Medicaid and the Children’s Health Insurance Program (CHIP) provide health coverage to more than 43 million children, including half of all low-income children in the United States. The federal government sets minimum guidelines for Medicaid eligibility but states can choose to expand coverage beyond the minimum threshold. All states have done so for children — the average CHIP income eligibility level for children is 241% of the Federal Poverty Level (FPL).
Most states have elected to provide Medicaid to children with family incomes above the minimum of 100% of the FPL, and all states have expanded coverage to children with higher incomes through the Children’s Health Insurance Program (CHIP). See the Medicaid and CHIP upper income eligibility levels for children by state.
In general, children in families with incomes up to $44,700/year (for a family of four in 2011) are likely to be eligible for Medicaid or CHIP coverage. In many states, families with higher incomes can still qualify for coverage for their children. This includes children in mandatory Medicaid eligibility groups, which states must cover in order to participate in Medicaid, as well as children in optional eligibility groups that a state may elect to cover. All children from birth to age 6 with family incomes up to 133% ($29,700 for a family of four in 2011) and children age 6-18 with family incomes up to 100% ($22,350 for a family of four in 2011) are eligible for Medicaid. Other eligible children include infants born to women covered by Medicaid (known as “deemed newborns”), certain children in foster care or an adoption assistance program and certain children with disabilities.
All children enrolled in Medicaid are entitled to the comprehensive set of health care services known as Early, Periodic Screening, Diagnosis and Treatment (EPSDT). CHIP also ensures a comprehensive set of benefits for children, but states have flexibility to design the benefit package.