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Basic Program Information

Medicaid Separate CHIP
Eligibility by age and income (% of FPL)1 0-1yr – up to 200%
1-5yr – up to 133%
6-19yr – up to 100%
0-1yr – 200%-250%
1-5yr – 133%-250%
6-19yr – 100%-250%
No. of Children Ever Enrolled2 1,966,400 651,900
FMAP3 50.00 65.004
Premium Payment5 160%-222%FPL=$9/Max $27
223%-250%FPL=$15/Max $45
Cost Sharing (Co-payments)6 None None
Waiting Period7 None None
Premium Assistance8 Provides a wrap for employer
coverage if cost-effective

Enrollment/Renewal Simplification Strategies9

Medicaid SCHIP
Joint Medicaid/CHIP Application x x
On-line/Electronic Application    
12 month Continuous Eligibility x x
Elimination of Asset Test x x
Administrative Asset Verification at Enrollment    
Elimination of In-Person Interview at Enrollment   x
Presumptive Eligibility for Children x x
Joint Medicaid/CHIP Renewal Form    
Administrative Asset Verification at Renewal x x
Elimination of In-Person Interview at Renewal x x
Administrative Renewal (inc. unless income changed)    


Joint Medicaid/CHIP Application: One application, instead of two separate forms, is used by the state agency to determine if an applicant is eligible for either Medicaid or CHIP.

On-line/Electronic Application: State has made application for coverage available to families on the internet, which makes the application process easier for working parents who have difficulty applying during conventional office hours.

12-month Continuous Eligibility: Designated set period of time that the state guarantees a child can remain covered under Medicaid or CHIP before requiring a re-determination of eligibility.

Elimination of Asset Test: The asset test sets a limit on the maximum amount of assets (i.e. home, vehicle, savings account) an applicant could posses in order to be eligible for Medicaid or CHIP. Eliminating the asset test means the state no longer considers the applicant’s assets to determine eligibility, but instead relies on income statements alone.

Administrative Asset Verification: The state agency assumes responsibility for checking a Medicaid or CHIP applicant’s assets (including income) using the provided social security number, which relieves the paperwork burden on the applicant. The state can use existing records from the state’s labor or tax agencies, or other reliable and current sources to verify recent income information.

Elimination of In-Person Interview: The state does not require the applicant or parent of the applicant to meet and conduct a face-to-face interview with a caseworker as part of the enrollment or renewal process in Medicaid or CHIP.

Presumptive Eligibility for Children: This option allows states to permit designated qualified entities (schools, providers, health centers, hospitals, etc) to determine a child’s temporary eligibility for Medicaid or CHIP if the child appears eligible for the coverage. If the child is determined to be presumptively eligible, he/she can be temporarily enrolled in coverage, typically for up to 60 days, to obtain health services while the application process is completed by the Medicaid or CHIP state agency.

Administrative Renewal (including unless income changed): Using information it already has the state reduces information requests of the family. In some cases the state allows families to renew coverage over the telephone or sends families pre-populated renewal forms using information from other available databases. Some states default to renewal unless they receive a renewal form that contains information disqualifying a child for coverage.

1 Federal Poverty Level (FPL)= Income amounts set each year by the U.S. Department of Health and Human Services used to determine whether a family’s income exceeds the “poverty level.” This standard is used as a threshold against which eligibility for federal and state low-income social welfare programs, including Medicaid and CHIP, is determined. Data from Kaiser State Health Facts. “Income Eligibility Levels for Children’s Regular Medicaid and Children’s SCHIP-funded Medicaid Expansions by Annual Incomes and as a Percent of Federal Poverty Level (FPL), 2009.” (accessed February 4, 2009).

2 These numbers represent the number of children ever enrolled in the state’s Medicaid and CHIP program during fiscal year 2007 as reported by the state to the Centers for Medicare and Medicaid Services (CMS).

3 Federal Matching Rate (FMAP)= The Secretary of Health and Human Services calculates and publishes the FMAPs each year, which are used in determining the amount of federal matching funds for state expenditures for assistance payments for certain social services, and state medical and medical insurance expenditures. Data from Kaiser State Health Facts. “Federal Matching Rate (FMAP) for Medicaid and Multiplier, FY2009” and “Federal Matching Rate (FMAP) for SCHIP, FY2009.” (accessed February 4, 2009).

4 New York covers all unqualified immigrants in its CHIP program using state-only dollars, reducing the effective match rate for CHIP.

5 Donna Cohen Ross and Caryn Marks. Challenges of Providing Health Coverage for Children and Parents in a Recession: A 50 State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and SCHIP in 2009. The Henry J. Kaiser Family Foundation, January 2009. Available online at

6 Ibid.

7 Waiting period refers to the length of time the state requires a child to be uninsured before he/she is eligible for coverage. Data from Ross and Marks, 2009, and is available online at

8 A state premium assistance program uses federal and state Medicaid and/or CHIP funds to help pay for a portion of the premium costs of employer-sponsored insurance or private health insurance for eligible populations. Premium assistance data for this table was provided by the state.

9 Information in this table comes from state-reported data and Kaiser State Health Facts. “Children’s Health Data.” (accessed February 4, 2009) and Ross and Marks, 2009, available online at