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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.

Figure 1: Income Eligibility Levels for Children in Medicaid/CHIP, January 2017

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).

Figure 2: Income Eligibility Levels for Pregnant Women in Medicaid/CHIP, January 2017

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.

Figure 3: Medicaid Income Eligibility Levels for Parents of Dependent Children, January 2017

Figure 4: Medicaid Income Eligibility Levels for Other Adults, January 2017

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

Figure 5: Medicaid Income Eligibility Limits for Adults in States that Have Not Implemented the Medicaid Expansion, January 2017

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.
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Table 1: Income Eligibility Limits for Children’s Health Coverage as a Percent of the Federal Poverty Level (FPL), January 2017[1]
State Upper Income Limit Medicaid Coverage for
Infants Ages 0-12
Medicaid Coverage for
Children Ages 1-52
Medicaid Coverage for
Children Ages 6-182
Separate CHIP  for Uninsured Children Ages 0-183
Medicaid Funded CHIP-Funded for Uninsured Children Medicaid Funded CHIP-Funded for Uninsured Children Medicaid Funded CHIP-Funded for Uninsured Children
Median4 255% 195% 217% 149% 216% 138% 155% 254%
Alabama5 317% 146% 146% 146% 107%-146% 317%
Alaska 208% 177% 159%-208% 177% 159%-208% 177% 124%-208%
Arizona6 205% 152% 146% 138% 104%-138% 205%
Arkansas 216% 147% 147% 147% 107%-147% 216%
California7 266% 208% 208%-266% 142% 142%-266% 133% 108%-266%
Colorado 265% 147% 147% 147% 108%-147% 265%
Connecticut 323% 201% 201% 201% 323%
Delaware 217% 217% 194%-217% 147% 138% 110%-138% 217%
District of Columbia5 324% 324% 206%-324% 324% 146%-324% 324% 112%-324%
Florida8 215% 211% 192%-211% 145% 138% 112%-138% 215%
Georgia 252% 210% 154% 138% 113%-138% 252%
Hawaii 313% 191% 191%-313% 139% 139%-313% 133% 105%-313%
Idaho 190% 147% 147% 138% 107%-138% 190%
Illinois9 318% 147% 147% 147% 108%-147% 318%
Indiana10 262% 218% 157%-218% 165% 141%-165% 165% 106%-165% 262%
Iowa 307% 380% 240%-380% 172% 172% 122%-172% 307%
Kansas11 244% 171% 154% 138% 113%-138% 243%
Kentucky 218% 200% 142% 142%-164% 133% 109%-164% 218%
Louisiana 255% 142% 142%-217% 142% 142%-217% 142% 108%-217% 255%
Maine 213% 196% 162% 140%-162% 162% 132%-162% 213%
Maryland 322% 194% 194%-322% 138% 138%-322% 133% 109%-322%
Massachusetts12 305% 205% 185%-205% 155% 133%-155% 155% 114%-155% 305%
Michigan13 217% 195% 195%-217% 160% 143%-217% 160% 109%-217%
Minnesota14 288% 275% 275%-288% 280% 280%
Mississippi 214% 199% 148% 138% 107%-138% 214%
Missouri 305% 201% 148% 148%-155% 148% 110%-155% 305%
Montana 266% 148% 148% 138% 109%-148% 266%
Nebraska 218% 162% 162%-218% 145% 145%-218% 133% 109%-218%
Nevada 205% 165% 165% 138% 122%-138% 205%
New Hampshire 323% 196% 196%-323% 196% 196%-323% 196% 196%-323%
New Jersey 355% 199% 147% 147% 107%-147% 355%
New Mexico 305% 240% 200%-305% 240% 200%-305% 190% 138%-245%
New York 405% 223% 154% 154% 110%-154% 405%
North Carolina15 216% 215% 194%-215% 215% 141%-215% 138% 107%-138% 216%
North Dakota 175% 152% 152% 138% 111%-138% 175%
Ohio 211% 156% 141%-211% 156% 141%-211% 156% 107%-211%
Oklahoma5,16 210% 210% 169%-210% 210% 151%-210% 210% 115%-210%
Oregon 305% 190% 133%-190% 138% 138% 100%-138% 305%
Pennsylvania 319% 220% 162% 138% 119%-138% 319%
Rhode Island 266% 190% 190%-266% 142% 142%-266% 133% 109%-266%
South Carolina 213% 194% 194%-213% 143% 143%-213% 133% 107%-213%
South Dakota 209% 187% 147%-187% 187% 147%-187% 187% 111%-187% 209%
Tennessee5,17 255% 195% 195%-216% 142% 142%-216% 133% 109%-216% 255%
Texas 206% 203% 149% 138% 109%-138% 206%
Utah 205% 144% 144% 138% 105%-138% 205%
Vermont 317% 317% 237%-317% 317% 237%-317% 317% 237%-317%
Virginia 205% 148% 148% 148% 109%-148% 205%
Washington 317% 215% 215% 215% 317%
West Virginia 305% 163% 146% 138% 108%-138% 305%
Wisconsin18 306% 306% 191% 133% 101%-156% 306%
Wyoming 205% 159% 159% 138% 119%-138% 205%
SOURCE: Based on a national survey conducted by the Kaiser Commission on Medicaid and the Uninsured with the Georgetown University Center for Children and Families, 2017.
Table presents rules in effect as of January 1, 2017

