Where Are States Today? Medicaid and CHIP Eligibility Levels for Children, Pregnant Women, and Adults
This fact sheet provides Medicaid and CHIP eligibility levels for children, pregnant women, parents, and other non-disabled adults as of January 2019, based on annual state survey data.1 The data highlight the central role Medicaid and CHIP play in covering low-income children and pregnant women and show Medicaid’s expanded role for low-income adults under the Affordable Care Act (ACA). See Tables 1-3 for state-specific data.
As of January 2019, 49 states cover children with incomes up to at least 200% of the federal poverty level (FPL, $42,660 per year for a family of three in 2019) through Medicaid and CHIP (Figure 1, Table 1 and 1A). This count includes 19 states that cover children with incomes at or above 300% FPL. Only two states (ID and ND) limit children’s eligibility to below 200% FPL. Across states, the upper Medicaid/CHIP eligibility limit for children ranges from 175% FPL in North Dakota to 405% FPL.
Figure 1 – Income Eligibility Levels for Children in Medicaid/CHIP, January 2019
Most states extend coverage to pregnant women beyond the federal minimum of 138% FPL through Medicaid and CHIP. As of January 2019, 34 states cover pregnant women with incomes at or above 200% FPL ($42,660 per year for a family of three in 2019), including 12 states (including DC) that cover pregnant women with family incomes above 250% FPL. Five states extend coverage for pregnant women through CHIP and 16 states use CHIP funding to provide coverage through the unborn child option, under which states cover income-eligible pregnant women regardless of immigration status (Figure 2, Table 2).
Figure 2 – Income Eligibility Levels for Pregnant Women in Medicaid/CHIP, January 2019
As of January 2019, 32 states cover parents and other adults with incomes up to 138% FPL ($29,435 per year for a family of three and $17,236 per year for an individual in 2019) under the ACA Medicaid expansion to low-income adults (Figures 3 and 4, Table 3). Idaho, Nebraska, and Utah have also adopted the Medicaid expansion, but had not implemented it as of January 2019. Connecticut and the District of Columbia cover parents to higher income levels. Connecticut extends eligibility to parents with incomes up to 155% FPL, and the District of Columbia covers parents with incomes up to 221% FPL and other adults with incomes up to 215%.
Figure 3 – Medicaid Income Eligibility Levels for Parents, January 2019
Figure 4 – Medicaid Income Eligibility Levels for Other Adults, January 2019
In the 14 states that have not adopted the Medicaid expansion, the median eligibility limit for parents is 40% FPL ($8,532 per year for a family of three in 2019) and other adults remain ineligible, except in Wisconsin (Figure 5). In ten of these states, parent eligibility is below half of the poverty level. Wisconsin provides Medicaid coverage to other adults, but eligibility at 100% FPL remains below the expansion level and the state does not receive the enhanced match available for expansion adults.2 In the non-expansion states, 2.5 million adults fall into a coverage gap, earning too much to qualify for Medicaid, but not enough to qualify for subsidies for Marketplace coverage, which become available at 100% FPL.3
Figure 5 – Medicaid Income Eligibility Limits for Adults in States that Have Not Adopted the Medicaid Expansion, January 2019
In sum, Medicaid and CHIP continue to be central sources of coverage for the low-income population, but eligibility varies widely across groups and states. Medicaid and CHIP provide a robust base of coverage to low-income children and pregnant women nationwide. Eligibility for adults has grown in states that implemented the Medicaid expansion, but remains limited in non-expansion states. There could be continued gains in eligibility for adults if additional states expand Medicaid. However, emerging actions to add new eligibility requirements to Medicaid could lead to coverage losses and erode coverage gains.
