Eligibility for public health coverage through Medicaid and the Children’s Health Insurance Program (CHIP) varies greatly by state, as seen in the maps of income limits above. This edition of the ACA Spotlight shows the maximum amount an individual or household can earn and still get Medicaid and CHIP coverage, such as for parents, children, pregnant women, and childless adults.
These varying income limits convey the flexibility that states have when interpreting federal guidelines for their Medicaid and CHIP programs. For example:
- Alabama provides Medicaid coverage for pregnant women up to 146% of FPL, parents/caretakers up to 18% of FPL, but not for childless adults.
- In contrast, Iowa provides Medicaid coverage for pregnant women up to 380% of FPL, parents/caretakers up to 138% of FPL, and childless adults up to 138% of FPL.
Depending on upcoming policy decisions and changes, the degrees of variation could change further and quite drastically. These critical decisions and changes could include:
- Any potential changes to the Affordable Care Act (ACA) would likely impact Medicaid’s funding structure, income limits, coverage for childless adults, and more.
- States can request federal waivers to alter their Medicaid programs to change income limits, impose premiums and cost sharing, and other alterations; under current leadership of the Centers for Medicare and Medicaid Services (CMS), more waivers that make such changes are predicted to be submitted and/or approved.
- Congress must decide whether to reauthorize CHIP funding before September 30, 2017. While CHIP has historically had bipartisan support over its 20-plus year existence, its continuance cannot be assumed in the current political environment.
|State||Implemented Expanded Medicaid as of June 2017*|
|District of Columbia||Yes|
Medicaid and CHIP are two major sources of public health care coverage in the US. They are jointly financed by the federal government and states and are administered at the state level. CHIP covers children in families with incomes too high for Medicaid but who still cannot afford private coverage. States can also use CHIP funding to similarly provide coverage to pregnant women. While Medicaid generally does not charge premiums nor cost-sharing, CHIP generally does charge modest amounts for premiums and cost-sharing.
For children (and pregnant women in states where CHIP is available to them), where income eligibility for Medicaid ends, income eligibility for CHIP begins. Additionally, states have the option to maintain a separate CHIP program from its Medicaid for children, only offer Medicaid for children but use CHIP funding for children past a certain income limit, or a combination of both.
Medicaid and CHIP have minimum income limits (meaning those at or below the specified income must be eligible for Medicaid or CHIP) that states must follow. These minimum income limits vary considerably among the different types of Medicaid and CHIP coverage. However, for certain coverage groups states can choose to expand their income limits beyond the required minimum income limits in exchange for federal matching dollars, and many have. Taken altogether, this means that a low-income individual’s or family’s access to Medicaid and CHIP depends in great part on where the individual or family lives.
A notable point of flexibility is states’ option to expand Medicaid coverage to childless adults. The ACA originally mandated states to expand Medicaid eligibility to childless adults with incomes at or below 138% of the federal poverty level (FPL) (in some states this expansion extends to parents/caretakers as well). However, the US Supreme Court ruled in its June 2012 decision in National Federation of Independent Business (NFIB) v. Sebelius that states were not required to implement the Medicaid expansion. As of May 2017, 19 states have chosen not to expand Medicaid, which means that many low-income adults in these states have no public health care coverage option.
The maps in this ACA Spotlight provide income limits expressed as a percentage of the federal poverty level (FPL) for Medicaid and CHIP coverage by state. Users can click the buttons above the map to toggle between different types of Medicaid and CHIP coverage, including for parents, children, pregnant women, and childless adults. Users can also download data using the “Download Data” button below the map.
The income thresholds for Medicaid and CHIP eligibility are based on data from CMS. Please note the CMS data, and therefore this ACA Spotlight, offer only Modified Adjusted Gross Income (MAGI) types of Medicaid and CHIP coverage. In contrast to the CMS data, the data in this ACA Spotlight incorporate the 5% income disregard applied to all forms of MAGI Medicaid and CHIP coverage.
Also note for the Medicaid for parents/caretakers map, in states that expanded Medicaid eligibility to childless adults under the ACA, if the state’s parent/caretaker Medicaid income limit is lower than the Medicaid expansion limit, then the Medicaid expansion limit is used instead.
Additionally, because in California CHIP is offered only as a separate program in three counties, no data are provided for California in the CHIP for children map. Data are provided for North Carolina in the CHIP for children map, but note however that in North Carolina CHIP is offered as a separate program only for children ages 6-18.
Income limits shown in this ACA Spotlight assume that an individual is not disabled and otherwise qualifies for 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).
Social Interest Solutions (SIS) produced the data and maps 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
- Georgetown University Health Policy Institute’s Center for Children and Families
- Medicaid and CHIP Payment and Access Commission
The Henry J. Kaiser Family Foundation
- Current Flexibility in Medicaid: An Overview of Federal Standards and State Options
- Current Status of State Medicaid Expansion Decisions
- Restructuring Medicaid in the American Health Care Act: Five Key Consideration
- What Coverage and Financing is at Risk Under a Repeal of the ACA Medicaid Expansion?
- Where Are States Today? Medicaid and CHIP Eligibility Levels for Children, Pregnant Women, and Adults