & Medicaid Services (CMS) also released a letter to states outlining a set of Targeted Enrollment Strategies (PDF, 206.71 KB) (PDF 206.71 KB) designed to assist states in the transition to the Affordable Care Act changes for 2014. Visit National Medicaid & CHIP Program Information for more information on those targeted enrollment strategies.
Presumptive eligibility is a strategy that states employ to facilitate enrollment of individuals who are likely eligible for Medicaid or CHIP to access services without having to wait for their full application to be processed. States may authorize "qualified entities" — health care providers, community-based organizations, hospitals and schools, among others — to screen for Medicaid and CHIP eligibility and immediately enroll eligible individuals.
Qualified entities can also help families gather documents to complete the full application process, reducing the administrative burden on states to get missing information.
Sixteen states use presumptive eligibility to enroll children in Medicaid and/or CHIP.
In addition, the Affordable Care Act extended the concept of presumptive eligibility to hospitals. All states must offer qualifying hospitals the opportunity to conduct presumptive eligibility determinations. Visit Medicaid and CHIP Learning Collaborative Toolbox for more information about Hospital Presumptive Eligibility.
Express Lane Eligibility (ELE)
States may rely on eligibility information from "Express Lane" agency programs to streamline and simplify enrollment and renewal in Medicaid and CHIP. Express Lane agencies may include Supplemental Nutrition Assistance Program (SNAP), School Lunch programs, Temporary Assistance for Needy Families (TANF), Head Start, and the Women, Infant, and Children's program (WIC) , among others. States can also use state income tax data to determine Medicaid and CHIP eligibility for children. Visit Express Lane Eligibility page to learn more about states that have adopted this strategy.
States may provide children with 12 months of continuous coverage through Medicaid and CHIP, even if the family's income changes during the year.
Guaranteeing ongoing coverage ensures that children receive appropriate care, and helps doctors develop relationships with children and their families. This option eliminates cycling on and off of coverage during the year. This also reduces state time and money that would be spent on unnecessary paperwork and preventable care needs.
Thirty-three states use continuous eligibility to keep eligible children enrolled in Medicaid and/or CHIP.
Lawfully Residing Immigrant Children and Pregnant Women
States may provide Medicaid and CHIP coverage to children and pregnant women (up to age 19 for CHIP or up to age 21 for Medicaid) who are lawfully residing in the United States, including those within their first 5 years of having certain legal status. Previously, federal law required a 5-year waiting period before many legal immigrants could enroll in Medicaid and CHIP, although many states offered health coverage to these populations with state-only funds.
For the list of states that provide Medicaid and/or CHIP coverage to lawfully residing immigrant children and pregnant women.
- CHIPRA 214 (PDF, 188.34 KB) (PDF 188.34 KB) federal policy guidance.