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Table 1A: Income Eligibility Limits for Children’s Health Coverage Based on Annual Income for a Family of Three, January 2017[1]
State Upper Income Limit Medicaid Coverage for
Infants Ages 0-12
Medicaid Coverage for
Children Ages 1-52
Medicaid Coverage for
Children Ages 6-182
Separate CHIP  for Uninsured Children Ages 0-183
Medicaid Funded CHIP-Funded for Uninsured Children Medicaid Funded CHIP-Funded for Uninsured Children Medicaid Funded CHIP-Funded for Uninsured Children
Median4 $53,081 $40,023 $44,515 $31,038 $44,311 $28,996 $31,549 $51,765
Alabama5 $64,731 $29,813 $29,813 $29,813 $29,813 $64,731
Alaska $53,081 $45,170 $53,081 $45,170 $53,081 $45,170 $53,081
Arizona6 $41,861 $31,038 $29,813 $28,179 $28,179 $41,861
Arkansas $44,107 $30,017 $30,017 $30,017 $30,017 $44,107
California7 $54,317 $42,473 $54,317 $28,996 $54,317 $27,158 $54,317
Colorado $54,113 $30,017 $30,017 $30,017 $30,017 $54,113
Connecticut $65,956 $41,044 $41,044 $41,044 $65,956
Delaware $44,311 $44,311 $44,311 $30,017 $28,179 $28,179 $44,311
District of Columbia5 $66,160 $66,160 $66,160 $66,160 $66,160 $66,160 $66,160
Florida8 $43,903 $43,086 $43,086 $29,609 $28,179 $28,179 $43,903
Georgia $51,458 $42,882 $31,446 $28,179 $28,179 $51,458
Hawaii $73,492 $44,846 $73,492 $32,637 $73,492 $31,228 $73,492
Idaho $38,798 $30,017 $30,017 $28,179 $28,179 $38,798
Illinois9 $64,935 $30,017 $30,017 $30,017 $30,017 $64,935
Indiana10 $53,500 $44,515 $44,515 $33,693 $33,693 $33,693 $33,693 $53,500
Iowa $62,689 $77,596 $77,596 $35,122 $35,122 $35,122 $62,689
Kansas11 $49,824 $34,918 $31,446 $28,179 $28,179 $49,620
Kentucky $44,515 $40,840 $28,996 $33,488 $27,158 $33,488 $44,515
Louisiana $52,071 $28,996 $44,311 $28,996 $44,311 $28,996 $44,311 $52,071
Maine $43,494 $40,023 $33,080 $33,080 $33,080 $33,080 $43,494
Maryland $65,752 $39,614 $65,752 $28,179 $65,752 $27,158 $65,752
Massachusetts12 $62,281 $41,861 $41,861 $31,651 $31,651 $31,651 $31,651 $62,281
Michigan13 $44,311 $39,819 $44,311 $32,672 $44,311 $32,672 $44,311
Minnesota14 $58,809 $56,155 $58,809 $57,176 $57,176
Mississippi $43,698 $40,635 $30,221 $28,179 $28,179 $43,698
Missouri $62,281 $41,044 $30,221 $31,651 $30,221 $31,651 $62,281
Montana $54,317 $30,221 $30,221 $28,179 $30,221 $54,317
Nebraska $44,515 $33,080 $44,515 $29,609 $44,515 $27,158 $44,515
Nevada $41,861 $33,693 $33,693 $28,179 $28,179 $41,861
New Hampshire $65,956 $40,023 $65,956 $40,023 $65,956 $40,023 $65,956
New Jersey $72,491 $40,635 $30,017 $30,017 $30,017 $72,491
New Mexico $62,281 $49,008 $62,281 $49,008 $62,281 $38,798 $50,029
New York $82,701 $45,536 $31,446 $31,446 $31,446 $82,701
North Carolina15 $44,107 $43,903 $43,903 $43,903 $43,903 $28,179 $28,179 $44,107
North Dakota $35,735 $31,038 $31,038 $28,179 $28,179 $35,735
Ohio $43,086 $31,855 $43,086 $31,855 $43,086 $31,855 $43,086
Oklahoma5,16 $42,882 $42,882 $42,882 $42,882 $42,882 $42,882 $42,882
Oregon $62,281 $38,798 $38,798 $28,179 $28,179 $28,179 $62,281
Pennsylvania $65,139 $44,924 $33,080 $28,179 $28,179 $65,139
Rhode Island $54,317 $38,798 $54,317 $28,996 $54,317 $27,158 $54,317
South Carolina $43,494 $39,614 $43,494 $29,200 $43,494 $27,158 $43,494
South Dakota $42,677 $38,185 $38,185 $38,185 $38,185 $38,185 $38,185 $42,677
Tennessee5,17 $52,071 $39,819 $44,107 $28,996 $44,107 $27,158 $44,107 $52,071
Texas $42,065 $41,452 $30,425 $28,179 $28,179 $42,065
Utah $41,861 $29,404 $29,404 $28,179 $28,179 $41,861
Vermont $64,731 $64,731 $64,731 $64,731 $64,731 $64,731 $64,731
Virginia $41,861 $30,221 $30,221 $30,221 $30,221 $41,861
Washington $64,731 $43,903 $43,903 $43,903 $64,731
West Virginia $62,281 $33,284 $29,813 $28,179 $28,179 $62,281
Wisconsin18 $62,485 $62,485 $39,002 $27,158 $31,855 $62,485
Wyoming $41,861 $32,467 $32,467 $28,179 $28,179 $41,861
SOURCE: Based on a national survey conducted by the Kaiser Commission on Medicaid and the Uninsured with the Georgetown University Center for Children and Families, 2017.
Table presents rules in effect as of January 1, 2017.

