What options do states have for expanding eligibility?

The CHIP statute and regulations specify that eligibility is limited to the higher of 200 percent of the Federal poverty level (FPL) or 50 percentage points above the Medicaid applicable income level (the upper Medicaid eligibility level in place in 1997 before the creation of CHIP).

Many states have exceeded the maximum for expansion of children’s eligibility with title XXI funds, for most - if not all - age ranges of children under age 19.

States that have exceeded the maximum have two options for expanding eligibility . States also have the following options for expanding eligibility:

States can provide CHIP and Medicaid coverage to children and pregnant women who are:

Lawfully present in the U.S.

Otherwise eligible for coverage, including those within their first 5 years of having certain legal status

See a list of states providing Medicaid and CHIP coverage to lawfully residing children and pregnant women.

If states don’t offer this option, federal law requires a 5-year waiting period before many legal immigrants can enroll in Medicaid and CHIP.

Learn more about providing health coverage to lawfully present children and pregnant women at 2107(e)(1)(N) of the Act and in the July 10, 2010 SHO Letter (# 10-006) .

States have the option to provide 12 months of extended postpartum coverage to pregnant women enrolled in Medicaid and CHIP. If states adopt this option in Medicaid, they must also adopt it in CHIP.

See a list of states providing extended postpartum coverage.

States can cover children of state employees if the states can show they meet 1 of these 2 conditions:

Maintenance of agency contribution where states must show they’ve been consistently contributing to the cost of employee coverage, with increases for inflation, since 1997.

Hardship where states must show the coverage currently available through the public employee system could be a financial hardship for families. To determine a hardship, states would assess whether the annual aggregate premiums and cost-sharing required by the state health benefits plan would be more than 5% of a family’s income during the year the child would be enrolled in CHIP.

Learn more from section 2110(b)(6) of the Act.