NOTE: New MAGI-equivalent eligibility thresholds are now in effect. For details on the conversion, please see “Getting into Gear for 2014: Shifting New Medicaid Eligibility and Enrollment Policies into Drive.” For eligibility thresholds as of April, 1, 2014, see Medicaid/CHIP Eligibility Limits, 2014.
Procedures for Children8
|No Face-to-Face Interview||No Asset Test||Presumptive
|Enrollment Procedures for Pregnant Women|
|Presumptive Eligibility||No Asset Test|
Procedures for Parents10
|No Face-to-Face Interview||No Asset Test||Simplifications
Consistent with Children
|In-Person Assistance at
State/County Eligibility Offices
State Eligibility Workers
for Community-Based Application Assisters
|Use of Telephone and Online
Applications in Medicaid and CHIP12
|Application Can be Submitted Over the Telephone||Application
Can be Submitted Electronically
Signature for Online Applications
|Online Account Capabilities12|
Stop, and Return to an Application
|Report Changes||View Notices|
of Renewal (in months)
|Frequency of Renewal (in months)||No
Consistent with Children’s Program
Available for Medicaid and CHIP
|Premium, Enrollment Fee, and Co-Payment Requirement|
|Premium or Enrollment
(of the FPL)
(of the FPL)
|Enhanced Systems Capabilities|
|Social Security Administration Data Match to Verify Citizenship15||Document
|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
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.
- 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.
- 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.
- 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.
- 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 Wyoming, the emergency room co-payment is waived if the child is admitted.
- This CHIPRA option became newly available in 2010 and allows states to conduct data matches with the Social Security Administration to verify citizenship.