Last updated 5 months ago. Our resources are updated regularly but please keep in mind that links, programs, policies, and contact information do change.
The Children’s Health Insurance Program (CHIP) provides low-cost health coverage for children in families with incomes too high for Medicaid but not enough to afford private insurance. Established as a partnership between federal and state governments, CHIP ensures children in working families can access essential healthcare.
What is CHIP?
CHIP is a joint federal and state initiative created to provide health insurance to children who might otherwise go uninsured. It targets families who earn too much for Medicaid but find private health insurance too expensive. In some states, CHIP coverage also extends to pregnant women.
Established under Title XXI of the Social Security Act through the Balanced Budget Act of 1997, CHIP represents the largest single investment in children’s health since Medicaid began in 1965. It was created to address a specific gap: many children had working parents who earned slightly too much for traditional Medicaid but lacked access to affordable employer or private plans.
CHIP provides coverage for routine check-ups, immunizations, doctor visits, prescriptions, dental and vision care, hospital care, and emergency services.
Who CHIP Serves
The primary beneficiaries of CHIP are uninsured children and teens up to age 19. Eligibility typically requires the child to be in a family whose income falls within specific limits set by their state—above the Medicaid threshold but below the CHIP ceiling.
Some states also use CHIP funds to cover pregnant women, often targeting those with incomes too high for Medicaid pregnancy coverage but still meeting CHIP income criteria. States choosing this option usually must meet certain conditions, such as already covering children up to a relatively high income level (e.g., 200% of the Federal Poverty Level).
While the federal government sets core requirements and provides funding, each state designs and manages its own CHIP program. This means specific eligibility rules, benefits, and costs vary by state.
CHIP and Medicaid: Working Together
CHIP and Medicaid are closely linked programs, often administered by the same state agency. When a family applies for health coverage assistance—through the state agency or the Health Insurance Marketplace (Healthcare.gov)—the system determines whether children are eligible for Medicaid or CHIP.
If a child’s family income is below the state’s Medicaid limit, they are typically enrolled in Medicaid. If the income is too high for Medicaid but falls within the state’s CHIP limits, they are enrolled in CHIP. This coordinated approach, strengthened by the Affordable Care Act (ACA), creates a “no wrong door” system, ensuring eligible children get enrolled in the appropriate program without families having to navigate multiple complex application processes.
Applying through Healthcare.gov, for instance, automatically screens for both programs and forwards the application to the state if eligibility is indicated.
CHIP Program Structures: Medicaid Expansion vs. Separate CHIP
States have flexibility in how they structure their CHIP initiatives, leading to different program types across the country. There are three main models:
Medicaid Expansion CHIP: Some states use CHIP funds to expand their existing Medicaid program to cover children at higher income levels. Children enrolled through this model typically receive the full Medicaid benefit package, including comprehensive Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, with very limited cost-sharing. The state receives the higher CHIP federal matching rate for these children.
Separate CHIP: Other states create a CHIP program that is separate from Medicaid. These programs have more flexibility in designing their benefit packages (though they must cover essential services like physician visits, hospital care, dental, and vision) and can charge monthly premiums and cost-sharing (like co-payments), although these costs are capped by federal law (generally at 5% of family income). Separate CHIP programs also implement measures to prevent families from substituting CHIP for available private insurance (“crowd-out”).
Combination CHIP: Many states use a combination approach, covering some children through Medicaid expansion and others through a separate CHIP program, often depending on the child’s specific income level.
The structure a state chooses directly influences the specific benefits, potential out-of-pocket costs (premiums or co-pays), and some administrative rules that families encounter.
Where to Find Authoritative CHIP Information
Navigating CHIP eligibility requires using official, up-to-date sources. Families should primarily rely on federal and state government websites for the most accurate information.
