The Children’s Health Insurance Program (CHIP) program, financed jointly by the federal government and individual states and administered by the states, insures over 8 million children as of 2014 [1]. Of all children enrolled in CHIP, 17% to 23% have special health care needs [2]. Under the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), states can now offer health insurance coverage to uninsured children in families with incomes above 200% of the federal poverty level (FPL) without facing major penalties. The federal government pays an enhanced matching rate for children in families up to 300% of the FPL and the Medicaid matching rate for children in families over 300% of the FPL. Across states, CHIP eligibility levels range between 175% and 405% of the FPL, with 33 states with income eligibility levels over 200% of FPL. For example, New Jersey operates a CHIP program called New Jersey Family Care for children in families whose income is up to 355% of the FPL. Premiums are required for those over 200% of the FPL, with a maximum premium rate of $133 per family, per month. At 355% of the FPL, the income eligibility ceiling for New Jersey Family Care is higher than the ceiling for most CHIP programs. The Patient Protection and Affordable Care Act of 2010 (ACA) contains provisions to strengthen coverage for children under CHIP, including requirements to conduct outreach and enrollment of vulnerable populations including children and youth with special health care needs. (View policy paper: Affordable Care Act and Children with Special Health Care Needs)

[1] Total Number of Children Enrolled in CHIP Annually, FY 2015. Retrieved December 21, 2015 from http://kff.org/other/state-indicator/annual-chip-enrollment.

[2] VanLandeghem, K. et. al. CHIRI™ Issue Brief No. 5. SCHIP Enrollees with Special Health Care Needs and Access to Care. 2006. 

Income Eligibility Limits for Separate CHIP Coverage as a Percent of the Federal Poverty Level (FPL), January 2017

N/A: State does not have a separate CHIP program

Note: income limits are MAGI-adjusted to include a five percentage point disregard of the FPL

Sources

Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2017: Findings from a 50-State Survey by Tricia Brooks, Karina Wagnerman, Samantha Artiga, Elizabeth Cornachione, and Petry Ubri. Table 1 Income Eligibility Limits for Children’s Health Coverage as a Percent of the Federal Poverty Level, January 2017, retrieved February 7, 2017 from http://files.kff.org/attachment/Report-Medicaid-and-CHIP-Eligibility-as-of-Jan-2017-Table-1.

For state-specific footnotes on eligibility, see http://kff.org/health-reform/state-indicator/medicaid-and-chip-income-eligibility-limits-for-children-as-a-percent-of-the-federal-poverty-level/

RELATED RESOURCES

• Fact Sheet: The Children’s Health Insurance Program (CHIP) and Children with Special Health Care Needs—An Overview
• Infographic: Medicaid & CHIP: What’s the Difference?
• Public Insurance Programs and Children with Special Health Care Needs: A Tutorial on the Basics of Medicaid and the Children’s Health Insurance Program (CHIP) Section 2
• Webinar: Understanding the Basics–Medicaid & CHIP and Building Partnerships among Stakeholders
• Webinar: What are the Pathways to Coverage and What Are Covered Services for Medicaid and CHIP?
• Medicaid and CHIP: Funding, Service Delivery, and Quality
• Interactive Medicaid and CHIP worksheet
• State-at-a-Glance Chartbook
• Children’s Health Insurance Program description on Medicaid website