| Table 1: Income Eligibility Limits for Children’s Health Coverage as a Percent of the Federal Poverty Level, January 20191 | ||||||||
| State | Upper Income Limit | Medicaid Coverage for Infants Ages 0-12 |
Medicaid Coverage for Children Ages 1-52 |
Medicaid Coverage for Children Ages 6-182 |
Separate CHIP for Uninsured Children Ages 0-183 |
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| Medicaid Funded | CHIP-Funded for Uninsured Children | Medicaid Funded | CHIP-Funded for Uninsured Children | Medicaid Funded | CHIP-Funded for Uninsured Children | |||
| Median4 | 255% | 195% | 218% | 149% | 216% | 138% | 155% | 254% |
| Alabama5 | 317% | 146% | 146% | 146% | 107%-146% | 317% | ||
| Alaska | 208% | 177% | 159%-208% | 177% | 159%-208% | 177% | 124%-208% | |
| Arizona | 205% | 152% | 146% | 138% | 104%-138% | 205% | ||
| Arkansas | 216% | 147% | 147% | 147% | 107%-147% | 216% | ||
| California6 | 266% | 208% | 208%-266% | 142% | 142%-266% | 133% | 108%-266% | |
| Colorado | 265% | 147% | 147% | 147% | 108%-147% | 265% | ||
| Connecticut | 323% | 201% | 201% | 201% | 323% | |||
| Delaware | 217% | 217% | 194%-217% | 147% | 138% | 110%-138% | 217% | |
| District of Columbia5 | 324% | 324% | 206%-324% | 324% | 146%-324% | 324% | 112%-324% | |
| Florida7 | 215% | 211% | 192%-211% | 145% | 138% | 112%-138% | 215% | |
| Georgia | 252% | 210% | 154% | 138% | 113%-138% | 252% | ||
| Hawaii | 313% | 191% | 191%-313% | 139% | 139%-313% | 133% | 105%-313% | |
| Idaho | 190% | 147% | 147% | 138% | 107%-138% | 190% | ||
| Illinois | 318% | 147% | 147% | 147% | 108%-147% | 318% | ||
| Indiana8 | 262% | 218% | 157%-218% | 165% | 141%-165% | 165% | 106%-165% | 262% |
| Iowa | 380% | 380% | 240%-380% | 172% | 172% | 122%-172% | 307% | |
| Kansas9 | 240% | 171% | 154% | 138% | 113%-138% | 240% | ||
| Kentucky | 218% | 200% | 142% | 142%-164% | 133% | 109%-164% | 218% | |
| Louisiana | 255% | 142% | 142%-217% | 142% | 142%-217% | 142% | 108%-217% | 255% |
| Maine | 213% | 196% | 162% | 140%-162% | 162% | 132%-162% | 213% | |
| Maryland | 322% | 194% | 194%-322% | 138% | 138%-322% | 133% | 109%-322% | |
| Massachusetts10 | 305% | 205% | 185%-205% | 155% | 133%-155% | 155% | 114%-155% | 305% |
| Michigan11 | 217% | 195% | 195%-217% | 160% | 143%-217% | 160% | 109%-217% | |
| Minnesota12 | 288% | 275% | 275%-288% | 280% | 280% | |||
| Mississippi | 214% | 199% | 148% | 138% | 107%-138% | 214% | ||
| Missouri | 305% | 201% | 148% | 148%-155% | 148% | 110%-155% | 305% | |
| Montana | 266% | 148% | 148% | 138% | 109%-148% | 266% | ||
| Nebraska | 218% | 162% | 162%-218% | 145% | 145%-218% | 133% | 109%-218% | |
| Nevada | 205% | 165% | 165% | 138% | 122%-138% | 205% | ||
| New Hampshire | 323% | 196% | 196%-323% | 196% | 196%-323% | 196% | 196%-323% | |
| New Jersey | 355% | 199% | 147% | 147% | 107%-147% | 355% | ||
| New Mexico | 305% | 240% | 200%-305% | 240% | 200%-305% | 190% | 138%-245% | |
| New York | 405% | 223% | 154% | 154% | 110%-154% | 405% | ||
| North Carolina13 | 216% | 215% | 194%-215% | 215% | 141%-215% | 138% | 107%-138% | 216% |
| North Dakota | 175% | 152% | 152% | 138% | 111%-138% | 175% | ||
| Ohio | 211% | 156% | 141%-211% | 156% | 141%-211% | 156% | 107%-211% | |
| Oklahoma5,14 | 210% | 210% | 169%-210% | 210% | 151%-210% | 210% | 115%-210% | |
| Oregon | 305% | 190% | 133%-190% | 138% | 138% | 100%-133% | 305% | |
| Pennsylvania | 319% | 220% | 162% | 138% | 119%-138% | 319% | ||
| Rhode Island | 266% | 190% | 190%-266% | 142% | 142%-266% | 133% | 109%-266% | |
| South Carolina | 213% | 194% | 194%-213% | 143% | 143%-213% | 133% | 107%-213% | |
| South Dakota | 209% | 187% | 147%-187% | 187% | 147%-187% | 187% | 111%-187% | 209% |
| Tennessee5,15 | 255% | 195% | 195%-216% | 142% | 142%-216% | 133% | 109%-216% | 255% |
| Texas | 206% | 203% | 149% | 138% | 101%-138% | 206% | ||
| Utah | 205% | 144% | 144% | 138% | 105%-138% | 205% | ||
| Vermont | 317% | 317% | 237%-317% | 317% | 237%-317% | 317% | 237%-317% | |
| Virginia | 205% | 148% | 148% | 148% | 109%-148% | 205% | ||
| Washington | 317% | 215% | 215% | 215% | 317% | |||
| West Virginia | 305% | 163% | 146% | 138% | 108%-138% | 305% | ||
| Wisconsin16 | 306% | 306% | 191% | 133% | 101%-156% | 306% | ||
| Wyoming | 205% | 159% | 159% | 138% | 119%-138% | 205% | ||
|
SOURCE: Based on a national survey conducted by KFF with the Georgetown University Center for Children and Families, 2019.