Key Federal Websites
Two main federal websites provide comprehensive information and access points for CHIP and related programs:
Healthcare.gov: This is the federal Health Insurance Marketplace website. Families can use this site to:
- Get a preliminary check on whether their income might qualify them for Medicaid or CHIP
- Fill out a single application that screens for eligibility for Medicaid, CHIP, and subsidized Marketplace plans
- Learn about and enroll in private health insurance plans through the Marketplace, potentially with financial assistance (premium tax credits), if they are not eligible for Medicaid or CHIP
Medicaid.gov: This is the official website for the Centers for Medicare & Medicaid Services (CMS) covering both Medicaid and CHIP. It offers:
- Detailed information on federal CHIP rules, policies, and program structure
- Data and reports on enrollment and program performance
- Links and contact information for each state’s Medicaid and CHIP agency
State-Level Resources
While federal sites provide the national framework and application portals, the definitive rules for CHIP eligibility are set at the state level. Therefore, consulting state-specific resources is essential:
State Medicaid/CHIP Agencies: Every state has an agency (often part of the Department of Health or Human Services) responsible for running its Medicaid and CHIP programs. Their official websites contain the most accurate and detailed information on:
- Specific income eligibility limits for that state, often presented in detailed charts showing monthly or annual income levels by family size
- Covered services and benefits within the state’s CHIP plan(s)
- Any premiums or co-payments required
- Specific application procedures and forms for applying directly to the state
Finding Your State Agency: The easiest way to find the official website and contact information for your state’s agency is through the directory provided on Medicaid.gov.
Families should use federal resources like Healthcare.gov to apply or get initial information and the Medicaid.gov directory to locate their specific state agency. The state agency’s website is the ultimate authority for the precise eligibility rules and income guidelines applicable in their location.
Income Eligibility Basics: The Role of FPL and State Rules
Income is the primary factor determining eligibility for CHIP. The system uses the Federal Poverty Level (FPL) as a benchmark, but states have significant flexibility in setting their specific thresholds.
Connecting CHIP to the Federal Poverty Level (FPL)
Eligibility for CHIP is fundamentally linked to the Federal Poverty Level (FPL). The FPL is an income measure updated annually by the U.S. Department of Health and Human Services (HHS). It reflects the minimum income a family needs for basic necessities and is used across many federal assistance programs.
CHIP eligibility isn’t based on having income below the FPL (that typically qualifies children for Medicaid), but rather on having income within a specific percentage range of the FPL set by the state. For example, a state might set its CHIP eligibility limit at 250% FPL.
States Set the Specific Limits
While the FPL provides a common reference point, the actual income cutoff for CHIP varies widely because each state determines the FPL percentage it will use.
Federal law establishes a basic framework. Initially, CHIP targeted children in families with incomes generally up to 200% FPL or 50 percentage points above the state’s Medicaid income limit in 1997, whichever was higher. The ACA further standardized minimum income levels for children’s coverage, generally requiring states to cover children through Medicaid up to at least 133% FPL (effectively 138% FPL with a standard disregard).
However, states have significant flexibility to set CHIP eligibility levels above these minimums. As a result, the upper income limit for CHIP eligibility can range dramatically across states, from around 170% FPL in some states to as high as 400% FPL in others.
This state-level decision-making means that a family with a particular income might find their children eligible for CHIP in one state but not in another. The FPL provides the scale, but the state sets the specific mark on that scale. Furthermore, some states may have different FPL thresholds for different age groups within CHIP or Medicaid (e.g., infants under 1 might be eligible at a higher %FPL than older children).
Finding Your State’s CHIP Income Guidelines
Given the state-by-state variation, families must consult resources specific to the state where they reside to determine if their income qualifies their children for CHIP. There is no single, nationwide income chart that applies everywhere.
Here’s how to find the specific income limits for your state:
Medicaid.gov Eligibility Levels Table: The Centers for Medicare & Medicaid Services (CMS) publishes comprehensive tables showing the upper income limits (as a percentage of FPL) that each state uses for different categories within Medicaid and CHIP, including various age groups for children and pregnant women. This is an excellent resource for comparing the general generosity of different state programs.
The table below, sourced from Medicaid.gov (data as of December 1, 2023), illustrates the state-level variations in eligibility thresholds (%FPL) for children and pregnant women.
