Other eligibility topics

To receive federal Medicaid funding, states must maintain Medicaid and CHIP eligibility standards, methodologies, and procedures that aren’t any more restrictive than those that went into effect on March 23, 2010.

This maintenance of effort (MOE) provision applies to states with eligibility levels that don’t exceed 300% of the FPL.

States with eligibility levels above 300% of the FPL can maintain coverage levels or reduce them to 300% FPL.

The MOE provisions in Medicaid and CHIP were extended through federal FY 2027 under the HEALTHY KIDS and ACCESS Acts, and can be found at sections 2105(d)(3), 1902(a)(74), and 1902(gg)(2) of the Act. Learn more about the MOE extension in the October 5, 2018 SHO letter (# 18-010) .

Sections 5121 and 5122 of the Consolidated Appropriations Act, 2023 (CAA, 2023) (P.L. 117- 328) include provisions that modify CHIP eligibility requirements for children who become incarcerated, effective January 1, 2025.

States are no longer permitted to terminate a child from CHIP solely because they are incarcerated, but states may suspend their CHIP coverage. The CAA, 2023 also added a new exception to the CHIP eligibility exclusion for inmates of a public institution at section 2110(b)(7) of the Act for children who are within 30 days prior to their release.

States also have the option to consider children who are inmates of a public institution pending disposition of charges as eligible for CHIP and provide all CHIP state plan services during that time.

States are also required to process any application submitted on behalf of an incarcerated child and complete any necessary redeterminations prior to release. For more information, please see SHO # 24-0004 and CMCS All State Slide Deck .