Table 1 and Table 1A Notes

  1. January 2017 income limits reflect Modified Adjusted Gross Income (MAGI)-converted income standards and include a disregard equal to five percentage points of the federal poverty level (FPL) applied at the highest income level for Medicaid and separate CHIP coverage. Eligibility levels are reported as percentage of the FPL. The 2017 FPL for a family of three was $20,420.
  2. States may use Title XXI CHIP funds to cover children through CHIP-funded Medicaid expansion programs and/or separate child health insurance programs for children not eligible for Medicaid. Use of Title XXI CHIP funds is limited to uninsured children. The Medicaid income eligibility levels listed indicate thresholds for children covered with Title XIX Medicaid funds and uninsured children covered with Title XXI funds through CHIP-funded Medicaid expansion programs. To be eligible in the infant category, a child has not yet reached his or her first birthday; to be eligible in the 1-5 category, the child is age 1 or older, but has not yet reached his or her 6th birthday; and to be eligible in the 6-18 category, the child is age 6 or older, but has not yet reached his or her 19th birthday.
  3. The states noted use federal CHIP funds to operate separate child health insurance programs for children not eligible for Medicaid. Such programs may either provide benefits similar to Medicaid or a somewhat more limited benefit package. They also may impose premiums or other cost-sharing obligations on some or all families with eligible children. These programs typically provide coverage for uninsured children until the child’s 19th birthday.
  4. Medians for CHIP-funded uninsured children are based on the upper limit of coverage.
  5. Alabama, the District of Columbia, Oklahoma, and Tennessee have different lower bounds for adolescents in Title XXI funded Medicaid expansions depending on age. The lower bound for Title XXI funded Medicaid is 18% for children ages 14 through 18 in Alabama, 63% for children ages 15 through 18 in the District of Columbia, 69% for children ages 14 through 18 in Oklahoma, and 29% for children ages 14 through 18 in Tennessee.
  6. Arizona’s CHIP program, KidsCare, re-opened enrollment in July 2016. Applications were accepted beginning July 26, 2016, and coverage began on September 1, 2016. New enrollment in KidsCare had been closed since December 21, 2009, prior to the Affordable Care Act’s (ACA’s) maintenance of effort requirement.
  7. In California, children with higher incomes are eligible for separate CHIP coverage in certain counties.
  8. In Florida, all infants are covered in Medicaid. Florida operates three separate CHIP programs: Healthy Kids covers children ages 5 through 18; MediKids covers children ages 1 through 4; and the Children’s Medical Service Network serves children with special health care needs from birth through age 18.
  9. In Illinois, infants born to non-Medicaid covered mothers are covered up to 147% FPL in Medicaid and up to 318% FPL under CHIP.
  10. Indiana uses a state-specific income disregard that is equal to five percent of the highest income eligibility threshold for the group.
  11. Kansas covers children in a separate CHIP program up to an income level that is equivalent to 238% FPL in 2008.