Medicaid and CHIP Upper Income Eligibility Levels as a Percent (%) of the Federal Poverty Level (FPL) for Children and Pregnant Women, Based on State Decisions as of December 1, 2023
| State | Children Medicaid Ages 0-1 | Children Medicaid Ages 1-5 | Children Medicaid Ages 6-18 | Children Separate CHIP¹ | Pregnant Women Medicaid | Pregnant Women CHIP² |
|---|---|---|---|---|---|---|
| Alabama | 141% | 141% | 141% | 312% | 141% | N/A |
| Alaska | 203% | 203% | 203% | N/A | 200% | N/A |
| Arizona | 147% | 141% | 133% | 200% | 156% | N/A |
| Arkansas | 142% | 142% | 142% | 211% | 209% | N/A |
| California | 261% | 261% | 261% | See note³ | 208% | N/A |
| Colorado | 142% | 142% | 142% | 260% | 195% | 260% |
| Connecticut | 196% | 196% | 196% | 318% | 258% | N/A |
| Delaware | 212% | 142% | 133% | 212% (1 up to 19) | 212% | N/A |
| District of Columbia | 319% | 319% | 319% | N/A | 319% | N/A |
| Florida | 206% | 140% | 133% | 210% (1 up to 19) | 191% | N/A |
| Georgia | 205% | 149% | 133% | 247% | 220% | N/A |
| Hawaii | 308% | 308% | 308% | N/A | 191% | N/A |
| Idaho | 142% | 142% | 133% | 185% | 133% | N/A |
| Illinois | 313% | 313% | 313% | N/A | 208% | N/A |
| Indiana | 208% | 158% | 158% | 250% | 208% | N/A |
| Iowa | 375% | 167% | 167% | 302% (1 up to 19) | 375% | N/A |
| Kansas | 166% | 149% | 133% | 250% | 166% | N/A |
| Kentucky | 213% | 213% | 213% | N/A | 195% | 213% |
| Louisiana | 212% | 212% | 212% | 250% | 133% | N/A |
| Maine | 300% | 300% | 300% | N/A | 209% | N/A |
| Maryland | 317% | 317% | 317% | N/A | 259% | N/A |
| Massachusetts | 200% | 150% | 150% | 300% | 200% | N/A |
| Michigan | 212% | 212% | 212% | N/A | 195% | N/A |
| Minnesota⁴ | 283% | 275% | 275% | N/A | 278% | N/A |
| Mississippi | 194% | 143% | 133% | 209% | 194% | N/A |
| Missouri | 196% | 150% | 150% | 300% | 196% | 300% |
| Montana | 143% | 143% | 143% | 261% | 157% | N/A |
| Nebraska | 213% | 213% | 213% | N/A | 194% | N/A |
| Nevada | 160% | 160% | 133% | 200% | 160% | N/A |
| New Hampshire | 318% | 318% | 318% | N/A | 196% | N/A |
| New Jersey | 194% | 142% | 142% | 350% | 194% | 200% |
| New Mexico | 300% | 300% | 240% | N/A | 250% | N/A |
| New York | 218% | 149% | 149% | 400% | 218% | N/A |
| North Carolina | 211% | 211% | 211% | N/A | 196% | N/A |
| North Dakota | 170% | 170% | 170% | N/A | 170% | N/A |
| Ohio | 206% | 206% | 206% | N/A | 200% | N/A |
| Oklahoma | 205% | 205% | 205% | N/A | 205% | N/A |
| Oregon | 185% | 133% | 133% | 300% | 185% | N/A |
| Pennsylvania | 215% | 157% | 133% | 314% | 215% | N/A |
| Rhode Island | 261% | 261% | 261% | N/A | 190% | 253% |
| South Carolina | 208% | 208% | 208% | N/A | 194% | N/A |
| South Dakota | 182% | 182% | 182% | 204% | 133% | N/A |
| Tennessee | 195% | 142% | 133% | 250% | 195% | N/A |
| Texas | 198% | 144% | 133% | 201% | 198% | N/A |
| Utah | 139% | 139% | 133% | 200% | 139% | N/A |
| Vermont | 312% | 312% | 312% | N/A | 208% | N/A |
| Virginia | 143% | 143% | 143% | 200% | 143% | 200% |
| Washington | 210% | 210% | 210% | 312% | 193% | N/A |
| West Virginia | 158% | 141% | 133% | 300% | 185% | 300% |
| Wisconsin | 301% | 186% | 151% | 301% (1 up to 19) | 301% | N/A |
| Wyoming | 200% | 200% | 200% | N/A | 154% | N/A |
Notes:
- CHIP covers birth up to age 19 unless otherwise noted in parentheses. Includes CHIP-funded Medicaid expansions.
- CHIP gives states the option to cover pregnant women. This table shows coverage of pregnant women only.
- The Separate CHIP in California covers certain children up to age 2 with incomes up to 317% FPL statewide; and it covers children up to age 19 also up to 317% FPL in three counties only.
- Minnesota covers children up to age 2 with incomes up to 283% FPL.
