Where Are States Today? Medicaid and CHIP Eligibility Levels for Children, Pregnant Women, and Adults
This fact sheet provides Medicaid and CHIP eligibility levels for children, pregnant women, parents, and other non-disabled adults as of January 2017, based on annual state survey data.1 The data highlight the central role Medicaid and CHIP play in covering low-income children and pregnant women and show Medicaid’s expanded role for low-income adults under the Affordable Care Act (ACA). See Tables 1-3 for state-specific data.
As of January 2017, 49 states cover children with incomes up to at least 200% of the federal poverty level (FPL) through Medicaid and CHIP (Figure 1, Table 1 and 1A). This count includes 19 states that cover children with incomes at or above 300% FPL. Only two states (ID and ND) limit children’s eligibility to below 200% FPL. CHIP plays a key role complementing Medicaid to cover children across states. As of January 2017, 36 states have separate CHIP programs, and CHIP funds coverage for some children in Medicaid in 49 states.
Most states extend coverage to pregnant women beyond the federal minimum of 138% FPL through Medicaid and CHIP. As of January 2017, 34 states cover pregnant women with incomes at or above 200% FPL, including 12 states that cover pregnant women with family incomes above 250% FPL. CHIP also complements Medicaid to cover pregnant women. Five states extend coverage for pregnant women through CHIP and 16 states use CHIP funding to provide coverage through the unborn child option, under which states cover income-eligible pregnant women regardless of immigration status (Figure 2, Table 2).
Reflecting adoption of the ACA Medicaid expansion, 32 states cover parents and other adults with incomes up to 138% FPL in Medicaid (Figures 3 and 4, Table 3). In addition, three states (AK, DC, and CT) extend eligibility for parents and/or other adults to levels higher than 138% FPL.
In the 19 states that have not expanded Medicaid, the median eligibility limit for parents is 44% FPL and other adults remain ineligible, except in Wisconsin (Figure 5). In 12 of these states, parent eligibility is at less than half of the poverty level, and only three of these states (ME, TN, and WI) cover parents at or above poverty. Wisconsin is the only non-expansion state that provides full Medicaid coverage to other adults, although eligibility at 100% FPL remains below the expansion level and the state does not receive the enhanced match available for expansion adults for this coverage.2 In the non-expansion states, 2.6 million adults with incomes above the Medicaid eligibility limit but below poverty fall into a coverage gap; they are ineligible for Medicaid and do not qualify for subsidies for Marketplace coverage, which are only available to those with incomes at or above 100% FPL.3
In sum, Medicaid and CHIP continue to be central sources of coverage for the low-income population, but access to coverage varies widely across groups and states. Medicaid and CHIP offer a base of coverage to low-income children and pregnant women nationwide. Eligibility for adults has grown under the Medicaid expansion, but remains low in states that have not expanded. Overall, eligibility continues to vary significantly by group, with coverage available to children and pregnant women at higher levels relative to parents and other adults. Eligibility also varies across states, and these differences have increased as a result of state Medicaid expansion decisions. Given this variation, there are substantial differences in individuals’ access to coverage based on their eligibility group and where they live.
Tricia Brooks, et. al., Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2017: Findings from a 50-State Survey, (Washington, DC: Kaiser Family Foundation, January 2017), http://kff.org/medicaid/report/medicaid-and-chip-eligibility-enrollment-renewal-and-cost-sharing-policies-as-of-january-2017-findings-from-a-50-state-survey/.
Oklahoma and Utah provide more limited coverage to some childless adults under Section 1115 waiver authority.
Rachel Garfield and Anthony Damico, The Coverage Gap: Uninsured Poor Adults in States that do not Expand Medicaid, (Washington, DC: Kaiser Commission for Medicaid and the Uninsured, October 2016), available at http://kff.org/uninsured/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/.