Medicaid and CHIP Eligibility Levels
CMS has worked with states to “convert” their Medicaid and CHIP eligibility levels to be based on modified adjusted gross income (MAGI) as required by the Affordable Care Act. Not all populations that are enrolled in Medicaid and CHIP will have their eligibility determined based on MAGI. The table below reflects eligibility levels in each state for key MAGI coverage groups, relative to the federal poverty guidelines, as of April 1, 2016.
| Children | Pregnant Women | Adults (Medicaid) | ||||||
|---|---|---|---|---|---|---|---|---|
| Medicaid Ages 0-12 | Medicaid Ages 1-52 | Medicaid Ages 6-182 | Separate CHIP3 | Medicaid | CHIP4 | Parent/ Caretaker5 | Expansion to Adults | |
| Alabama | 141% | 141% | 141% | 312% | 141% | N/A | 13% | No |
| Alaska6 | 203% | 203% | 203% | N/A | 200% | N/A | 142%($) | 133% |
| Arizona | 147% | 141% | 133% | 200%7 | 156% | N/A | 106% | 133% |
| Arkansas | 142% | 142% | 142% | 211% | 209% | N/A | 17%($) | 133% |
| California | 261% | 261% | 261% | 317%8 | 208% | N/A | 109% | 133% |
| Colorado | 142% | 142% | 142% | 260% | 195% | 260% | 68% | 133% |
| Connecticut | 196% | 196% | 196% | 318% | 258% | N/A | 150% | 133% |
| Delaware | 212% | 142% | 133% | 212% (1-18) | 212% | N/A | 87% | 133% |
| District of Col. | 319% | 319% | 319% | N/A | 319% | N/A | 216% | 210% |
| Florida | 206% | 140% | 133% | 210% (1-18) | 191% | N/A | 29%($) | No9 |
| Georgia | 205% | 149% | 133% | 247% | 220% | N/A | 34%($) | No |
| Hawaii6 | 308% | 308% | 308% | N/A | 191% | N/A | 105% | 133% |
| Idaho | 142% | 142% | 133% | 185% | 133% | N/A | 24%10($) | No10 |
| Illinois | 142% | 142% | 142% | 313% | 208% | N/A | 133% | 133% |
| Indiana | 208% | 158% | 158% | 250% | 208% | N/A | 19%($) | 133% |
| Iowa | 375% | 167% | 167% | 302% (1-18) | 375% | N/A | 54%($) | 133% |
| Kansas | 166% | 149% | 133% | 238% | 166% | N/A | 33% | No |
| Kentucky | 195% | 159% | 159% | 213% | 195% | N/A | 23%($) | 133% |
| Louisiana | 212% | 212% | 212% | 250% | 133% | N/A | 19% | 133% (7/1/16) |
| Maine | 191% | 157% | 157% | 208% | 209% | N/A | 100% | No9 |
| Maryland | 317% | 317% | 317% | N/A | 259% | N/A | 123% | 133% |
| Massachusetts | 200% | 150% | 150% | 300% | 200% | N/A | 133% | 133%9 |
| Michigan | 212% | 212% | 212% | N/A | 195% | N/A | 54% | 133% |
| Minnesota | 283%11 | 275% | 275% | N/A | 278% | N/A | 133% | 200%12 |
| Mississippi | 194% | 143% | 133% | 209% | 194% | N/A | 23%($) | No |
| Missouri | 196% | 150% | 150% | 300% | 196% | 300% | 18%10($) | No10 |
| Montana | 143% | 143% | 143% | 261% | 157% | N/A | 24%($) | 133% |
| Nebraska | 213% | 213% | 213% | N/A | 194% | N/A | 58% | No |
| Nevada | 160% | 160% | 133% | 200% | 160% | N/A | 32%($) | 133% |
| New Hampshire | 318% | 318% | 318% | N/A | 196% | N/A | 68%($) | 133% |
| New Jersey | 194% | 142% | 142% | 350% | 194% | 200% | 32%($) | 133% |
| New Mexico | 300% | 300% | 240% | N/A | 250% | N/A | 46%($) | 133% |
| New York | 218% | 149% | 149% | 400% | 218% | N/A | 133% | 200%12 |
| North Carolina | 210% | 210% | 133% | 211% (6-18) | 196% | N/A | 44%($) | No9 |
| North Dakota | 147% | 147% | 133% | 170% | 147% | N/A | 52%($) | 133% |
| Ohio | 206% | 206% | 206% | N/A | 200% | N/A | 90% | 133% |
| Oklahoma | 205% | 205% | 205% | N/A | 133% | N/A | 41%10($) | No10 |
| Oregon | 185% | 133% | 133% | 300% | 185% | N/A | 40%($) | 133% |
| Pennsylvania | 215% | 157% | 133% | 314% | 215% | N/A | 33% | 133% |
| Rhode Island | 261% | 261% | 261% | N/A | 190% | 253% | 116% | 133% |
| South Carolina | 208% | 208% | 208% | N/A | 194% | N/A | 62% | No |
