Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2020: Findings from a 50-State Survey

Key Findings

  • More individuals can access Medicaid coverage in states that have implemented the ACA Medicaid expansion to low-income adults than states that have not expanded.
  • Largely because of the ACA, individuals can apply for Medicaid and CHIP online or via phone, and states can connect individuals to coverage quickly through real-time eligibility determinations and automate the renewals process using electronic data matches.
  • Eligible individuals may face barriers to maintaining coverage at renewal or when states conduct periodic data matches between renewals.
  • Some states have adopted policy options to facilitate enrollment in coverage and promote continuity of coverage.
  • Premiums and cost sharing are limited consistent with federal rules that reflect enrollees’ limited ability to pay out-of-pocket health care costs.


As the COVID-19 pandemic expands, needs for health insurance coverage through Medicaid and CHIP will increase for people who get sick and who lose private coverage due to the declining economy. Increasing enrollment for the 6.7 million uninsured individuals who are eligible for Medicaid and facilitating enrollment for the growing numbers of individuals who will become eligible for Medicaid as they lose jobs and incomes decrease will help expand access to care for COVID-19-related needs and health care needs and more broadly. States can adopt a range of options under current rules to increase Medicaid eligibility, facilitate enrollment and continuity of coverage, and eliminate out-of-pocket costs. States can seek additional flexibility through waivers. The Families First Coronavirus Response Act provides states additional options and enhanced federal funding to support state response.

This 18th annual survey of the 50 states and the District of Columbia (DC) provides data on Medicaid and the Children’s Health Insurance Program (CHIP) eligibility, enrollment, renewal, and cost sharing policies as of January 2020. The survey findings highlight state variation in policies that affect individuals’ ability to access coverage and care amid the COVID-19 public health crisis. They also provide examples of actions states can take to expand eligibility and simplify enrollment to respond to the COVID-19 epidemic. Further, the survey findings highlight how changes under the ACA to expand Medicaid eligibility and streamline enrollment and renewal processes have better positioned the Medicaid program to respond to a public health crisis such as COVID-19.

Full Report

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Tricia Brooks is a Research Professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.