Table presents rules in effect as of January 1, 2019.
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| Table 1A: Income Eligibility Limits for Children’s Health Coverage Based on Annual Income for a Family of Three, January 20191 | ||||||||
| State | Upper Income Limit | Medicaid Coverage for Infants Ages 0-12 |
Medicaid Coverage for Children Ages 1-52 |
Medicaid Coverage for Children Ages 6-182 |
Separate CHIP for Uninsured Children Ages 0-183 |
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| Medicaid Funded | CHIP-Funded for Uninsured Children | Medicaid Funded | CHIP-Funded for Uninsured Children | Medicaid Funded | CHIP-Funded for Uninsured Children | |||
| Median4 | $55,452 | $41,806 | $46,499 | $32,421 | $46,286 | $30,288 | $32,955 | $54,071 |
| Alabama5 | $67,616 | $31,141 | $31,141 | $31,141 | $31,141 | $67,616 | ||
| Alaska | $55,452 | $47,188 | $55,452 | $47,188 | $55,452 | $47,188 | $55,452 | |
| Arizona | $43,726 | $32,421 | $31,141 | $29,435 | $29,435 | $43,726 | ||
| Arkansas | $46,072 | $31,355 | $31,355 | $31,355 | $31,355 | $46,072 | ||
| California6 | $56,737 | $44,366 | $56,737 | $30,288 | $56,737 | $28,368 | $56,737 | |
| Colorado | $56,524 | $31,355 | $31,355 | $31,355 | $31,355 | $56,524 | ||
| Connecticut | $68,895 | $42,873 | $42,873 | $42,873 | $68,895 | |||
| Delaware | $46,286 | $46,286 | $46,286 | $31,355 | $29,435 | $29,435 | $46,286 | |
| District of Columbia5 | $69,109 | $69,109 | $69,109 | $69,109 | $69,109 | $69,109 | $69,109 | |
| Florida7 | $45,859 | $45,006 | $45,006 | $30,928 | $29,435 | $29,435 | $45,859 | |
| Georgia | $53,751 | $44,793 | $32,848 | $29,435 | $29,435 | $53,751 | ||
| Hawaii | $76,810 | $46,871 | $76,810 | $34,110 | $76,810 | $32,638 | $76,810 | |
| Idaho | $40,527 | $31,355 | $31,355 | $29,435 | $29,435 | $40,527 | ||
| Illinois | $67,829 | $31,355 | $31,355 | $31,355 | $31,355 | $67,829 | ||
| Indiana8 | $55,884 | $46,499 | $46,499 | $35,194 | $35,194 | $35,194 | $35,194 | $55,884 |
| Iowa | $81,054 | $81,054 | $81,054 | $36,687 | $36,687 | $36,687 | $65,483 | |
| Kansas9 | $51,192 | $36,474 | $32,848 | $29,435 | $29,435 | $51,192 | ||
| Kentucky | $46,499 | $42,660 | $30,288 | $34,981 | $28,368 | $34,981 | $46,499 | |
| Louisiana | $54,391 | $30,288 | $46,286 | $30,288 | $46,286 | $30,288 | $46,286 | $54,391 |
| Maine | $45,432 | $41,806 | $34,554 | $34,554 | $34,554 | $34,554 | $45,432 | |
| Maryland | $68,682 | $41,380 | $68,682 | $29,435 | $68,682 | $28,368 | $68,682 | |
| Massachusetts10 | $65,056 | $43,726 | $43,726 | $33,061 | $33,061 | $33,061 | $33,061 | $65,056 |
| Michigan11 | $46,286 | $41,593 | $46,286 | $34,128 | $46,286 | $34,128 | $46,286 | |
| Minnesota12 | $61,430 | $58,657 | $61,430 | $59,724 | $59,724 | |||
| Mississippi | $45,646 | $42,446 | $31,568 | $29,435 | $29,435 | $45,646 | ||
| Missouri | $65,056 | $42,873 | $31,568 | $33,061 | $31,568 | $33,061 | $65,056 | |
| Montana | $56,737 | $31,568 | $31,568 | $29,435 | $31,568 | $56,737 | ||
| Nebraska | $46,499 | $34,554 | $46,499 | $30,928 | $46,499 | $28,368 | $46,499 | |
| Nevada | $43,726 | $35,194 | $35,194 | $29,435 | $29,435 | $43,726 | ||