Healthcare.gov Screening Tool: The “Check if you qualify based on income” tool on Healthcare.gov allows families to enter their state, household size, and estimated annual income. It provides a quick assessment of potential eligibility for Medicaid, CHIP, or savings on Marketplace plans. This is a helpful starting point but not a final eligibility determination.
URL: https://www.healthcare.gov/lower-costs/
State Agency Websites: This is the most crucial resource for definitive, state-specific income guidelines. State agency websites often provide detailed charts that translate the FPL percentages into actual monthly or annual dollar amounts based on family size. They may also have online eligibility screening tools specific to their state programs. Use the Medicaid.gov directory to find your state’s site.
URL for State Directory: https://www.medicaid.gov/about-us/where-can-people-get-help-medicaid-chip
How Your Income is Counted: The MAGI Method
Understanding whether your family’s income meets the state’s CHIP limit requires knowing how income is counted. For CHIP, most Medicaid categories, and Marketplace subsidies, eligibility is determined using a specific methodology called Modified Adjusted Gross Income (MAGI).
Introducing Modified Adjusted Gross Income (MAGI)
MAGI is an income calculation method based on federal income tax rules. It was implemented as part of the ACA to create a more standardized and simplified way of determining income eligibility across different health coverage programs (Medicaid, CHIP, Marketplace).
Before MAGI, states used widely varying rules to count income for Medicaid, making comparisons and transitions difficult. While MAGI aims for simplification by aligning with tax concepts, it means families need a basic understanding of terms like Adjusted Gross Income (AGI).
Calculating MAGI
The MAGI calculation starts with a figure from your federal tax return, Adjusted Gross Income (AGI), and then adds back a few specific types of income that are not typically taxed.
The Formula: In general, MAGI is calculated as follows:
MAGI = Adjusted Gross Income (AGI) + Untaxed Foreign Earned Income + Tax-Exempt Interest + Non-Taxable Social Security Benefits
Finding AGI: Your AGI is a line item on your federal income tax return (IRS Form 1040, line 11). It represents your gross income (total income from all taxable sources) minus certain specific deductions known as “adjustments to income” or “above-the-line” deductions. Common examples include deductions for traditional IRA contributions, student loan interest payments, or self-employment taxes.
MAGI vs. AGI: For many households, their MAGI will be the same as or very close to their AGI. This is because the items added back (untaxed foreign income, tax-exempt interest, non-taxable Social Security) do not apply to everyone. However, if a family does receive income from these sources, particularly non-taxable Social Security benefits, their MAGI could be higher than their AGI, potentially affecting eligibility.
What Income Counts Towards MAGI?
When estimating your household income for a CHIP application, you need to include income from various sources. Generally, most taxable income is counted. Common types of income included in the MAGI calculation are:
- Wages, salaries, tips: Use federal taxable wages if listed on pay stubs; otherwise, use gross pay minus pre-tax deductions for things like health insurance or retirement contributions
- Net income from self-employment: This is your profit after deducting allowable business expenses
- Unemployment compensation
- Social Security benefits: This is a key point – both the taxable and non-taxable portions of Social Security benefits (like retirement, survivor, or disability benefits, SSDI) are added together for the MAGI calculation. Do not include Supplemental Security Income (SSI)
- Retirement income: Includes pensions, and withdrawals from traditional IRAs and 401(k)s. Qualified distributions from Roth accounts are generally not included
- Investment income: Interest (including tax-exempt interest), dividends, capital gains
- Net rental income and royalties
- Alimony received: Only for divorce or separation agreements finalized before January 1, 2019
- Taxable scholarships and fellowship grants
The inclusion of non-taxable Social Security benefits is a significant aspect of the MAGI calculation that differs from AGI alone and can impact eligibility determinations for families receiving these benefits.
What Income Generally Does NOT Count Towards MAGI?
Just as important as knowing what to include is knowing what income sources are generally excluded from the MAGI calculation for CHIP and Medicaid eligibility:
- Child support payments received (This is a change from pre-MAGI Medicaid rules)
- Supplemental Security Income (SSI)
- Gifts and inheritances
- Veterans’ disability payments
- Workers’ compensation benefits
- Proceeds from loans (like student loans, home equity loans, bank loans)
- Alimony received (for divorce or separation agreements finalized on or after January 1, 2019)
- Federal tax credits like the Earned Income Tax Credit (EITC) or Child Tax Credit payments
- Income from certain Native American or Alaska Native sources
- Pre-tax contributions made through an employer to health insurance premiums, flexible spending accounts (FSAs), or retirement plans (like a 401(k))
Accurately identifying which income sources to exclude can be critical for families near the eligibility threshold.
