Medicaid for children plays a vital role in covering kids in the United States. As of late 2024, more than 37 million children – almost half the nation’s children – were enrolled in Medicaid or the Children’s Health Insurance Program (CHIP).
But many families may not be aware of the state and federal guidelines that make their children eligible for coverage. Here are six facts about eligibility that might help if you need Medicaid for your children.
1. Your kids might be eligible for Medicaid even if you’re not.
When parents are looking for affordable children’s health insurance, they may be pleasantly surprised to learn that Medicaid income limits for children can be much higher than the limits that apply to adults.
Depending on the state, the coverage might be provided by Medicaid, a separate CHIP, or a combination of the two. But in all states except Idaho and North Dakota, Medicaid or CHIP is available to kids in households with income up to at least 200% of the federal poverty level (FPL), and in many states the income limits are much higher than that. In almost all cases, Medicaid eligibility for children is based on modified adjusted gross income alone, without considering their household’s asset levels.
The income eligibility limits for adults – especially those who are not pregnant – tend to be quite a bit lower than the limits to determine a child’s eligibility for Medicaid. So even if the adults in a household are not eligible for Medicaid, the children might be. In that scenario, the kids can be enrolled in Medicaid and the parents will need to enroll in other coverage – possibly through an employer’s plan or a policy obtained in the health insurance Marketplace.
In nine states, there’s a “coverage gap” for some low-income adults who aren’t eligible for Medicaid and whose income is too low to be eligible for Marketplace subsidies. (Income generally must be at least 100% of the federal poverty level to qualify for Marketplace subsidies). But there is no coverage gap for children, because Medicaid income limits for kids extend well above the federal poverty level in all states.
Are my children eligible for Medicaid? You can use our federal poverty level calculator to get an idea of whether your kids might be eligible for Medicaid or CHIP.
2. Your children can enroll in Medicaid at any time.
Unlike private health insurance through the Marketplace, off-exchange from an insurer, or from an employer, there is no annual enrollment window for Medicaid. An eligible person can enroll anytime. So if your kids are uninsured and you think they might be eligible for Medicaid or CHIP, you can apply for coverage on their behalf right away. You can select your state on this page to see details about eligibility and the enrollment process.
And Medicaid can be retroactive by up to three months in most states, meaning that medical expenses your kids incurred recently might be covered after they enroll.
3. Medicaid might help pay for employer-sponsored coverage for your children.
If your employer offers family health benefits but you can’t afford the premiums, you might find that you can get help with the cost. The majority of the states have programs that use Medicaid or CHIP funds to help Medicaid-eligible and CHIP-eligible families pay for employer-sponsored health insurance (in addition to Medicaid or CHIP) if it’s available to them.
The specifics of these programs – including whether they’re voluntary or mandatory – vary from one state to another, so you’ll need to contact your state Medicaid office for details.
If your child has Medicaid in addition to other coverage, Medicaid is always the secondary payer. This means the other insurance will be primary, and Medicaid will only start to pay benefits after the claim has been processed by the primary insurance.
With limited exceptions, CHIP is not available to children who are eligible for coverage under a state health benefits plan. So if a parent works for the state and has access to family coverage under the state health benefits program, their children will generally not be eligible for CHIP.
And states can impose more restrictive limits on CHIP. For example, Utah does not allow a child to enroll in CHIP if the child could enroll in an employer-sponsored plan for less than 5% of the household’s income.
4. A child’s disability may make them eligible for Medicaid.
If your child is disabled or has certain special healthcare needs, they may qualify for Medicaid – even if your household’s income isn’t within the standard eligibility limits. And depending on the state and the child’s medical needs, they may qualify for Medicaid coverage for in-home care as an alternative to institutional care, without being disqualified due to their parents’ income and assets. (In other words, these kids can potentially be in households that would not otherwise qualify for income-based Medicaid, or for disability-based Medicaid — which uses both income and assets to determine eligibility.)
As is always the case with Medicaid and CHIP, the details vary by state. But if your child is disabled or has costly ongoing medical needs, you may find that they can qualify for Medicaid even if your household wouldn’t otherwise qualify based on income alone. You can reach out to the Medicaid office in your state to get more information.
5. In most states, you’ll need to renew your kids’ coverage each year.
If your kids are enrolled in Medicaid or CHIP, it’s important to pay attention to any paperwork you get from the state regarding their coverage. Most state Medicaid programs recheck enrollees’ eligibility each year.
Your state may be able to confirm your child’s ongoing eligibility automatically. But if not, they will send you a request for updated information, and your children can be disenrolled if you don’t respond.
Some states have changed their rules to ensure continuous Medicaid and CHIP coverage for kids up to a certain age. This means that a child’s coverage will continue regardless of changes to the family’s circumstances, and without the need for annual eligibility redeterminations. Continuous coverage extends through different ages, depending on the state:
Colorado: Until the child turns 3.
Hawaii: Until the child turns 6. Then eligibility is redetermined every 24 months until age 19.
Minnesota: Until the child turns 6.
New Mexico: Until the child turns 6.
New York: Until the child turns 6.
Oregon: Until the child turns 6. (Eligibility for most other enrollees is only redetermined every two years.)
Pennsylvania: Until the child turns 6.
Washington: Until the child turns 6.
California. and Ohio. are working to gain federal approval for continuous Medicaid coverage for children until they turn four.
There are several states with legislation pending in 2025 that would direct the state to seek federal approval for various terms of continuous Medicaid coverage for kids. They include Alaska, Montana, Rhode Island, and Texas.
6. If your baby’s birth is covered by Medicaid, they will remain covered for at least a full year.
Medicaid covers more than 40% of births in the U.S. Those infants are automatically covered by Medicaid or CHIP as soon as they’re born, and will remain eligible at least until their first birthday. As noted above, eligibility is redetermined annually in most states, so ongoing eligibility will depend on the household’s financial circumstances.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org