| New Hampshire | $68,895 | $41,806 | $68,895 | $41,806 | $68,895 | $41,806 | $68,895 | |
| New Jersey | $75,721 | $42,446 | $31,355 | $31,355 | $31,355 | $75,721 | ||
| New Mexico | $65,056 | $51,192 | $65,056 | $51,192 | $65,056 | $40,527 | $52,258 | |
| New York | $86,386 | $47,565 | $32,848 | $32,848 | $32,848 | $86,386 | ||
| North Carolina13 | $46,072 | $45,859 | $45,859 | $45,859 | $45,859 | $29,435 | $29,435 | $46,072 |
| North Dakota | $37,327 | $32,421 | $32,421 | $29,435 | $29,435 | $37,327 | ||
| Ohio | $45,006 | $33,274 | $45,006 | $33,274 | $45,006 | $33,274 | $45,006 | |
| Oklahoma5,14 | $44,793 | $44,793 | $44,793 | $44,793 | $44,793 | $44,793 | $44,793 | |
| Oregon | $65,056 | $40,527 | $40,527 | $29,435 | $29,435 | $29,435 | $65,056 | |
| Pennsylvania | $68,042 | $46,926 | $34,554 | $29,435 | $29,435 | $68,042 | ||
| Rhode Island | $56,737 | $40,527 | $56,737 | $30,288 | $56,737 | $28,368 | $56,737 | |
| South Carolina | $45,432 | $41,380 | $45,432 | $30,501 | $45,432 | $28,368 | $45,432 | |
| South Dakota | $44,579 | $39,887 | $39,887 | $39,887 | $39,887 | $39,887 | $39,887 | $44,579 |
| Tennessee5,15 | $54,391 | $41,593 | $46,072 | $30,288 | $46,072 | $28,368 | $46,072 | $54,391 |
| Texas | $43,939 | $43,299 | $31,781 | $29,435 | $29,435 | $43,939 | ||
| Utah | $43,726 | $30,715 | $30,715 | $29,435 | $29,435 | $43,726 | ||
| Vermont | $67,616 | $67,616 | $67,616 | $67,616 | $67,616 | $67,616 | $67,616 | |
| Virginia | $43,726 | $31,568 | $31,568 | $31,568 | $31,568 | $43,726 | ||
| Washington | $67,616 | $45,859 | $45,859 | $45,859 | $67,616 | |||
| West Virginia | $65,056 | $34,767 | $31,141 | $29,435 | $29,435 | $65,056 | ||
| Wisconsin16 | $65,269 | $65,269 | $40,740 | $28,368 | $33,274 | $65,269 | ||
| Wyoming | $43,726 | $33,914 | $33,914 | $29,435 | $29,435 | $43,726 | ||
| SOURCE: Based on a national survey conducted by KFF with the Georgetown University Center for Children and Families, 2019. Table presents rules in effect as of January 1, 2019. |
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Table 1 and 1A Notes
- January 2019 income limits are reported as a percentage of the federal poverty level (FPL). The 2019 FPL for a family of three was $21,330. The reported levels reflect Modified Adjusted Gross Income (MAGI)-converted income standards and include a disregard equal to five percentage points of the FPL applied at the highest income level for Medicaid and separate CHIP coverage. In states without a separate CHIP program, the disregard is added to the highest Medicaid or the CHIP-funded Medicaid expansion limit. In states with a separate CHIP program, the disregard is applied to the highest Medicaid or CHIP-funded Medicaid expansion limit as well as to the upper eligibility limit of the separate CHIP program. Because CHIP funding is limited to uninsured children, in states that have a higher eligibility limit for their CHIP-funded Medicaid expansion than regular Medicaid, there may be a small number of children who have another source of coverage that would be eligible for Medicaid when the five percentage point disregard is applied, which is not reflected in the table. Eligibility levels are reported as a percentage of the FPL.
