CHIP Eligibility & Enrollment Waiting Periods Continuous Eligibility (CE) Enrollment Strategies Substitution Strategies

The Children’s Health Insurance Program (CHIP) is a joint federal and state program that provides health coverage to uninsured children in families with incomes too high to qualify for Medicaid, but too low to afford private or group health plan coverage.

Learn more about Medicaid and CHIP eligibility levels , which vary by state and can range from as low as 170% up to 400% of the Federal poverty level (FPL).

There are three different populations in CHIP: children, pregnant women, and targeted low-income children from-conception-to-end-of-pregnancy

Eligibility for the populations is based on financial and non-financial information

States have several options to expand eligibility within these populations

There are also different enrollment strategies states can use, like express lane eligibility , continuous eligibility , and presumptive eligibility

Overview of Eligibility for Non-Citizens in Medicaid and CHIP

The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) included a new option for states to provide Medicaid and CHIP coverage to children and pregnant women who are lawfully residing in the United States, including those within their first five years of having certain legal status. Previously, federal law required a 5-year waiting period before many legal immigrants were permitted to enroll in Medicaid and CHIP, although many states offered health coverage to these populations with state-only funds. This coverage may be applied to pregnant women in Medicaid and CHIP and/or to children up to age 19 for CHIP or up to age 21 for Medicaid who would otherwise be eligible for coverage through these programs.

Learn more about providing health coverage to lawfully residing children and pregnant women .

States providing Medicaid or CHIP coverage to lawfully residing children and/or pregnant women include:

State CHIP Medicaid American Samoa*** Children and pregnant women Arkansas Children Children and pregnant women* California Children Children and pregnant women Colorado Children and pregnant women Children and pregnant women* Connecticut Children Children and pregnant women Commonwealth of the Northern Mariana Islands (CNMI)*** Children and pregnant women* Washington, D.C.*** Children and pregnant women Delaware Children Children and pregnant women Florida Children Children* Georgia Children Children and pregnant women* Hawaii*** Children and pregnant women* Illinois*** Children* Iowa Children Children Kentucky*** Pregnant women Children and pregnant women* Louisiana Children Children* Maine*** Children and pregnant women Maryland*** Children and pregnant women Massachusetts Children Children and pregnant women Michigan*** Children and pregnant women Minnesota*** Children and pregnant women Montana Children Children* Nebraska*** Children and pregnant women* New Hampshire*** Children and pregnant women* New Jersey Children and pregnant women Children and pregnant women New Mexico*** Children and pregnant women New York Children Children and pregnant women Nevada Children Children and pregnant women* North Carolina*** Children and pregnant women* North Dakota Pregnant women Ohio*** Children and pregnant women Oregon*** Children* Pennsylvania Children Children and pregnant women Rhode Island*** Pregnant women Children and pregnant women* South Carolina*** Children and pregnant women Texas Children Children* U.S. Virgin Islands*** Children and pregnant women Utah Children Children* Vermont*** Children and pregnant women Virginia** Children and pregnant women Children and pregnant women* Washington Children Children and pregnant women West Virginia Children and pregnant women Children and pregnant women* Wisconsin Children Children and pregnant women* Wyoming Pregnant women

Updated as of April 2, 2026.

* These states cover children in Medicaid up to age 19.

** Virginia is using an 1115 demonstration to cover pregnant women.

*** These states are CHIP Medicaid expansion programs for their CHIPRA 214 child population.

Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that are found by the Secretary to be likely to assist in promoting the objectives of the Medicaid program. The purpose of these demonstrations, which give states additional flexibility to design and improve their programs, is to demonstrate and evaluate state-specific policy approaches to better serving Medicaid populations.

CMS performs a case-by-case review of each proposal to determine whether its stated objectives are aligned with those of Medicaid. CMS also considers whether proposed waiver and/or expenditures authorities are appropriate and consistent with federal policies, including the degree to which they supplant state-only costs for existing programs or services and can and should be supported through other federal and non-federal funding sources.

On April 10, 2025, CMS released a letter explaining that CMS does not anticipate approving new state proposals of section 1115 demonstration expenditure authority for federal designated state health program (DSHP) or designated state investment program (DSIP) funding or renewing existing section 1115 demonstration expenditure authority for federal DSHP or DSIP funding, including when current DSHP or DSIP authority concludes before the expiration date of the demonstration.

On July 17, 2025, CMS released a letter explaining that CMS does not anticipate approving new state proposals or extending existing section 1115 demonstration expenditure authority for expanded continuous eligibility for certain populations beyond what is allowable under current Medicaid or CHIP statute.

Also on July 17, 2025, CMS released a letter explaining that CMS does not anticipate approving new state proposals or extending existing section 1115 demonstration expenditure authority for workforce initiatives and will continue to monitor results of currently approved initiatives to assess the impact.

Demonstrations must also be "budget neutral" to the Federal government, which means that, during the course of the project, Federal Medicaid expenditures will not be more than Federal spending without the demonstration. Section 71118 of the Working Families Tax Cut (WFTC) legislation adds budget neutrality as a new statutory requirement in subsection (g) of section 1115 of the Act and introduces the role of the CMS Chief Actuary to certify demonstration, amendment, and renewal approvals made on or after January 1, 2027. For additional guidance on budget neutrality, reference the State Medicaid Director Letter released on June 11, 2026.