Eligibility

Federal CHIP eligibility rules set the guidelines determining which children states can cover with federal CHIP funds. In Medicaid-expansion states, children who cannot be covered with CHIP funds may, in certain situations, be covered with Medicaid funds. The key eligibility rules are:

Income	States have broad flexibility to set their CHIP income eligibility levels. Most states cover children up to or above 200 percent of the federal poverty level (see federal poverty guidelines). States can establish asset or resource requirements, but they need not do so. States expanding coverage up up to 300 percent of the FPL receive an enhanced match rate. States that expand further receive the Medicaid match for their coverage.
Ages	States may cover children up to 18 years of age.
Insurance Status	Children must be uninsured to qualify for CHIP-funded coverage. Some states require children to be uninsured for a certain period of time before they can enroll, but this is not a federal requirement.
Coordination	States with separate CHIP-funded programs must coordinate their enrollment procedures with Medicaid to prevent children from “falling through the cracks” and remaining uninsured, as well as to ensure that children are enrolled in the appropriate program. These coordination rules require state CHIP programs to screen children who are applying for coverage for Medicaid and CHIP eligibility and to assure that the Medicaid-eligible children are enrolled into Medicaid, rather than simply turning them away from CHIP. This “screen and enroll” requirement also applies to Medicaid programs to assure they screen for CHIP eligibility. Most states with a separate CHIP-funded program use a joint Medicaid/CHIP application.
Citizenship/ Immigration Status	CHIP covers citizens and certain legal immigrants. States have the option of covering lawfully present immigrant children who have not been in the country for five years (with exceptions for refugees). Federal funds may not be used to cover undocumented children (except for emergency or pregnancy-related services). Some states use state funding to provide coverage to children regardless of immigration status.
Renewal	Federal law generally requires states to review eligibility circumstances at least every 12 months. States can either review eligibility when financial circumstances change or they can enroll children for periods of up to 12 months, regardless of changes in income, through a continuous eligibility option.
Documentation	States have discretion in requiring families to provide documentation of income or other eligibility requirements. The only eligibility criteria that federal law requires families to document is immigration status and citizenship status (unless the state implements an option to use electronic means for documenting citizenship).
Parents and Adults	CHIP law does not allow coverage of parents and adults. A handful of states obtained waivers from the federal government to use their CHIP funds to cover uninsured adults and parents but these waivers are no longer allowed in CHIP. The existing adult waivers expire January 1, 2010 and the existing parent waivers expire September 30, 2011. States may be able to receive funding outside of CHIP to continue coverage for those already enrolled.