- States may use Title XXI CHIP funds to cover children through CHIP-funded Medicaid expansion programs and/or separate child health insurance programs for children not eligible for Medicaid. Use of Title XXI CHIP funds is limited to uninsured children. The Medicaid income eligibility levels listed indicate thresholds for children covered with Title XIX Medicaid funds and uninsured children covered with Title XXI funds through CHIP-funded Medicaid expansion programs. To be eligible in the infant category, a child has not yet reached his or her first birthday; to be eligible in the 1-5 category, the child is age one or older, but has not yet reached his or her sixth birthday; and to be eligible in the 6-18 category, the child is age six or older, but has not yet reached his or her 19th birthday.
- The states noted use federal CHIP funds to operate separate child health insurance programs for children not eligible for Medicaid. Such programs may either provide benefits similar to Medicaid or a somewhat more limited benefit package. They also may impose premiums or other cost sharing obligations on some or all families with eligible children. These programs typically provide coverage for uninsured children until the child’s 19th birthday.
- Medians for CHIP-funded uninsured children are based on the upper limit of coverage.
- Alabama, the District of Columbia, Oklahoma, and Tennessee have different lower bounds for adolescents in Title XXI funded Medicaid expansions depending on age. The lower bound for Title XXI funded Medicaid is 18% for children ages 14 through 18 in Alabama, 63% for children ages 15 through 18 in the District of Columbia, 69% for children ages 14 through 18 in Oklahoma, and 29% for children ages 14 through 18 in Tennessee.
- In California, children with higher incomes are eligible for separate CHIP coverage in certain counties.
- In Florida, all infants are covered in Medicaid. Florida operates three separate CHIP programs: Healthy Kids covers children ages 5 through 18; MediKids covers children ages 1 through 4; and the Children’s Medical Services Managed Care Plan serves children with special health care needs from birth through age 18. In Florida, families can buy-in to Healthy Kids for children ages 5-19 and to MediKids for children ages 1 to 4.
- Indiana uses a state-specific income disregard that is equal to five percent of the highest income eligibility threshold for the group.
- In Kansas, eligibility for children in the separate CHIP program is a dollar-based income level equal to 238% FPL in 2008. This amount increased in 2014 for the MAGI conversion, but as a fixed dollar amount, the equivalent FPL level may erode over time.
- Massachusetts also covers insured children in its separate CHIP program with Title XIX Medicaid funds under its Section 1115 waiver. Massachusetts also covers uninsured 18-year-olds with incomes up to 150% FPL under its Medicaid expansion.
- Michigan also provides CHIP-funded Medicaid expansion coverage to children with incomes between 212% and 400% FPL affected by the Flint water crisis.
- In Minnesota, the infant category under Title XIX-funded Medicaid includes insured and uninsured children up to age two with incomes up to 275% FPL.
- In North Carolina, all children ages 0 through 5 are covered in Medicaid while the separate CHIP program covers children ages 6 through 18 with incomes above Medicaid limits.
- Oklahoma offers a premium assistance program to children ages 0 through 18 with incomes up to 222% FPL with access to employer-sponsored insurance through its Insure Oklahoma program.
- In Tennessee, Title XXI funds are used for two programs: TennCare Standard and CoverKids (a separate CHIP program). TennCare Standard provides Medicaid coverage to uninsured children who lose eligibility under TennCare (Medicaid), have no access to insurance, and have a family income below 216% FPL or are medically eligible.
- In Wisconsin, children are not eligible for CHIP if they have access to health insurance coverage through a job where the employer covers at least 80% of the cost.
