Medicaid and CHIP Eligibility – Update

All but two states maintained or improved eligibility rules for their Medicaid and Children’s Health Insurance Program, commonly known as CHIP, in 2010.These programs continued to be critical to providing insurance coverage for children and families that otherwise would be uninsured. The median state income limit for children’s coverage is now above 200 percent of the FPL, and pregnant women are eligible up to a median of 185% FPL. However, the median income limit for adult coverage is significantly below the higher eligibility level of 133% FPL that will be implemented under health reform in 2014.

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All but two states maintained or improved eligibility rules for their Medicaid and Children’s Health Insurance Program, commonly known as CHIP, in 2010. These programs continued to be critical to providing insurance coverage for children and families that otherwise would be uninsured.

  • State programs remained stable during the recession, even with increased unemployment and declining state tax revenues, largely due to the temporary funding, called FMAP, through the American Recovery and Reinvestment Act of 2009 and requirements that states maintain Medicaid coverage policies until federal health reform coverage takes effect in 2014. In 2010, 13 states expanded eligibility for Medicaid and CHIP. 
  • Ten states expanded children’s eligibility for Medicaid and CHIP coverage in 2010. (See Figure 1.)

    • Three states increased income eligibility limits for uninsured children—Colorado, Kansas and Oregon.
    • Six states accessed the optional federal funding to cover lawfully residing immigrant children during their first five years of residence in the U.S. Delaware, Minnesota, Montana, Nebraska, North Carolina and Wisconsin are now included in the 21 states that participate in this option.
    • Tennessee reopened enrollment in its CHIP program; Arizona was the only state that did not enroll any new children into its CHIP program.
  • Coverage for pregnant women was stable in 2010, and 39 states have eligibility limits of 185 percent of the federal poverty level or higher. Colorado expanded coverage from 200 to 250 percent of the federal poverty level. Five states—Delaware, Minnesota, Nebraska, North Carolina and Wisconsin—implemented the optional federal funding to cover lawfully residing pregnant women during their first five years of residence in the U.S. and eliminated the five‐year waiting period. This barrier to covering immigrant pregnant women is now eliminated in 17 states.
  • Medicaid income eligibility for adults lags far behind that of children, and states made few expansions in coverage for low‐income parents and other adults in 2010. Most uninsured, low‐income adults remain ineligible for Medicaid in most states. Colorado increased Medicaid eligibility for parents to 100 percent of the federal poverty level. About 20 states now have supplemental programs that offer additional limited coverage to some parents. These programs include Medicaid waiver or state-funded programs and many limit benefits or require premium payments. 
  • The median state income limit for children’s coverage is now above 200 percent of the federal poverty level, but the median income limit for adult coverage is one-fourth that level. (See Figure 2.)
  • Although 40 states offer coverage for pregnant women with incomes over 185 percent of the federal poverty level, coverage is much more limited for other parents. About two-thirds of the states have income limits below 100 percent of the federal poverty level for both working and jobless parents. (See Figure 3.)