| South Dakota | 182% | 182% | 182% | 204% | 133% | N/A | 57%($) | No |
| Tennessee | 195% | 142% | 133% | 250% | 195% | N/A | 103%($) | No |
| Texas | 198% | 144% | 133% | 201% | 198% | N/A | 15%($) | No |
| Utah | 139% | 139% | 133% | 200% | 139% | N/A | 44%10($) | No10 |
| Vermont | 312% | 312% | 312% | N/A | 208% | N/A | 53%($) | 133% |
| Virginia | 143% | 143% | 143% | 200% | 143% | 200% | 49%($) | No |
| Washington | 210% | 210% | 210% | 312% | 193% | N/A | 40%($) | 133% |
| West Virginia | 158% | 141% | 133% | 300% | 158% | N/A | 19%($) | 133% |
| Wisconsin | 301% | 186% | 151% | 301% (1-18) | 301% | N/A | 95%10 | No/95% |
| Wyoming | 154% | 154% | 133% | 200% | 154% | N/A | 55%($) | No |
- Note that this table reflects the principal but not all MAGI coverage groups. All income standards are expressed as a percentage of the federal poverty level (FPL). For the eligibility groups reflected in the table, an individual’s income, computed using the Modified Adjusted Gross Income (MAGI)-based income rules described in 42 CFR 435.603, is compared to the income standards identified in this table to determine if they are income eligible for Medicaid or CHIP. The MAGI-based rules generally include adjusting an individual’s income by an amount equivalent to 5% FPL disregard. Other eligibility criteria also apply, for example, with respect to citizenship, immigration status and residency.
- These eligibility standards include CHIP-funded Medicaid expansions.
- CHIP covers birth through age 18 unless otherwise noted in parentheses.
- States have the option to cover pregnant women under CHIP. This table does not include notations of states that have elected to provide CHIP coverage of unborn children from conception to birth.
- Reflects Medicaid state plan coverage of the eligibility group for parents and other caretaker relatives. Parents and caretaker relatives with income over the income standard for coverage under this group may be eligible for coverage in the adult group in states that have expanded to cover the adult group. In states that use dollar amounts based on household size, rather than percentages of the FPL, to determine eligibility for paAdults with incomes between 133 and 200% of the FPL are covered through the Basic Health Programrents, we converted those amounts to a percentage of the FPL and selected the highest percentage to reflect the eligibility level for the group. States that actually use dollar amounts in making determinations are indicated by ($).
- The dollar values that represent the FPLs in Alaska and Hawaii are higher than in the contiguous 48 states. For example, as of 2016, 100% of the FPL for a family of four is equal to $30,380 in Alaska and $27,950 in Hawaii, compared to $24,300 in the other 48 states and the District of Columbia.
- The separate CHIP program in Arizona has been closed to new applicants and will begin new enrollment on September 1, 2016.
- The separate CHIP program in California operates in three counties only.
- The state covers some 19 and 20 year olds – FL (29%), ME (156%), MA (150%), NC (44%).
- The state has a section 1115 demonstration that provides Medicaid coverage to some additional low-income adults. The demonstration includes limitations on eligibility and/or benefits, is not offered to all residents of the state, and/or includes an enrollment cap.
- Minnesota covers children up to age 2 with income up to 283% of the FPL.
- Adults with incomes between 133 and 200% of the FPL are covered through the Basic Health Program.