Defining Your Household for MAGI
Determining whose income counts requires correctly identifying the members of the MAGI “household.” This isn’t always the same as who lives under one roof; it’s primarily based on tax filing relationships.
Tax-Based Rules: For individuals who expect to file a federal income tax return, or who expect to be claimed as a tax dependent, the MAGI household generally includes:
- The tax filer
- The tax filer’s spouse (if filing jointly, or sometimes even if filing separately but living together for Medicaid/CHIP)
- All individuals the tax filer expects to claim as tax dependents (children or other qualifying relatives)
Whose Income Counts: The total household income used for eligibility determination is the sum of the MAGI of the tax filer, their spouse (if applicable), and only those tax dependents who are required by the IRS to file their own tax return. A dependent generally must file a tax return for 2024 if they have earned income over $14,600, unearned income (like investment income) over $1,300, or a specific combination of earned and unearned income exceeding certain thresholds. If a dependent has income below these filing thresholds, their income is typically not counted towards the household MAGI, even if they are part of the household size count.
Non-Filer Rules: Different rules apply to individuals who do not expect to file a federal tax return and do not expect to be claimed as a tax dependent.
- For an adult non-filer, the household typically includes the individual, their spouse (if living together), and their children under 19 (or under 21 if a student) living with them
- For a child non-filer, the household typically includes the child, their parents (if living with them), and their siblings under 19 (or under 21 if a student) living with them
Special Cases:
- Pregnancy: A pregnant individual is counted as themselves plus the number of children they are expected to deliver when determining household size for eligibility purposes
- Complex Dependents: Special rules may apply for children claimed as dependents by someone other than a parent (e.g., a grandparent), children living with parents who file taxes separately, or children claimed by a non-custodial parent. In these situations, the child’s household might be determined using non-filer rules or specific tax dependent exceptions
Because household composition rules under MAGI depend heavily on tax filing status and relationships, they can be complex. Correctly identifying the household size and whose income counts is crucial, as it impacts both the income calculation and the FPL threshold used for comparison.
Beyond Income: Other CHIP Eligibility Factors
While income is a central requirement, several other factors determine a child’s eligibility for CHIP.
Age Requirements: Children must generally be under 19 years old to qualify for CHIP. States may have different income thresholds linked to specific age groups within their combined Medicaid/CHIP structure (e.g., infants 0-1, children 1-5, children 6-18).
State Residency Rules: The child must live in the state where the family is applying for CHIP coverage. States generally require proof of residency, such as a utility bill, lease agreement, or state-issued ID, although self-attestation may sometimes be sufficient. Individuals residing in U.S. territories generally apply through their territory’s programs, not the state-based Marketplace.
Citizenship and Immigration Status: To be eligible for CHIP, a child must be a U.S. citizen or a “qualified non-citizen.” Qualified non-citizens include Lawful Permanent Residents (LPRs or Green Card holders), refugees, asylees, individuals granted withholding of deportation/removal, Cuban/Haitian entrants, certain Amerasians, and others with specific statuses recognized under immigration law.
The 5-Year Waiting Period: Federal law generally imposes a five-year waiting period (often called the “five-year bar”) for many qualified non-citizens, including most LPRs. This means they must wait five years after obtaining their qualifying immigration status before they can enroll in federally funded CHIP or Medicaid.
Exceptions to the Wait: Importantly, several groups are exempt from this five-year bar, including refugees, asylees, LPRs who previously held refugee/asylee status, Compact of Free Association (COFA) migrants, veterans and active-duty military members and their families, and others.
State Option (CHIPRA 214): Recognizing the barrier the five-year wait creates, federal law allows states the option (known as the CHIPRA 214 option or Immigrant Children’s Health Improvement Act option) to eliminate the waiting period and cover lawfully residing children and/or pregnant women in Medicaid and CHIP using federal funds. “Lawfully residing” generally aligns with the definition of “lawfully present” used for Marketplace eligibility. As of May 2023, a majority of states (36 states plus DC and some territories) had adopted this option for children and/or pregnant women, significantly improving access for immigrant families in those states. Families should check their state’s specific policy regarding this option.