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| Table 2: Medicaid and CHIP Coverage for Pregnant Women, January 2019 | ||||||
| State | Percent of the FPL | Annual Income | ||||
| Medicaid1 | CHIP1 | Unborn Child Option (CHIP-Funded)1,2 |
Medicaid1 | CHIP1 | Unborn Child Option (CHIP-Funded)1,2 |
|
| Median or Total | 200% | 258% | 214% | $42,660 | $55,031 | $45,539 |
| Alabama | 146% | $31,141 | ||||
| Alaska | 205% | $54,653 | ||||
| Arizona | 161% | $34,341 | ||||
| Arkansas3 | 214% | 214% | $45,646 | $45,646 | ||
| California | 213% | 322% | $45,432 | $68,682 | ||
| Colorado | 200% | 265% | $42,660 | $56,524 | ||
| Connecticut | 263% | $56,097 | ||||
| Delaware | 217% | $46,286 | ||||
| District of Columbia4 | 324% | $69,109 | ||||
| Florida | 196% | $41,806 | ||||
| Georgia | 225% | $47,992 | ||||
| Hawaii | 196% | $48,098 | ||||
| Idaho | 138% | $29,435 | ||||
| Illinois | 213% | 213% | $45,432 | $45,432 | ||
| Indiana5 | 218% | $46,499 | ||||
| Iowa | 380% | $81,054 | ||||
| Kansas | 171% | $36,474 | ||||
| Kentucky9 | 200% | $42,660 | ||||
| Louisiana | 138% | 214% | $29,435 | $45,646 | ||
| Maine | 214% | $45,646 | ||||
| Maryland | 264% | $56,311 | ||||
| Massachusetts4 | 205% | 205% | $43,726 | $43,726 | ||
| Michigan6 | 200% | 200% | $42,660 | $42,660 | ||
| Minnesota | 283% | 283% | $60,363 | $60,363 | ||
| Mississippi | 199% | $42,446 | ||||
| Missouri | 201% | 305% | 305% | $42,873 | $65,056 | $65,056 |
| Montana | 162% | $34,554 | ||||
| Nebraska | 199% | 202% | $42,446 | $43,086 | ||
| Nevada | 165% | $35,194 | ||||
| New Hampshire | 201% | $42,873 | ||||
| New Jersey4 | 199% | 205% | $42,446 | $43,726 | ||
| New Mexico | 255% | $54,391 | ||||
| New York8 | 223% | $47,565 | ||||
| North Carolina7 | 201% | $42,873 | ||||
| North Dakota | 152% | $32,421 | ||||
| Ohio | 205% | $43,726 | ||||
| Oklahoma8 | 138% | 210% | $29,435 | $44,793 | ||
| Oregon4 | 190% | 190% | $40,527 | $40,527 | ||
| Pennsylvania | 220% | $46,926 | ||||
| Rhode Island | 195% | 258% | 258% | $41,593 | $55,031 | $55,031 |
| South Carolina | 199% | $42,446 | ||||
| South Dakota9 | 138% | $29,435 | ||||
| Tennessee10 | 200% | 255% | $42,660 | $54,391 | ||
| Texas | 203% | 207% | $43,299 | $44,153 | ||
| Utah | 144% | $30,715 | ||||
| Vermont | 213% | $45,432 | ||||
| Virginia | 148% | 205% | $31,568 | $43,726 | ||
| Washington4 | 198% | 198% | $42,233 | $42,233 | ||
| West Virginia | 163% | $34,767 | ||||
| Wisconsin | 306% | 306% | $65,269 | $65,269 | ||
| Wyoming | 159% | $33,914 | ||||
| SOURCE: Based on a national survey conducted by KFF with the Georgetown University Center for Children and Families, 2019. Table presents rules in effect as of January 1, 2019. |
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Table 2 Notes
- January 2019 income limits reflect Modified Adjusted Gross Income (MAGI)-converted income standards and include a disregard equal to five percentage points of the federal poverty level (FPL). As of 2019, the FPL for a family of three was $21,330.
- The unborn child option permits states to consider the fetus a “targeted low-income child” for purposes of CHIP coverage.
- Arkansas provides the full Medicaid benefits to pregnant women with incomes up to levels established for the old Aid to Families with Dependent Children (AFDC) program, which is $220 per month. Above those levels, more limited pregnancy-related benefits are provided to pregnant women covered under Medicaid and the unborn child option in CHIP with incomes up to 209% FPL.
- The District of Columbia, Massachusetts, New Jersey, New York, Oregon, and Washington provide some services not covered through emergency Medicaid for some income-eligible pregnant women or women in the post-partum period who are not otherwise eligible due to immigration status using state-only funds.
- Indiana uses a state-specific income disregard that is equal to five percent of the highest income eligibility threshold for the group.
- Michigan also provides coverage to pregnant women with incomes over 400% FPL affected by the Flint water crisis.
- North Carolina provides full Medicaid benefits to pregnant women with incomes up to roughly 43% FPL. Above that level, more limited pregnancy-related benefits are provided to pregnant women covered under Medicaid.
