Children’s eligibility for public health coverage through Medicaid and the Children’s Health Insurance Program (CHIP) varies greatly by age, family income, and state. This edition of the ACA Spotlight shows income limits in terms of both federal poverty levels (FPLs) and real dollar amounts for a family of five.
While the federal government sets minimum requirements on income eligibility for Medicaid and CHIP at different ages, states have the flexibility to expand eligibility to higher income levels with federal funding. States may use CHIP funding to cover kids whose household incomes are above the minimum Medicaid income limits either in a separate CHIP program, or under its Medicaid program. Together, the two programs provide a patchwork of coverage for low-to-moderate income children.
Following implementation of the Affordable Care Act (ACA) and significant efforts to enroll kids in Medicaid and CHIP in recent years, the national uninsured rate for children is about 5%, a historic low. However, children covered by Medicaid and CHIP face uncertainty about their future eligibility due to potential upcoming policy changes. Specifically:
- Federal funding for CHIP expires on September 30, 2017, and must be reauthorized by Congress for CHIP to continue. The loss of CHIP funding would affect children covered by CHIP as well as those covered by expanded Medicaid that is funded by CHIP.
- Current proposals to roll back the ACA would reduce the amount of federal Medicaid funding states receive, including capping Medicaid funding to states. In response, states may choose to lower income limits or impose new eligibility requirements for children’s coverage.
- Whether or not the ACA is altered, states may change eligibility requirements through the existing Medicaid waiver process. If approved by the Centers for Medicare and Medicaid Services (CMS), states’ waivers may make it more difficult for low-income families, including children, to enroll or keep their existing Medicaid eligibility.
Medicaid and CHIP provide affordable health care coverage to 36 million US children, who represent 50% of all those enrolled in Medicaid and CHIP.
Medicaid is available for low-income children while CHIP is available for children in families with incomes too high for Medicaid but who do not have access to affordable private health coverage. While generally Medicaid does not charge premiums nor cost-sharing, CHIP does charge modest amounts.
Medicaid and CHIP have federal minimum income limits (meaning those at or below a specified FPL must be eligible for Medicaid or CHIP) that states must follow. The ACA required states to raise their Medicaid income limits for children in all Medicaid age groups (0-1 years, 1-5 years, and 6-18 years) to 138% of FPL. States can choose to expand income limits beyond the required minimums, however. States can also have a separate CHIP program, use CHIP funding to cover uninsured children in higher-income families under Medicaid, or both. Taken altogether, this means that within and across states, income limits can vary considerably by type of coverage (Medicaid or CHIP) and age.
This ACA Spotlight provides program eligibility income limits for children’s Medicaid and CHIP in each state plus the District of Columbia for each of the three standard CMS children’s age groups: 0-1 years, 1-5 years, and 6-18 years. Income limits are expressed as a percentage of FPL, using a family size of five as an example for illustrating how FPL factors in both family size and income. The charts separate coverage for children into three categories:
- CHIP-funded Medicaid
Users can click the buttons above the chart to display a bar graph for each state plus the District of Columbia (DC) to see how income limits vary by age group and program. Users can hover the mouse over a bar segment for details. Users can also use the income slider to see what children in the family would be eligible for at a particular income level.
The income limits for Medicaid and CHIP shown in this ACA Spotlight are based on data from the Henry J. Kaiser Family Foundation (KFF). Income limits assume that an individual is not disabled and otherwise qualifies for MAGI Medicaid or CHIP coverage (e.g., they meet requirements for citizenship and immigration status, are not incarcerated, and do not have affordable coverage from another source).
Also note in the original KFF data that several states have overlapping income limits for Medicaid and CHIP-funded Medicaid. In these areas of overlap, uninsured children are covered by CHIP funding (since CHIP funding can only be used to cover uninsured children) and other children are covered by Medicaid funding. For simplification, in these cases this ACA Spotlight chooses to overlap the lower end of the CHIP-funded Medicaid bar segment over the upper end of the Medicaid bar segment. One reason for this display choice is to highlight that in the event of CHIP funding cuts or program elimination, significant portions of Medicaid eligibility for children could be affected as well.
Social Interest Solutions (SIS) produced the data and bar graphs using the MAGI Cloud platform, which includes a comprehensive rules engine that can generate ACA eligibility results across all states and across the full spectrum of health insurance options, including Medicaid, CHIP, and Qualified Health Plans (QHPs) with and without premium tax credits and cost-sharing reduction subsidies. Learn more about the MAGI Cloud platform.
- Centers for Medicare & Medicaid Services, U.S. Department of Health & Human Services
- First Focus
- Georgetown University Health Policy Institute’s Center for Children and Families
The Henry J. Kaiser Family Foundation
- Children’s Health Coverage: Medicaid, CHIP and the ACA
- Medicaid and CHIP Income Eligibility Limits for Children as a Percent of the Federal Poverty Level
- Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2017: Findings from a 50-State Survey
- Next Steps for CHIP: What is at Stake for Children?
- Medicaid and CHIP Payment and Access Commission
- The National Academy For State Health Policy (NASHP)
- Office of the Assistant Secretary for Planning and Evaluation
- The Robert Wood Johnson Foundation
- US Census Bureau