Who is eligible?

States have the option to cover two populations:

Targeted low-income children,

Targeted low-income pregnant women under a separate CHIP, and

Targeted low-income children from-conception-to-end-of-pregnancy (FCEP) under a separate CHIP

There are eligibility criteria for targeted low-income children. To be eligible for CHIP, children must be:

Under 19 years of age

Uninsured (determined ineligible for Medicaid, and not covered through a group health plan or creditable health insurance)

U.S. citizens or meet immigration requirements

Residents of the state

Eligible in the state’s CHIP income range, based on family income, and any other state specified rules in the CHIP state plan

The following children generally cannot be eligible for CHIP:

Inmates of a public institution (exceptions described in the “Incarcerated Youth” tab below)

Patients in an institution for mental diseases, and

Children who are eligible for health benefits coverage under a State health benefits plan due to a family member's employment with a public agency (unless a state qualifies for either the maintenance of agency contribution, or hardship exception described below).

Within these guidelines, states have the flexibility to adopt their own eligibility standards. For example, some states have programs for specific geographic areas, or for children with a disability status.

States can’t establish certain types of eligibility criteria, like discriminating because of a diagnosis.

Under their CHIP state plans, states can cover prenatal, delivery, and postpartum care to targeted low-income, uninsured pregnant women. To offer this coverage, states have to meet several conditions, including requirements to cover:

Children under 19 years of age under Medicaid or CHIP, up to at least 200% of the FPL

Pregnant women under Medicaid up to at least 185% of the FPL

This isn’t a complete list of conditions that states must meet to cover pregnant women in CHIP. See Section 2112 of the Social Security Act (the Act) and State Health Official (SHO) letter #09-006 for more information.

Infants born to targeted low-income pregnant women must automatically deemed eligible for Medicaid or CHIP, without an application or further determination of eligibility. These infants are covered until the child turns one year of age […]. For more guidance regarding deemed newborns, please see SHO #09-009 .

States can also provide deemed eligibility to children born to mothers who, on the date of the child’s birth, are covered as targeted low-income children under CHIP.

States have the option in CHIP to provide prenatal care and pregnancy related benefits to targeted low-income children beginning from conception to end of pregnancy regardless of their parent’s citizenship or immigration status.

For the child to be eligible for FCEP, the pregnant woman must be:

Uninsured

Ineligible for other coverage under CHIP or Medicaid

Resident of the state

At or below the state’s income standard for the FCEP option

Children covered under the FCEP option may also need to meet other state specific eligibility criteria like other targeted low-income children in CHIP, such as living within certain geographic areas.

At birth, many infants previously covered under the FCEP option in CHIP will be eligible for Medicaid. If not eligible for Medicaid, these infants will remain eligible for CHIP.