  12. Massachusetts also covers insured children in its separate CHIP program with Title XIX Medicaid funds under its Section 1115 waiver.
  13. In 2016, Michigan expanded CHIP-funded Medicaid expansion coverage to children with incomes between 212-400% FPL affected by the Flint water crisis.
  14. In Minnesota, the infant category under Title XIX-funded Medicaid includes insured and uninsured children up to age two with incomes up to 275% FPL.
  15. In North Carolina, all children ages 0 through 5 are covered in Medicaid while the separate CHIP program covers children ages 6 through 18 with incomes above Medicaid limits.
  16. Oklahoma offers a premium assistance program to children ages 0 through 18 with income up to 222% FPL with access to employer sponsored insurance through its Insure Oklahoma program.
  17. In Tennessee, Title XXI funds are used for two programs, TennCare Standard and CoverKids (a separate CHIP program). TennCare Standard provides Medicaid coverage to uninsured children who lose eligibility under TennCare (Medicaid), have no access to insurance, and have family income below 216% FPL or are medically eligible.
  18. In Wisconsin, children are not eligible for CHIP if they have access to health insurance coverage through a job where the employer covers at least 80% of the cost.

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Table 2: Medicaid and CHIP Income Eligibility Limits for Pregnant Women, January 2017
State Percent of the Federal Poverty Level1 Annual Income
Medicaid CHIP Unborn Child
Option
(CHIP-Funded)2
Medicaid CHIP Unborn Child
Option
(CHIP-Funded)2
Median 200% 258% 214% $40,840 $52,683 $43,596
Alabama 146% $29,813
Alaska 205% $52,316
Arizona 161% $32,876
Arkansas3 214% 214% $43,698 $43,698
California 213% 322% $43,494 $65,752
Colorado 200% 265% $40,840 $54,113
Connecticut 263% $53,704
Delaware 217% $44,311
District of Columbia4 324% $66,160
Florida 196% $40,023
Georgia 225% $45,945
Hawaii 196% $46,020
Idaho 138% $28,179
Illinois 213% 213% $43,494 $43,494
Indiana5 213% $43,494
Iowa 380% $77,596
Kansas 171% $34,918
Kentucky 200% $40,840
Louisiana 138% 214% $28,179 $43,698
Maine 214% $43,698
Maryland 264% $53,908
Massachusetts 205% 205% $41,861 $41,861
Michigan6 200% 200% $40,840 $40,840
Minnesota 283% 283% $57,788 $57,788
Mississippi 199% $40,635
Missouri7 201% 305% 305% $41,044 $62,281 $62,281
Montana 162% $33,080
Nebraska 199% 202% $40,635 $41,248
Nevada 165% $33,693
New Hampshire 201% $41,044
New Jersey4 199% 205% $40,635 $41,861
New Mexico 255% $52,071
New York4 223% $45,536
North Carolina8 201% $41,044
North Dakota 152% $31,038
Ohio 205% $41,861
Oklahoma9 138% 210% $28,179 $42,882
Oregon 190% 190% $38,798 $38,798
Pennsylvania 220% $44,924
Rhode Island 195% 258% 258% $39,819 $52,683 $52,683
South Carolina 199% $40,635
South Dakota10 138% $28,179
Tennessee 200% 255% $40,840 $52,071
Texas 203% 207% $41,452 $42,269
Utah 144% $29,404
Vermont 213% $43,494
Virginia 148% 205% $30,221 $41,861
Washington 198% 198% $40,431 $40,431
West Virginia 163% $33,284
Wisconsin 306% 306% $62,485 $62,485
Wyoming 159% $32,467
SOURCE: Based on a national survey conducted by the Kaiser Commission on Medicaid and the Uninsured with the Georgetown University Center for Children and Families, 2017.
Table presents rules in effect as of January 1, 2017

