Trends in Medicaid and CHIP Eligibility Over Time
Section 1: Eligibility Trends by Group
Eligibility for children and pregnant women has been consistently higher than for parents and other adults over time, reflecting both higher federal minimums and state take up of options to expand eligibility for these groups, including coverage under CHIP (Exhibit 1.1). Median eligibility levels for each eligibility group have increased over time. The Medicaid expansion narrowed the gap between median eligibility limits for parents and other adults and children and pregnant women beginning in 2014, but median eligibility limits for parents and other adults still remain below those for children and pregnant women.
Children. For children, the number of states that limit eligibility to less than 200% FPL decreased from 14 to 3 between 2000 and 2016, while the number of states extending eligibility to children with incomes at 250% FPL or higher grew from 11 to 28 over the period (Exhibit 1.2).
Pregnant women. Similar patterns were observed for pregnant women. The number of states limiting eligibility to less than 200% FPL decreased from 34 to 18 between 2003 and 2016, and the number of states covering pregnant women with incomes at or above 250% FPL rose from 3 to 11 (Exhibit 1.3).
Parents. Parent eligibility levels across states remained low and fairly stable over the study period prior to the Medicaid expansion (Exhibit 1.4). The Medicaid expansion significantly increased the number of states covering parents at or above 138% FPL. However, 13 of the 20 states that had not implemented the expansion as of January 2016 still had eligibility limits for parents that were less than 50% FPL.
Other adults. Other adults remained ineligible for Medicaid in the majority of states prior to the Medicaid expansion, reflecting the fact that states could not cover these adults through Medicaid prior to the ACA unless they obtained a waiver (Exhibit 1.5). The Medicaid expansion significantly increased the number of states covering these adults beginning in 2014, but they remain ineligible in all of the non-expansion states, with the exception of Wisconsin, which covers adults up to 100% FPL.Executive Summary Section 2: Eligibility Trends by Geographic Region