Medicaid & CHIP in

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Explore key characteristics of Medicaid and CHIP in , including documents and information relevant to how the programs have been implemented by within federal guidelines.

expanded coverage to low-income adults.

adopted one or more of the targeted enrollment strategies outlined in guidance CMS issued on May 17, 2013, designed to facilitate enrollment in Medicaid and CHIP.

In federal fiscal year (FFY) , voluntarily reported of frequently reported health care quality measures in the CMS Medicaid/CHIP Child Core Set. voluntarily reported of frequently reported health care quality measures in the CMS Medicaid Adult Core Set.

More detailed information and source references are available on each of these topics.

Eligibility in

Information about how determines whether a person is eligible for Medicaid and CHIP.

Most Medicaid eligibility and all CHIP eligibility is based on modified adjusted gross income (MAGI). Income eligibility levels are tied to the federal poverty level (FPL).

The following table provides a more detailed view of 's MAGI-based eligibility levels, expressed as a percentage of the FPL, for several key groups: children, pregnant women, parents/caretaker relatives, and, other adults

Medicaid & CHIP Eligibility¹ as of

Children Eligibility Level

Medicaid Ages 0-1²

Medicaid Ages 1-5²

Medicaid Ages 6-18²

Separate CHIP³

Pregnant Women Eligibility Level

Medicaid

CHIP⁴

Adults (Medicaid) Eligibility Level

Parent/Caretaker⁵

Expansion to Adults

1. 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.

2. These eligibility standards include CHIP-funded Medicaid expansions.

3. CHIP covers birth through age 18 unless otherwise noted in parentheses.

4. 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.

5. 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 parents, we converted those amounts to a percentage of the FPL and selected the highest percentage to reflect the eligibility level for the group.

Source: Medicaid Eligibility.

Learn more about how states determine Medicaid eligibility for other populations.

View available state's eligibility verifications plans, MAGI Conversion Plans and Results.

Medicaid and CHIP agencies now rely primarily on information available through data sources (for example, the Social Security Administration, the Departments of Homeland Security and Labor) rather than paper documentation from families for purposes of verifying eligibility for Medicaid and CHIP.
Enrollment in

Information about efforts to enroll eligible individuals in Medicaid and CHIP in .

Medicaid & CHIP Enrollment Data

The table below presents the most recent, point-in-time count of total Medicaid and CHIP enrollment in for the last day of the indicated month, and is not solely a count of those newly enrolled during the reporting period. For purpose of comparison, the table also presents (a) the change in enrollment since the initial open of the Health Insurance Marketplaces, and (b) national counts and change statistics for the same period.

Medicaid & CHIP Enrollment as of

Metric National Totals

Total Medicaid & CHIP Enrollment (Preliminary)

Net Change in Enrollment July-September 2013

% Change in Enrollment July-September 2013

Source: Medicaid/CHIP Enrollment.
Quality of Care in

Information about performance on frequently-reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets in .

Child Quality Measure Data

In federal fiscal year (FFY) , reported of frequently reported health care quality measures in the CMS Medicaid/CHIP Child Core Set.

Adult Quality Measure Data

In federal fiscal year (FFY) , reported of frequently reported health care quality measures in the CMS Medicaid Adult Core Set.
Program Documents for

Children	Eligibility Level
Medicaid Ages 0-1²
Medicaid Ages 1-5²
Medicaid Ages 6-18²
Separate CHIP³

Metric		National Totals
Total Medicaid & CHIP Enrollment (Preliminary)
Net Change in Enrollment July-September 2013
% Change in Enrollment July-September 2013

Pregnant Women	Eligibility Level
Medicaid
CHIP⁴

Adults (Medicaid)	Eligibility Level
Parent/Caretaker⁵
Expansion to Adults

Medicaid & CHIP in

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Medicaid & CHIP Enrollment Data

Child Quality Measure Data

Adult Quality Measure Data