California
Eligibility1
Children's
Medicaid2
|
Separate
Children's
CHIP2
|
Pregnant
Women3
|
Parents4
|
0-1: 200%
1-5: 133%
6-19: 100%
|
250%
|
300%
|
100%
|
ICHIA Option5
Children
|
Pregnant
Women
|
Yes
|
Yes
|
Waiting Period
Waiting
Period
|
Length
|
Yes
|
3 Months
|
Enrollment Procedures for Children6
Program
Type7
|
Joint Application8
|
Face-to-Face Interview
|
Asset Test9
|
Paper Documentation of
Income Not Requested10
|
Combo
|
Yes
|
No
|
No
|
No
|
Enrollment Processes for Children6
Presumptive Eligibility11
|
Express Lane Eligibility12
|
SSA Data Match to
Verify Citizenship13
|
Yes
|
No
|
Medicaid Only
|
Use of Online Application Forms in Medicaid and CHIP14
Application Available
Online
|
Application Form
Submitted Electronically
|
Electronic Signature
|
Paper Documentation of
Income Not Requested10
|
Yes
|
Yes
|
Yes
|
No
|
Renewal Procedures for Children6
Frequency of Renewal
(in months)
|
12-month
Continuous Eligibility
|
Face-to-Face Interview
|
Paper Documentation of Income
Not Requested10
|
12
|
Yes
|
No
|
No
|
Renewal Methods for Children6
| Joint Renewal Form15 |
Administrative Renewal16
|
Telephone Renewal |
Online Renewal
|
Express Lane12
|
Yes
|
No
|
No
|
No
|
No
|
Enrollment Procedures for Parents17
Simplified Family
Application18
|
Face-to-Face Interview
|
Asset Test9
|
SSA Data Match to
Verify Citizenship13
|
Paper Documentation of
Income Not Requested10
|
No
|
No
|
$3,150
|
Yes
|
No
|
Renewal Procedures for Parents17
Frequency of Renewal
(in months)
|
Face-to-Face Interview
|
Paper Documentation of
Income Not Requested10
|
12
|
No
|
No
|
Enrollment Procedures for Pregnant Women
Presumptive
Eligibility
|
Asset Test19
|
Yes
|
No
|
Premium, Enrollment Fee, and Copayment Requirements for Children
Premium/Enrollment
Fee Required
|
Begin at
(of the FPL)
|
Copayments
Required
|
Begin at
(of the FPL)
|
Yes
|
101%
|
Yes
|
101%
|
Source: M. Heberlein,
et al., "
Holding Steady, Looking Ahead," Kaiser Commission on Medicaid and the Uninsured, (January
2011); updated by the Center for Children and Families. Data as of January 1, 2011.
Notes:
1: Income eligibility levels noted are expressed as a percentage of the
Federal Poverty Level (FPL), without regard to income disregards or
deductions.
2: Income eligibility levels for children's Medicaid includes CHIP-funded
Medicaid expansions; separate CHIP programs are shown under children's CHIP. Infants born to mothers in California's Access for Infants and Mothers (AIM) program are automatically enrolled in CHIP. The income guideline for these infants, through their second birthday, is 300 % of the FPL.
3: Pregnant women's income eligibility levels are shown for regular Medicaid, CHIP, and through the unborn child option.
4: Parents' income eligibility levels are shown for parents without earned
incomes (i.e., does not reflect earnings disregards used to determine
income eligibility for working parents) applying for comprehensive
Medicaid coverage based on a family size of three. Note that several states, including California, have established coverage
for parents through waivers, however this coverage generally offers
fewer benefits, higher cost-sharing, or is limited to premium
assistance for employer-sponsored coverage.
5: The "ICHIA" option in CHIPRA allows states to use federal funds to
cover lawfully residing immigrant children and pregnant women in
Medicaid/CHIP without imposing a five-year waiting period. This
indicates whether the state has received approval of a State Plan
Amendment to
adopt this option. In California, some undocumented immigrant children are covered through local programs.
6: Information applies to both Medicaid and CHIP, if applicable, unless otherwise noted. The use of pre-populated renewal forms and telephone and online renewals varies by county in California.
7: States can use their Title XXI (CHIP) funds to expand Medicaid
(M-CHIP), cover children through a separate program (S-CHIP), or
combine the two approaches (COMBO). Arkansas, Minnesota, Oklahoma,
Rhode Island, and Wisconsin have separate CHIP programs for their
coverage of pregnant women using the unborn child option. Connecticut,
Florida, Illinois, Maine, Minnesota, New Hampshire, New Jersey, New
York, North Carolina, Ohio, Oregon, Pennsylvania, Tennessee, and
Wisconsin allow families with incomes above the levels shown buy into
Medicaid/CHIP.
8: In California, although separate applications are used to apply for Medicaid and CHIP, the programs will accept the other's application. In California the family must consent to the application transfer.
9: Asset limits noted are for a family of three.
10: In states that do not require families to provide documentation of
income at application, states generally verify this information through
data matches with other government agencies, such as the Social
Security Administration and state departments of labor. Often, families
in states with administrative verification have to provide
documentation of income if self-employed, if income is questionable, or
if the state is unable to administratively verify the information. Some
states request paper documentation of income at application, but if the
family does not submit the documentation with the application, the
state will attempt to administratively verify the information before
following up with the family. States that verify income
administratively, but continue to ask for income documentation on their
applications are not counted as streamlining their procedures. This is
different than how it has been defined in the past.
11: In California, the CHIP program has a presumptive eligibility process available to families with income up to 200% of the FPL. This process is available through the Child Health and Disability Prevention program provider and the presumptive enrollment process, which provides temporary full scope no cost medical coverage.
12: The new Express Lane Eligibility option allows states to use data
and eligibility findings from other public benefit programs when
determining children’s eligibility for Medicaid and CHIP at enrollment
or renewal. States are designated as using Express Lane Eligibility if
they have implemented an initiative and have an approved State Plan
Amendment from CMS.
13: This CHIPRA option became newly available in 2010 and allows states
to conduct data matches with the Social Security Administration to
verify citizenship.
14: Unless specified otherwise, the Medicaid online application and
electronic submission, electronic signature, and documentation rules
apply to both children and parents. Waiver or state-funded coverage
for parents may have different policies.
15: In California, although separate applications are used to apply for Medicaid and CHIP, the programs will accept the other's application. In California the family must consent to the application transfer.
16: A state is classified as providing administrative renewal if it
sends a pre-populated form with all eligibility information available
or a renewal letter to the family in advance of the renewal date. The
family is required to either sign and return the form, signaling that
they wish to continue coverage, or do nothing. States that send a
pre-populated form, but require families to submit paper documentation
to continue coverage do not qualify has having implemented
administrative renewals.
17: Data represents policies for parents covered through 1931 Medicaid
coverage; some states have differing policies for parents and other
non-disabled adults covered through waiver or state-funded coverage
programs. In California, Indiana, Iowa, and North Carolina, the same simplified application can be used for children and parents but parents must complete additional forms or take additional steps. States are classified as having consistent policies for children and parents if they have adopted all of the simplification measures listed in both programs.
18: States are classified as providing a simplified family application
if parents can apply for coverage without having to complete a separate
application or additional forms. In some states a longer form must be
used to apply for family coverage while a shorter, simpler form is
available for children's coverage; these states are not classified as
offering a simplified family application.
19: With the exception of Arkansas, all states with an asset test for
pregnancy coverage rely on a standard limit regardless of family size.