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Medicaid & CHIP in

Explore key characteristics of Medicaid and CHIP in , including documents and information relevant to how the programs have been implemented by within federal guidelines.

has expanded coverage to low-income adults.

As of December 2019, has enrolled 985,201 individuals in Medicaid and CHIP — a net increase of 57.29% since the first Marketplace Open Enrollment Period and related Medicaid program changes in October 2013. has adopted one or more of the targeted enrollment strategies outlined in guidance CMS issued on May 17, 2013, designed to facilitate enrollment in Medicaid and CHIP.

For XXXX reporting of the CMS Medicaid and CHIP Child Core Set, reported XXX health care quality measures, including XXX out of XXX publicly reported measures. When a state used non-Core Set specifications, the measure is included in the count of measures reported by the state but the data are not included in the state profile.

For XXXX reporting of the CMS Medicaid and CHIP Adult Core Set, reported XXX health care quality measures, including XXX out of XXX publicly reported measures. When a state used non-Core Set specifications, the measure is included in the count of measures reported by the state but the data are not included in the state profile.

Source: Medicaid Quality of Care Performance Measurement

More detailed information and source references are available on each of these topics.

Most Medicaid eligibility and all CHIP eligibility is based on modified adjusted gross income (MAGI). Income eligibility levels are tied to the federal poverty level (FPL).

The following table provides a more detailed view of 's MAGI-based eligibility levels, expressed as a percentage of the FPL, for several key groups: children, pregnant women, parents/caretaker relatives, and, other adults

Medicaid & CHIP Eligibility1 as of
Children Eligibility Level
Children   Medicaid Ages 0-12 Eligibility Level  
Children   Medicaid Ages 1-52 Eligibility Level  
Children   Medicaid Ages 6-182 Eligibility Level  
Children   Separate CHIP3 Eligibility Level  
Pregnant Women Eligibility Level
Pregnant Women   Medicaid Eligibility Level  
Pregnant Women   CHIP4 Eligibility Level  
Adults (Medicaid) Eligibility Level
Adults (Medicaid)   Parent/Caretaker5 Eligibility Level  
Adults (Medicaid)   Expansion to Adults Eligibility Level  

1. This table reflects the principal but not all MAGI coverage groups. All income standards are expressed as a percentage of the federal poverty level (FPL). For the eligibility groups reflected in the table, an individual’s income, computed using the Modified Adjusted Gross Income (MAGI)-based income rules described in 42 CFR 435.603, is compared to the income standards identified in this table to determine if they are income eligible for Medicaid or CHIP. The MAGI-based rules generally include adjusting an individual’s income by an amount equivalent to 5% FPL disregard. Other eligibility criteria also apply, for example, with respect to citizenship, immigration status and residency.

2. These eligibility standards include CHIP-funded Medicaid expansions.

3. CHIP covers birth through age 18 unless otherwise noted in parentheses.

4. States have the option to cover pregnant women under CHIP. This table does not include notations of states that have elected to provide CHIP coverage of unborn children from conception to birth.

5. Reflects Medicaid state plan coverage of the eligibility group for parents and other caretaker relatives. Parents and caretaker relatives with income over the income standard for coverage under this group may be eligible for coverage in the adult group in states that have expanded to cover the adult group. In states that use dollar amounts based on household size, rather than percentages of the FPL, to determine eligibility for parents, we converted those amounts to a percentage of the FPL and selected the highest percentage to reflect the eligibility level for the group.

Source: Medicaid Eligibility.

Learn more about how states determine Medicaid eligibility for other populations.

View available state's eligibility verifications plans, MAGI Conversion Plans and Results.

Medicaid and CHIP agencies now rely primarily on information available through data sources (for example, the Social Security Administration, the Departments of Homeland Security and Labor) rather than paper documentation from families for purposes of verifying eligibility for Medicaid and CHIP.

Medicaid & CHIP Enrollment Data

The table below presents the most recent, point-in-time count of total Medicaid and CHIP enrollment in  for the last day of the indicated month, and is not solely a count of those newly enrolled during the reporting period. For purpose of comparison, the table also presents (a) the change in enrollment since the initial open of the Health Insurance Marketplaces, and (b) national counts and change statistics for the same period.

Medicaid & CHIP Enrollment as of December 2019
Metric National Totals
Metric   Total Medicaid & CHIP Enrollment (Preliminary)   National Totals  
Metric   Net Change in Enrollment July-September 2013   National Totals  
Metric   % Change in Enrollment July-September 2013   National Totals  

Source: Medicaid/CHIP Enrollment.

Core Set Data

CMS developed the Medicaid and Children’s Health Insurance Program (CHIP) Core Set Data Dashboard to improve accessibility of data about the quality of care provided to Medicaid and CHIP beneficiaries. CMS encourages users to explore Core Set Data to examine performance across states and to inspire and inform efforts to improve the quality of care provided to Medicaid and CHIP beneficiaries.

Starting with the 2024 Core Set, reporting of the Child Core Set and the behavioral health measures on the Adult Core Set is mandatory for states. The term “states” in this context refers to the 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. More information on mandatory Core Set reporting requirements is available in 42 CFR Parts 433, 437, and 457, and the Initial Core Set Mandatory Reporting Guidance State Health Official Letter.

The Child and Adult Core Sets assist CMS, states, and the public in understanding and monitoring access and quality of health care provided to individuals enrolled in Medicaid and CHIP. The Core Sets include measures of health care quality across the lifespan and domains of care.

CMS reports state performance on the Child and Adult Core Set measures annually. The Core Set Data Dashboard shows detailed information, including state-specific performance and national medians, on each measure that was reported by at least 25 states and met CMS’s standards for data quality for the reporting year. Data include measures reported by states and on behalf of states.