- Oklahoma offers a premium assistance program to pregnant women with incomes up to 205% FPL who have access to employer sponsored insurance through its Insure Oklahoma program.
- South Dakota provides full Medicaid benefits to pregnant women with incomes up to $591 per month (for a family of three). Above that level, more limited pregnancy-related benefits are provided to pregnant women covered under Medicaid.
- In Tennessee, women covered under the unborn child option receive comprehensive medical services but do not receive chiropractic, dental or vision benefits that CHIP children receive.
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| Table 3: Medicaid Income Eligibility Limits for Adults as a Percent of the Federal Poverty Level, January 20191 | ||||
| State | Percent of the Federal Poverty Level | Annual Income | ||
| Parents (in a family of three) |
Other Adults (for an individual) |
Parents (in a family of three) |
Other Adults (for an individual) |
|
| Median | 138% | 138% | $29,435 | $17,236 |
| Alabama | 18% | 0% | $3,839 | $0 |
| Alaska | 138% | 138% | $36,790 | $21,528 |
| Arizona | 138% | 138% | $29,435 | $17,236 |
| Arkansas | 138% | 138% | $29,435 | $17,236 |
| California | 138% | 138% | $29,435 | $17,236 |
| Colorado | 138% | 138% | $29,435 | $17,236 |
| Connecticut | 155% | 138% | $33,061 | $17,236 |
| Delaware | 138% | 138% | $29,435 | $17,236 |
| District of Columbia2 | 221% | 215% | $47,139 | $26,853 |
| Florida | 32% | 0% | $6,825 | $0 |
| Georgia | 35% | 0% | $7,465 | $0 |
| Hawaii2 | 138% | 138% | $33,865 | $19,844 |
| Idaho3 | 25% | 0% | $5,332 | $0 |
| Illinois4 | 138% | 138% | $29,435 | $17,236 |
| Indiana5 | 139% | 139% | $29,648 | $17,361 |
| Iowa | 138% | 138% | $29,435 | $17,236 |
| Kansas | 38% | 0% | $8,105 | $0 |
| Kentucky | 138% | 138% | $29,435 | $17,236 |
| Louisiana | 138% | 138% | $29,435 | $17,236 |
| Maine6 | 138% | 138% | $29,435 | $17,236 |
| Maryland | 138% | 138% | $29,435 | $17,236 |
| Massachusetts2,7 | 138% | 138% | $29,435 | $17,236 |
| Michigan | 138% | 138% | $29,435 | $17,236 |
| Minnesota9 | 138% | 138% | $29,435 | $17,236 |
| Mississippi | 26% | 0% | $5,545 | $0 |
| Missouri | 21% | 0% | $4,479 | $0 |
| Montana8 | 138% | 138% | $29,435 | $17,236 |
| Nebraska10 | 63% | 0% | $13,437 | $0 |
| Nevada | 138% | 138% | $29,435 | $17,236 |
| New Hampshire | 138% | 138% | $29,435 | $17,236 |
| New Jersey | 138% | 138% | $29,435 | $17,236 |
| New Mexico2 | 138% | 138% | $29,435 | $17,236 |
| New York2,9 | 138% | 138% | $29,435 | $17,236 |
| North Carolina | 42% | 0% | $8,958 | $0 |
| North Dakota | 138% | 138% | $29,435 | $17,236 |
| Ohio | 138% | 138% | $29,435 | $17,236 |
| Oklahoma11 | 42% | 0% | $8,958 | $0 |
| Oregon | 138% | 138% | $29,435 | $17,236 |
| Pennsylvania2 | 138% | 138% | $29,435 | $17,236 |
| Rhode Island | 138% | 138% | $29,435 | $17,236 |
| South Carolina | 67% | 0% | $14,291 | $0 |
| South Dakota | 49% | 0% | $10,451 | $0 |
| Tennessee | 95% | 0% | $20,263 | $0 |
| Texas12 | 17% | 0% | $3,626 | $0 |
| Utah13 | 60% | 0% | $12,798 | $0 |
| Vermont14 | 138% | 138% | $29,435 | $17,236 |
| Virginia6,15 | 138% | 138% | $29,435 | $17,236 |
| Washington | 138% | 138% | $29,435 | $17,236 |
| West Virginia | 138% | 138% | $29,435 | $17,236 |
| Wisconsin16 | 100% | 100% | $21,330 | $12,490 |
| Wyoming | 54% | 0% | $11,518 | $0 |
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SOURCE: Based on a national survey conducted by KFF with the Georgetown University Center for Children and Families, 2019.
