NOTE: New MAGI-equivalent eligibility thresholds are in effect as of January 1, 2014. For details and state-by-state thresholds, please see “Getting into Gear for 2014: Shifting New Medicaid Eligibility and Enrollment Policies into Drive.”
Procedures for Children8
|No Face-to-Face Interview||No Asset Test9||Presumptive
|Yes||Medicaid: $2,000 CHIP:$10,000||No||No|
|Enrollment Procedures for Pregnant Women|
|Presumptive Eligibility11||No Asset Test|
Procedures for Parents12
|No Face-to-Face Interview||No Asset Test||Simplifications
Consistent with Children
Assistance at State/County Eligibility Offices
State Eligibility Workers
for Community-Based Application Assisters
|Use of Telephone and Online Applications in
Medicaid and CHIP14
|Application Can be Submitted Over the Telephone||Application
Can be Submitted Electronically
Signature for Online Applications
Stop, and Return to an Application
|Report Changes||View Notices|
of Renewal (in months)15
|Frequency of Renewal (in months)||No
Consistent with Children’s Program
Available for Medicaid and CHIP
Enrollment Fee, and Copayment Requirements for Children
(of the FPL)
(of the FPL)
|CHIP only||151%||CHIP only||101%|
|Social Security Administration
Data Match to Verify Citizenship19
|State Data Hub||Paperless
a Scanned Document
Upgrade of Medicaid Eligibility Systems
|Medicaid System Used for Other Assistance Programs (e.g., SNAP, TANF)||Same
Eligibility System for Medicaid and CHIP
|Approved or Submitted APD for
Upgrading Medicaid Eligibility System
Begun on Medicaid Eligibility System Upgrade
Source: M. Heberlein, et al., “Getting into Gear for 2014,” Kaiser Commission on Medicaid and the Uninsured, (January 2013); updated by the Center for Children and Families. Data as of January 1, 2013.
- Income eligibility levels noted are expressed as a percentage of the Federal Poverty Level (FPL).
- Income eligibility levels for children’s Medicaid includes CHIP-funded Medicaid expansions; separate CHIP programs are shown under children’s CHIP. The income eligibility levels noted may refer to gross or net income depending on the state.
- States with a separate CHIP program use federal CHIP funds to operate a health insurance program for children not eligible for Medicaid.
- Pregnant women’s income eligibility levels are shown for regular Medicaid, CHIP, and through the unborn child option.
- 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.
- For other adults, any applicable earnings disregards are based on the individual
- 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.
- Information applies to both Medicaid and CHIP, if applicable, unless otherwise noted.
- Asset limit noted is for a family of three. In Texas, the limit is $3,000 if a family contains a disabled or elderly member. The $10,000 limit applies to those with income over 150% of the FPL. The state does not require families to provide proof of assets.
- The 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.
- Louisiana has a presumptive eligibility like process for pregnant women.
- 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
- 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. In Louisiana, the Medicaid/CHIP application is not designed for use by parents but can be used in some circumstances to determine eligibility for a parent.
- Unless specified otherwise, the online application and electronic submission, electronic signature, and online account capabilities apply to both children and parents in Medicaid. Waiver or state-funded coverage for parents may have different policies.
- In Texas, children covered under CHIP have 12 months of continuous coverage. However, the state will conduct administrative renewal for children in CHIP in families with income between 185% and 200% of the FPL at 6 months to determine whether income has exceeded 200% of the FPL.
- Texas added online renewals for Medicaid in 2012.
- 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 take no action. 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. In addition, there are some states that conduct administrative renewals through other means that does not involve sending out a pre-populated form to families; these states are also counted. In Texas, administrative renewals are done for children, but not for parents.
- Texas increased copays for non-preventive physician visits, non-emergency use of the ER, inpatient hospital visits, and generic and preferred brand name drugs in 2012.
- This CHIPRA option became newly available in 2010 and allows states to conduct data matches with the Social Security Administration to verify citizenship.