Undocumented Status: Individuals who are not lawfully present in the U.S. are generally ineligible for CHIP. However, they may qualify for emergency Medicaid services if they meet all other eligibility criteria (like income and residency). Some states may offer state-funded programs or use the CHIP “unborn child” option (FCEP) to provide prenatal care regardless of the mother’s immigration status.
Public Charge: It is critical to note that applying for or receiving CHIP or Medicaid benefits does not make an individual a “public charge” under current U.S. immigration policy. Using these health benefits will not negatively impact an individual’s application for a Green Card or U.S. citizenship.
Need for Coverage (Uninsured Status): Generally, a child must be uninsured to qualify for CHIP coverage. States with Separate CHIP programs are required to have measures in place to prevent families from dropping private insurance just to enroll in CHIP; this sometimes involves a waiting period (e.g., 90 days) after private coverage ends, although exceptions for involuntary loss of coverage usually apply. Families might also need to confirm that the child does not have access to affordable health insurance through a parent’s employer.
Checking Eligibility and Applying for CHIP
One significant advantage of CHIP and Medicaid is that families can apply for coverage at any point during the year.
Year-Round Enrollment
Unlike the Health Insurance Marketplace, which has a specific annual Open Enrollment Period for most people, there is no limited enrollment period for CHIP or Medicaid. Families can apply whenever they need coverage. If determined eligible, coverage can often begin immediately or retroactively for a short period in some cases.
How to Apply
Families generally have two main pathways to apply for CHIP:
Via the Health Insurance Marketplace (Healthcare.gov):
Process: The most common method, especially encouraged since the ACA, is to complete an application online at Healthcare.gov. Families create an account and fill out a single application covering household members, income, and other relevant details.
Screening & Referral: The Marketplace system uses the provided information (primarily MAGI-based income and household details) to assess potential eligibility for all relevant programs: Medicaid, CHIP, and Marketplace plans with financial assistance. If the system indicates that anyone in the household might be eligible for Medicaid or CHIP, the application information is securely transmitted to the appropriate state Medicaid/CHIP agency.
State Follow-Up: The state agency receives the referred application and takes over the process. They will contact the family if more information is needed, make the final eligibility determination based on state-specific rules, and handle the enrollment into the correct program (Medicaid or CHIP).
Directly Through Your State Medicaid/CHIP Agency:
Process: Families can also choose to bypass the Marketplace and apply directly to their state’s Medicaid and CHIP agency.
Methods: The methods available for direct application vary by state but commonly include:
- Applying online through the state agency’s dedicated portal
- Applying by phone by calling the state agency’s helpline
- Downloading, printing, and mailing or faxing a paper application
- Applying in person at a local county social services or human services office
Finding Contact Info: To find the correct website, phone number, and application methods for your specific state, use the state agency directory on Medicaid.gov.
Information Needed to Apply
Regardless of the application method, families should be prepared to provide information about their household, income, and status. Having documents ready can speed up the process. Common information needed includes:
- Household Information: Full legal names, dates of birth, and Social Security Numbers (if available) for everyone applying for coverage. Relationship of household members to each other.
- Income Information: Details about income for all household members whose income counts under MAGI rules. This includes pay stubs, W-2 forms, tax returns, records of self-employment income and expenses, unemployment benefit statements, Social Security award letters, etc.
- Citizenship/Immigration Status: Documentation for applicants (e.g., birth certificate, passport, Green Card, immigration documents).
- Residency: Proof of living in the state (e.g., driver’s license, utility bill, lease).
- Current Health Insurance: Information about any existing health coverage for household members, including employer-sponsored insurance if available (even if not enrolled).
Getting Help
Applying can sometimes feel overwhelming. Free help is available:
- State Helplines: State Medicaid/CHIP agencies have toll-free numbers to answer questions and assist with applications. Find your state’s number via the Medicaid.gov directory.
- Local Offices: County social service or human service departments often provide in-person assistance.
- Navigators and Assisters: Trained individuals are available in many communities to provide free, impartial help with understanding options and completing applications for Medicaid, CHIP, and Marketplace coverage. Healthcare.gov’s “Find Local Help” tool can locate these resources.