Table 2 Notes

  1. January 2017 income limits reflect Modified Adjusted Gross Income (MAGI)-converted income standards, and include a disregard equal to five percentage points of the federal poverty level (FPL). As of 2017, the FPL for a family of three was $20,420.
  2. The unborn child option permits states to consider the fetus a “targeted low-income child” for purposes of CHIP coverage.
  3. Arkansas provides the full Medicaid benefits to pregnant women with incomes up to levels established for the old Aid to Families with Dependent Children (AFDC) program, which is $220 per month. Above those levels, more limited pregnancy-related benefits are provided to pregnant women covered under Medicaid and the unborn child option in CHIP with incomes up to 209% FPL.
  4. The District of Columbia, New Jersey, and New York provide pregnancy-related services not covered through emergency Medicaid for some income-eligible pregnant women who are not otherwise eligible due to immigration status using state-only funds.
  5. Indiana uses a state-specific income disregard that is equal to five percent of the highest income eligibility threshold for the group.
  6. In 2016, Michigan expanded coverage to pregnant women with incomes up to 400% FPL affected by the Flint water crisis. The Flint waiver does not apply to pregnant women covered under the unborn child option.
  7. In January 2016, Missouri adopted the unborn child option in CHIP and expanded CHIP coverage to pregnant women with incomes up to 300% FPL.
  8. North Carolina provides full Medicaid benefits to pregnant women with incomes up to roughly 43% FPL. Above that level, more limited pregnancy-related benefits are provided to pregnant women covered under Medicaid.
  9. Oklahoma offers a premium assistance program to pregnant women with incomes up to 205% FPL who have access to employer sponsored insurance through its Insure Oklahoma program.
  10. South Dakota provides full Medicaid benefits to pregnant women with incomes up to $591 per month (for a family of three). Above that level, more limited pregnancy-related benefits are provided to pregnant women covered under Medicaid.

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Table 3: Medicaid Income Eligibility Limits for Adults as of January 2017[1]
State Percent of the Federal Poverty Level Annual Income
Parents
(in a family of three)
Other Adults
(for an individual)
Parents
(in a family of three)
Other Adults
(for an individual)
Median 138% 138% $28,179 $16,642
Alabama 18% 0% $3,675 $0
Alaska 141% 138% $35,983 $20,782
Arizona2 138% 138% $28,179 $16,642
Arkansas2 138% 138% $28,179 $16,642
California 138% 138% $28,179 $16,642
Colorado 138% 138% $28,179 $16,642
Connecticut 155% 138% $31,651 $16,642
Delaware 138% 138% $28,179 $16,642
District of Columbia 221% 215% $45,128 $25,929
Florida 33% 0% $6,738 $0
Georgia       37% 0% $7,555 $0
Hawaii 138% 138% $32,402 $19,126
Idaho 26% 0% $5,309 $0
Illinois 138% 138% $28,179 $16,642
Indiana2,5 139% 139% $28,383 $16,763
Iowa2 138% 138% $28,179 $16,642
Kansas 38% 0% $7,759 $0
Kentucky 138% 138% $28,179 $16,642
Louisiana6 138% 138% $28,179 $16,642
Maine 105% 0% $21,441 $0
Maryland 138% 138% $28,179 $16,642
Massachusetts3,7 138% 138% $28,179 $16,642
Michigan2 138% 138% $28,179 $16,642
Minnesota8 138% 138% $28,179 $16,642
Mississippi 27% 0% $5,513 $0
Missouri 22% 0% $4,492 $0
Montana2,9 138% 138% $28,179 $16,642
Nebraska 63% 0% $12,864 $0
Nevada 138% 138% $28,179 $16,642
New Hampshire2 138% 138% $28,179 $16,642
New Jersey 138% 138% $28,179 $16,642
New Mexico   138% 138% $28,179 $16,642
New York3,8 138% 138% $28,179 $16,642
North Carolina 44% 0% $8,984 $0
North Dakota 138% 138% $28,179 $16,642
Ohio 138% 138% $28,179 $16,642
Oklahoma10 44% 0% $8,984 $0
Oregon 138% 138% $28,179 $16,642
Pennsylvania3 138% 138% $28,179 $16,642
Rhode Island 138% 138% $28,179 $16,642
South Carolina 67% 0% $13,681 $0
South Dakota 51% 0% $10,414 $0
Tennessee 99% 0% $20,215 $0
Texas 18% 0% $3,675 $0
Utah11 44% 0% $8,984 $0
Vermont13 138% 138% $28,179 $16,642
Virginia14 38% 0% $7,759 $0
Washington 138% 138% $28,179 $16,642
West Virginia 138% 138% $28,179 $16,642
Wisconsin15 100% 100% $20,420 $12,060
Wyoming 56% 0% $11,435 $0
SOURCE: Based on a national survey conducted by the Kaiser Commission on Medicaid and the Uninsured with the Georgetown University Center for Children and Families, 2017.
Table presents rules in effect as of January 1, 2017

