Where Are States Today? Medicaid and CHIP Eligibility Levels for Adults, Children, and Pregnant Women
This fact sheet provides eligibility levels for parents, other non-disabled adults, children, and pregnant women in Medicaid and CHIP as of January 2016. The findings highlight Medicaid’s expanded role for low-income adults under the Affordable Care Act (ACA) and its continued role as a primary source of coverage for children and pregnant women. State-specific data is available in Tables 1 through 3.
As of January 2016, 31 states have Medicaid income eligibility levels for parents and other adults at or above 138% FPL, reflecting their implementation of the ACA Medicaid expansion to adults (Figures 1 and 2, Table 1). This count includes three states (AK, DC, and CT) that extend eligibility for parents and/or other adults to levels higher than 138% FPL. Louisiana has also adopted the Medicaid expansion, but it is not reflected in the eligibility levels since it has not yet been implemented. The state’s expansion will become effective as of July 2016.1
In the 20 states that have not expanded Medicaid, the median eligibility limit for parents is 42% FPL; other adults remain ineligible in all of these state except Wisconsin (Figure 3). In 13 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 childless adults, although eligibility at 100% FPL remains below the expansion level.2 In the other non-expansion states, parents and other adults with incomes above Medicaid eligibility limits 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.
Medicaid and CHIP coverage for children and pregnant women remains considerably higher than adult coverage across all states. As of January 2016, 48 states cover children with incomes above 200% FPL, with 19 states extending eligibility to greater than 300% FPL (Figure 4, Table 2 and 2A). Only three states (AZ, ID and ND) limit children’s eligibility to below 200% FPL. Most states extend coverage to pregnant women beyond the federal minimum of 138% FPL through Medicaid and CHIP. As of January 2016, nearly two-thirds of states (33) cover pregnant women at or above 200% FPL, including eleven states that cover pregnant women with family incomes above 250% FPL in Medicaid and CHIP (Figure 5, Table 3).
In sum, Medicaid and CHIP continue to be central source 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.
Kaiser Family Foundation State Health Facts, Status of State Action on the Medicaid Expansion Decision. Data Source: KCMU tracking and analysis of state executive activity (Feb. 24, 2016), http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/.
Oklahoma and Utah provide more limited coverage to some childless adults under Section 1115 waiver authority.