Waiting Periods in CHIP

Section 2102(b)(3)(C) of the Social Security Act requires states to include in their state plan a description of how the state ensures that CHIP coverage does not substitute for coverage under group health plans. Prior to January 1, 2014, 36 states elected to institute a period of uninsurance (“waiting period”) ranging from one month to 12 months to address this requirement.

Effective January 1, 2014, CHIP regulations at 42 CFR 457.805 provide that a waiting period imposed under the state plan cannot exceed 90 days. Section 457.805(b)(3) of the regulations also requires states to adopt certain exemptions to any waiting period. States have the option to adopt additional exemptions. Regulations at 42 CFR 457.340(d)(3) and 457.350(i) require states to implement processes ensuring a smooth and seamless transition to other insurance affordability programs for which children may be eligible during a waiting period.

As of November 2016, only 15 states had a waiting period. The 21 states that eliminated their waiting period protect against substitution of coverage by using various procedures to monitor for substitution, including use of survey data, and private insurance database checks. Fifteen states have elected to continue to have a waiting period. Of these, 12 have a 90 day waiting period, 1 state has a two month waiting period, and 2 states have a one month waiting period.

The following table provides a summary of state policies in this area prior to, and subsequent to January 1, 2014.

Separate CHIP Waiting Periods National Snapshot
State	Waiting Period prior to January 1, 2014	Waiting Period as of November 2016	Exemptions to the Waiting Period (In Addition to Federally Mandated Exemptions under 42 CFR §457.805(b)(3))
Alabama	3 months	None	N/A
Arizona	3 months	90 days	Newborn children Lifetime insurance limit reached Enrolled in Children's Rehabilitative Services Native American members receiving services from IHS or a 638 Tribal Facility
Arkansas	6 months	90 days	Unborn children
California	3 months	None	N/A
Colorado	3 months	None	N/A
Connecticut	2 months	None	N/A
Delaware	6 months	None	N/A
Florida	2 months	2 months	Domestic violence led to the loss of coverage The child has exhausted coverage under COBRA continuation provision The health benefits coverage does not cover the child's health care needs Lifetime insurance limit reached
Georgia	60 days	None	N/A
Idaho	6 months	None	N/A
Illinois	12 months	90 days	Children in families with incomes at or above 209% FPL Newborn under age 1
Indiana	3 months	90 days	Children in families with incomes at or below 158% FPL
Iowa	1 month	1 month	Children in families with incomes at or below 181% FPL Children eligible for dental only supplemental coverage Child lost coverage due to: domestic violence, lifetime insurance limit reached, expiration of coverage under COBRA, or due to reason beyond control of parent such as serious illness of the parent, flood, fire, or natural disaster Health insurance was through an individual plan
Kansas	8 months	90 days	Children in families with incomes below 219% FPL Lifetime insurance limit reached
Kentucky	6 months	None	N/A
Louisiana	12 months	90 days	Unborn children Lifetime insurance limit reached Long-term disability or other medical condition
Maine	3 months	90 days	None
Massachusetts	6 months	None	N/A
Michigan	6 months	None	N/A
Minnesota	None	None	N/A
Mississippi	None	None	N/A
Missouri	6 months	None	N/A
Montana	3 months	None	N/A
Nevada	6 months	None	N/A
New Jersey	3 months	90 days	Children in families with incomes at or below 200% FPL Pregnant women Physical or emotional abuse led to loss of coverage Child was previously covered under an individual health benefits plan or COBRA plan preceding application for NJ FamilyCare Child covered under a plan where the defined network is not accessible with 45 minutes travel time of the child's residency The employer ceased operations in this state, and the succeeding employer has altered the terms of a noncontributory group health plan to require a premium contribution (for a class of employee to which the child's household member belongs)
New York	6 months	None	N/A
North Carolina	None	None	N/A
North Dakota	6 months	90 days	The family lives in a Presidentially-declared disaster county which was declared a federal disaster area within last 12 months
Oklahoma	None	None	N/A
Oregon	2 months	None	N/A
Pennsylvania	6 months	None	N/A
Rhode Island	None	None	N/A
South Dakota	3 months	90 days	None
Tennessee	3 months	None	N/A
Texas	90 days	90 days	Unborn children Expiration of COBRA period of coverage HHSC determines good cause exists Loss of coverage in the Texas Employee Retirement System
Utah	90 days	90 days	Voluntary termination of COBRA coverage Voluntary termination of coverage by a non-custodial parent Voluntary termination of insurance that does not provide coverage in Utah Voluntary termination of a limited health insurance plan
Virginia	4 months	None	N/A
Washington	4 months	None	N/A
West Virginia	3 months	None	N/A
Wisconsin	3 months	None	N/A
Wyoming	1 month	1 month	None
Totals	36 states	15 states	N/A