Table presents rules in effect as of January 1, 2019.
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Table 3 Notes
- January 2019 income limits reflect Modified Adjusted Gross Income (MAGI)-converted income standards and include a disregard equal to five percentage points of the Federal Poverty Level (FPL) applied to the highest eligibility limit for the group. In some states, eligibility limits for Section 1931 parents are based on a dollar threshold. The values listed represent the truncated FPL equivalents calculated from these dollar limits. Eligibility levels for parents are presented as a percentage of the 2019 FPL for a family of three, which is $21,330. Eligibility limits for other adults are presented as a percentage of the 2019 FPL for an individual, which is $12,490.
- The District of Columbia, Hawaii, Massachusetts, New Mexico, New York, and Pennsylvania cover some income-eligible adults who are not otherwise eligible due to immigration status using state-only funds. Oregon began providing reproductive health benefits regardless of immigration status as of January 1, 2018.
- Idaho voters approved a ballot measure in November 2018 that requires the state to submit a state plan amendment to CMS to implement the Medicaid expansion. The expansion has not yet been implemented as of January 2019.
- Parents have been covered in Illinois in an optional group under Title XIX up to 133% FPL from July 2012 to January 2014.
- Indiana uses a state-specific income disregard that is equal to five percent of the highest income eligibility threshold for the group.
- Maine and Virginia began coverage for expansion adults in January 2019.
- Massachusetts provides subsidies for Marketplace coverage for parents and childless adults with incomes up to 300% through its Connector Care program. The state’s Section 1115 waiver also authorizes MassHealth coverage for HIV-positive individuals with incomes up to 200% FPL, uninsured individuals with breast or cervical cancer with incomes up to 250% FPL, and individuals who work for a small employer and purchase employer-sponsored insurance (ESI) with incomes up to 300% FPL, as well as coverage through MassHealth CommonHealth for adults with disabilities with no income limit, provided that they have either met a one-time deductible or are working disabled adults.
- Minnesota and New York have implemented Basic Health Programs (BHPs) established by the Affordable Care Act (ACA) for adults with incomes between 138%-200% FPL.
- In Montana, the Medicaid expansion to adults will end at the end of June 2019 in the absence of state legislative action.
- Nebraska voters approved a ballot measure on November 6, 2018 to expand Medicaid coverage to low-income adults. The initiative requires the state to file all paperwork to the federal government by April 1, 2019.
- In Oklahoma, individuals without a qualifying employer with incomes up to 100% FPL are eligible for more limited subsidized insurance though the Insure Oklahoma Section 1115 waiver program. Individuals working for certain qualified employers with incomes at or below 222% FPL are eligible for premium assistance for employer-sponsored insurance.
- In Texas, the income limit for parents and other caretaker relatives is based on monthly dollar amounts which differ depending on family size and whether there is one or two-parents in the family. The eligibility level shown is for a single parent household and a family size of three.
- In November 2018, Utah voters approved a ballot initiative to expand Medicaid under the ACA. It has not been implemented as of January 2019. Certain adults with incomes up to 100% FPL continue to be eligible for coverage of primary care services under the Primary Care Network Section 1115 waiver program in Utah. Enrollment is opened periodically when there is capacity to accept new enrollees.
- Vermont also provides a 1.5% reduction in the federal applicable percentage of the share of premium costs for individuals who qualify for advance premium tax credits to purchase Marketplace coverage with income up to 300% FPL.
- In Virginia, eligibility levels for 1931 parents vary by region. The value shown is the eligibility level for Region 2, the most populous region.
- Wisconsin covers adults up to 100% FPL in Medicaid but did not adopt the ACA Medicaid expansion.
Endnotes
Tricia Brooks, et. al., Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey, (Washington, DC: Kaiser Family Foundation, January 2019), available at https://www.kff.org/medicaid/report/medicaid-and-chip-eligibility-enrollment-renewal-and-cost-sharing-policies-as-of-january-2019-findings-from-a-50-state-survey/.
Oklahoma and Utah provide more limited coverage to some childless adults under Section 1115 waiver authority.
Rachel Garfield, Kendal Orgera, and Anthony Damico, The Coverage Gap: Uninsured Poor Adults in States that do not Expand Medicaid, (Washington, DC: Kaiser Family Foundation, March 2019), available at https://www.kff.org/uninsured/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/.