Putting It Together: CHIP Income Examples
Understanding the FPL percentages and MAGI rules is important, but seeing how they translate into actual income limits in specific states can make eligibility clearer. Below are examples of monthly income limits for CHIP (or the equivalent program for children above Medicaid levels) in several states. These are illustrative and subject to change; always verify the current limits with your state’s official agency. Income limits shown generally reflect MAGI rules and may include a standard 5% FPL disregard applied by the state or Marketplace.
Example 1: Mississippi CHIP (Effective March 1, 2025)
Mississippi offers CHIP for uninsured children up to age 19 whose family income is at or below 209% FPL.
| Family Size | Monthly Income Limit (≤ 209% FPL) |
|---|---|
| 1 | $2,791 |
| 2 | $3,772 |
| 3 | $4,753 |
| 4 | $5,734 |
| 5 | $6,715 |
| 6 | $7,696 |
| 7 | $8,677 |
| 8 | $9,658 |
| Add’l Person | Add $958 |
Example 2: North Carolina Health Choice (NC Medicaid for Children) (Effective until April 1, 2026)
North Carolina covers children ages 0-18 through NC Medicaid up to 211% FPL. (Note: NC integrated its separate CHIP into Medicaid).
| Family Size | Monthly Income Limit (Children 0-18, ≤ 211% FPL) |
|---|---|
| 1 | $2,752 |
| 2 | $3,719 |
| 3 | $4,686 |
| 4 | $5,645 |
| 5 | $6,621 |
| Larger families have higher limits |
Example 3: California Medi-Cal (Children via OTLICP) (Based on 2025 FPL Chart)
California covers children 0-19 years old in families with income up to 266% FPL through Medi-Cal (using the Optional Targeted Low-Income Children Program structure, considered MAGI Medi-Cal).
| Family Size | Monthly Income Limit (≤ 266% FPL) |
|---|---|
| 1 | $3,472 |
| 2 | $4,690 |
| 3 | $5,908 |
| 4 | $7,129 |
| 5 | $8,348 |
| 6 | $9,566 |
| 7 | $10,787 |
| 8 | $12,005 |
| Add’l Person | Add $1,219 |
Example 4: Texas CHIP (Based on HHS Website Data, likely reflecting 2024/2025 FPLs)
Texas CHIP covers children 18 and younger in families with income at or below 201% FPL.
| Family Size | Monthly Income Limit (≤ 201% FPL) |
|---|---|
| 1* | $2,622 |
| 2 | $3,543 |
| 3 | $4,464 |
| 4 | $5,386 |
| 5 | $6,307 |
| 6 | $7,228 |
| 7 | $8,149 |
| 8 | $9,071 |
| Add’l Person | Add $922 |
*A family of one might be a child not living with a parent/relative.
Example 5: New York Child Health Plus (Effective Feb 15, 2025)
New York’s Child Health Plus covers children under 19. Premiums vary based on income relative to FPL. Coverage is free up to 222% FPL, with increasing monthly premiums up to 400% FPL.
| Family Size | Free Insurance (≤ 222% FPL) | $15/Child Premium (≤ 250% FPL) | $30/Child Premium (≤ 300% FPL) | $45/Child Premium (≤ 350% FPL) | $60/Child Premium (≤ 400% FPL) |
|---|---|---|---|---|---|
| 1 | $2,896 | $3,261 | $3,913 | $4,565 | $5,217 |
| 2 | $3,913 | $4,407 | $5,288 | $6,169 | $7,050 |
| 3 | $4,931 | $5,553 | $6,663 | $7,773 | $8,884 |
| 4 | $5,948 | $6,698 | $8,038 | $9,378 | $10,717 |
| 5 | $6,966 | $7,844 | $9,413 | $10,982 | $12,550 |
| 6 | $7,983 | $8,990 | $10,788 | $12,586 | $14,384 |
| 7 | $9,001 | $10,136 | $12,163 | $14,190 | $16,217 |
| 8 | $10,018 | $11,282 | $13,538 | $15,794 | $18,050 |
| Add’l Person | Add $1,018 | Add $1,146 | Add $1,375 | Add $1,605 | Add $1,834 |
(Premiums are per child, capped at 3 children per family. Families over 400% FPL pay the full premium.)
These examples starkly illustrate how significantly CHIP income eligibility thresholds differ across states, emphasizing the need for families to consult their own state’s specific guidelines.
Our articles make government information more accessible. Please consult a qualified professional for financial, legal, or health advice specific to your circumstances.
