Medicaid and the Children's Health Insurance Program (CHIP)

Medicaid and the Children's Health Insurance Program (CHIP) provide health coverage to millions of people in America—including 35 million children—who would otherwise be unable to afford health insurance.

A child’s eligibility for these programs is primarily based on a family income and assets. While there are federal guidelines for coverage, every state can set its own eligibility criteria. Some states have expanded their Medicaid and CHIP programs, while other states just meet the minimum requirements.

The Medicaid program is often a target during budget cuts, and recently, the Bush Administration tried to cut vital protections for low-income families and children. But there has also been great progress covering children! In 2009, Congress reauthorized CHIP and expanded the program to cover more uninsured children—so that by 2013, about 9 million children will be enrolled. This renewal also included some strong reforms for children, including the abolishment of the 5 year waiting period for legal immigrant children eligible for the program.

What is Medicaid and Who is Eligible?

Established in 1965, Medicaid is a joint federal-state entitlement program that finances health care coverage for certain low-income families, children, pregnant women, and individuals who are aged or disabled. In fiscal year 2006, children accounted for more than half of all Medicaid enrollees.

Medicaid requires every state to provide coverage to:

• Children under age 6 and pregnant women who are just above the poverty level—at 133% of the Federal Poverty Level ($29,327) for a family of four)
• Children 6-19 who are at or below the poverty level ($22,050 for a family of four)

States have the option to use Medicaid funds to provide coverage to:

• Pregnant women up to 185% FPL ($40,792 for a family of four)
• Children at any income level. Some states cover children up to 300% FPL ($66,150 for a family of four) in Medicaid

What is CHIP and who is eligible?

In 1997, millions of children were uninsured but in families earning too much to qualify for Medicaid. So Congress created the Children’s Health Insurance Program in 1997 to expand eligibility to children at slightly higher income levels. Every state was allowed to design its CHIP program in one of three ways: as a separate program, a Medicaid expansion, or a combination approach. Like Medicaid, states are also allowed to set the income eligibility, benefits, and enrollment procedures within broad federal guidelines.

Today, all but 4 states cover children at or above 200 percent of poverty ($44,100 for a family of four) in CHIP.

How do you enroll?

Most states have their own Medicaid and CHIP websites that outline the necessary steps to enroll. Each state has different income eligibility levels and can include other requirements to qualify for coverage. It’s important to know that some states require proof of income, conduct asset tests or face-to-face interviews or have waiting periods before care can begin.

If you have an uninsured child, please find out more about your state's Medicaid or CHIP programs at the Insure Kids Now website or with CDF’s State Health Fact Sheets.