Eligibility for Medicaid and CHIP Requirements

By | March 2, 2015

In all states: You may qualify for Medicaid and Children’s Health Insurance Program CHIP by income, household size, disability, family status, and other factors. Eligibility rules are different for different states. In states that have expanded Medicaid coverage to cover all low-income adults: You may qualify for Medicaid based only on their income and family size.


Apply for Medicare and CHIP

  • To find out if your children qualify for CHIP coverage: Visit www.insurekidsnow.gov or call 1-877-543-7669. You can apply right now, any time of year, and find out if you qualify. If you apply for Medicaid coverage to your state agency, you’ll also find out if your children qualify for CHIP. If you qualify, coverage can begin immediately.
  • To find out if you and your family qualify for Medicaid, CHIP, or a private insurance plan with a single application: Fill out an application in the Health Insurance Marketplace. We’ll tell you which programs you and your family qualify for. If it looks like anyone is eligible for Medicaid and/or CHIP, we’ll let the state agency know so you can enroll. If anyone is eligible to buy a private insurance plan through the Marketplace, we’ll let you know that and tell you your next steps.


What is the income limit to qualify for Medicaid?

It depends on the state you live in.

If your state is NOT expanding Medicaid, you qualify under existing rules in your state. These vary from state to state and may take into account income, household size, family status (such as pregnancy or caring for young children), disability, age and other factors. Because every state and every family situation is different, there is no way to find out if you qualify without filling out an application. You can apply directly to the Medicaid office in your state, or fill out an application of the Insurance Market.

If your state IS expanding Medicaid, you may qualify based solely on their income and household size. 


If I can not get Medicaid, I can buy a plan in the insurance market?

Generally, yes. As long as you qualify for the HealthCare Marketplace Coverage. Most uninsured people with incomes too high for Medicaid can obtain lower costs for private health plans through the market. How to reduce costs depends on family income and household size . But if all of the following apply, you will not get reduced costs of a plan Market:

  • If you live in a state that is NOT expanding Medicaid
  • Your income is below 100% of federal poverty level
  • You do not qualify for Medicaid under current rules in your state

Learn more about the expansion of Medicaid and what it means for you.


What if I’m eligible for Medicaid, but would rather buy a plan in the Marketplace?

If you are eligible for Medicaid, no need to buy a plan in the insurance market. A plan of insurance market may be more expensive than Medicaid and generally will not provide coverage or additional benefits. You may not benefit from any savings insurance market and will have to pay the full price.

If you have limited Medicaid coverage, you can apply for coverage through the market to achieve full coverage. You could get this coverage, plus Medicaid coverage. If you have limited Medicaid coverage, when completing the application of the Market and you are asked if you have coverage now, uncheck the box that says iene Medicaid. Check “None of the above” instead.


Medicaid and Foster Children

All states must provide to children in foster care (foster care) Medicaid coverage without interruption until they turn 26 years unless one of the following statements are true:

  • They were in temporary custody and receiving Medicaid benefits when they turned 18 years
  • They ceased to be old for temporary guardianship while they had Medicaid coverage after 18 years or more

These rules apply from 1 January 2014. Note: If the child into temporary custody move to another state, that state Medicaid agency may not give you coverage. For more information, check with your state Medicaid agency.