Table 3 Notes

  1. January 2017 income limits reflect Modified Adjusted Gross Income (MAGI)-converted income standards, and include a disregard equal to five percentage points of the federal poverty level (FPL) applied to the highest income limit for the group. In some states, eligibility limits for parents are based on a dollar threshold. The values listed represent the truncated FPL equivalents calculated from these dollar limits. Eligibility levels for parents are presented as a percentage of the 2017 FPL for a family of three, which is $20,420. Eligibility limits for other adults are presented as a percentage of the 2017 FPL for an individual, which is $12,060.
  2. Arizona, Arkansas, Indiana, Iowa, Michigan, Montana and New Hampshire implemented the Medicaid expansion under Section 1115 waiver authority. Arizona received approval for a Section 1115 waiver to make changes to its expansion coverage in September 2016. Prior to that, Arizona had implemented a traditional Medicaid expansion.
  3. The District of Columbia, Massachusetts, New York, and Pennsylvania cover some income-eligible adults who are not otherwise eligible due to immigration status using state-only funds.
  4. The District of Columbia covers adults up to 215% FPL as an optional Medicaid eligibility category in its state plan.
  5. Indiana uses a state-specific income disregard that is equal to five percent of the highest income eligibility threshold for the group.
  6. Louisiana implemented the Medicaid expansion for adults in July 2016.
  7. Massachusetts provides subsidies for Marketplace coverage for parents and childless adults with incomes up to 300% through its Connector Care program. The state’s Section 1115 waiver also authorizes MassHealth coverage for HIV-positive individuals with incomes up to 200% FPL, uninsured individuals with breast or cervical cancer with incomes up to 250% FPL, and individuals who work for a small employer and purchase employer-sponsored insurance (ESI) with incomes up to 300% FPL, as well as coverage through MassHealth CommonHealth for adults with disabilities with no income limit.
  8. Minnesota and New York have implemented Basic Health Programs (BHPs) established by the Affordable Care Act (ACA) for adults with incomes between 138%-200% FPL.
  9. Montana changed parent eligibility from a dollar- to FPL-based threshold during 2016, which decreased the base 1931 parent eligibility level. Parents above this level are eligible for coverage under the Medicaid expansion.
  10. In Oklahoma, individuals without a qualifying employer with incomes up to 100% FPL are eligible for more limited subsidized insurance though the Insure Oklahoma Section 1115 waiver program. Individuals working for certain qualified employers with incomes at or below 200% FPL are eligible for premium assistance for employer-sponsored insurance.
  11. In Texas, the income limit for parents and other caretaker relatives is based on monthly dollar amounts which differ depending on family size and whether there is one or two-parents in the family. The eligibility level shown is for a single parent household and a family size of three.
  12. In Utah, adults with incomes up to 100% FPL are eligible for coverage of primary care services under the Primary Care Network Section 1115 waiver program. Enrollment is opened periodically when there is capacity to accept new enrollees.
  13. Vermont also provides a 1.5% reduction in the federal applicable percentage of the share of premium costs for individuals who qualify for advance premium tax credits to purchase Marketplace coverage with income up to 300% FPL.
  14. In Virginia, eligibility levels for 1931 parents vary by region. The value shown is the eligibility level for Region 2, the most populous region.
  15. Wisconsin covers adults up to 100% FPL in Medicaid but did not adopt the ACA Medicaid expansion.
Endnotes
  1. 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/.

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  2. Oklahoma and Utah provide more limited coverage to some childless adults under Section 1115 waiver authority.

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  3. 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/.

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