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.

Eligibility1
Children’s Medicaid2 Separate
Children’s CHIP3
Pregnant4
Women
Parents5 Other Adults6
0-5: 133% 200% 133% 37%
6-19: 100%
ICHIA Options7
Children Pregnant Women
No No
Waiting Period
Waiting
Period
Length
Yes 1
Enrollment
Procedures for Children8
No Face-to-Face Interview No Asset Test Presumptive
Eligibility
Express Lane9
Eligibility
Yes Yes No No
Enrollment Procedures for Pregnant Women
Presumptive Eligibility No Asset Test
Yes Yes
Enrollment
Procedures for Parents10
Simplified
Family Application11
No Face-to-Face Interview No Asset Test Simplifications
Consistent with Children
Yes Yes Yes Yes
Outreach and
Application Assistance
In-Person Assistance at
State/County Eligibility Offices
Toll-Free Hotline Out-Stationed
State Eligibility Workers
State Funding
for Community-Based Application Assisters
Yes CHIP only No No
Use of Telephone and Online
Applications in Medicaid and CHIP12
Application Can be Submitted Over the Telephone Application
Can be Submitted Electronically
Electronic
Signature for Online Applications
No Yes Yes
Online Account Capabilities12
Start,
Stop, and Return to an Application
Review
Application Status
Report Changes View Notices
Yes Medicaid Only Yes No
Renewal Procedures
for Children
Frequency
of Renewal (in months)
12-month
Continuous Eligibility
No
Face-to-Face  Interview
Express Lane9
Eligibility
12 Yes Yes No
Renewal Procedures
for Parents
Frequency of Renewal (in months) No
Face-to-Face Interview
Simplifications
Consistent with Children’s Program
12 Yes Yes
Renewal Methods
Available for Medicaid and CHIP
Telephone
Renewal
Online
Renewal
Administrative
Renewal13
CHIP only Yes No
Premium, Enrollment Fee, and Co-Payment Requirement
Premium or Enrollment
Fee Required
Begin at
(of the FPL)
Copayments14
Required
Begin at
(of the FPL)
No N/A CHIP only 101%
Enhanced Systems Capabilities
Social Security Administration Data Match to Verify Citizenship15 Document
Imaging
State Data Hub Paperless
Notices
Upload
a Scanned Document
No No No No No
Integration and
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
Work
Begun on Medicaid Eligibility System Upgrade
Yes No Yes Yes

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.

Notes:

  1. Income eligibility levels noted are expressed as a percentage of the Federal Poverty Level (FPL).
  2. 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.
  3. States with a separate CHIP program use federal CHIP funds to operate a health insurance program for children not eligible for Medicaid.
  4. Pregnant women’s income eligibility levels are shown for regular Medicaid, CHIP, and through the unborn child option.
  5. 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.
  6. For other adults, any applicable earnings disregards are based on the individual
  7. 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.
  8. Information applies to both Medicaid and CHIP, if applicable, unless otherwise noted.
  9. 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.
  10. 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
  11. 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.
  12. 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.
  13. 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.
  14. In  Wyoming, the emergency room co-payment is waived if the child is admitted.
  15. This CHIPRA option became newly available in 2010 and allows states to conduct data matches with the Social Security Administration to verify citizenship.
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