Healthcare Assistance

Medicaid and CHIP Cover Nearly Half of All U.S. Children — Here's How to Find Out If Your Kids May Qualify

A practical breakdown of Medicaid and CHIP eligibility for children, what documents you'll need, and how to start the application process in your state.

June 14, 2026·MSBy Michael Spitaleri, Editor-in-Chief·✓ Reviewed July 2025

Close-up of hands holding a home insurance document indoors, showing personal details section.

Key Takeaways

✓Medicaid and the Children's Health Insurance Program (CHIP) together cover nearly 1 in 2 children in the United States, making them the largest source of health coverage for kids.
✓Most states cover children in families earning up to 200%–300% of the Federal Poverty Level (FPL), and some states go higher — meaning many working families may be eligible.
✓CHIP was specifically designed to fill the gap for children whose families earn too much for Medicaid but cannot afford private insurance.
✓Applications can be submitted online, by mail, in person, or by phone — and coverage, if approved, can sometimes be backdated to the date of application.
✓You do not need to be a U.S. citizen to apply on behalf of your child in many states — immigration status rules vary significantly, so checking your state's specific guidelines is essential.

Informational guide only. Not affiliated with any government agency. Program details vary by state and change frequently. Verify eligibility directly with your local agency or at Benefits.gov.

Medicaid and the Children's Health Insurance Program (CHIP) are the two largest sources of health coverage for children in the United States — and according to data from the Centers for Medicare & Medicaid Services, they cover nearly half of all kids in the country. If you're a parent or caregiver wondering whether your child may be eligible for low-cost or no-cost health insurance through one of these programs, this article walks through income thresholds, required documents, and how to start the application process in your state.

Data Snapshot

According to the Centers for Medicare & Medicaid Services (CMS), as of early 2024, approximately 40 million children were enrolled in Medicaid and CHIP nationwide — representing roughly 46% of all children in the U.S. (source: CMS Medicaid & CHIP Enrollment Data Highlights). Children's hospitals report that Medicaid is the single largest payer for pediatric inpatient care, covering more than half of all children's hospital admissions in many states. These figures reflect how central Medicaid and CHIP are to child health in America — not as a last resort, but as a mainstream coverage pathway for tens of millions of families across every income bracket that meets state thresholds.

---

What Are Medicaid and CHIP, and What's the Difference?

Medicaid for Children

Medicaid is a joint federal-state program that provides free or very low-cost health coverage to eligible low-income individuals and families. For children specifically, Medicaid covers a broad range of services, including:

Well-child visits and immunizations
Dental and vision care
Mental health and behavioral health services
Emergency care
Prescription medications
Specialty care, including services at children's hospitals

Under federal law, states must cover children in families earning up to 133% of the Federal Poverty Level (FPL) — but most states have expanded coverage well beyond that floor. Many states now cover children up to 200%, 250%, or even 300% of FPL, depending on the child's age and the state's specific rules.

CHIP: The Children's Health Insurance Program

CHIP was created specifically for children in families who earn too much to qualify for Medicaid but still struggle to afford private health insurance. It functions as a bridge between Medicaid and employer-sponsored or marketplace coverage.

In most states, CHIP covers children in families earning between roughly 200% and 300% of FPL, though exact thresholds vary significantly by state. Some states have set their upper income limits even higher. CHIP may involve small monthly premiums and modest copays, but costs are kept intentionally low to reduce barriers to enrollment.

In some states, Medicaid and CHIP operate as a single, seamless program — you apply once and the state determines which program your child may be eligible for based on household income.

---

Income Eligibility: What the FPL Thresholds Mean in Practice

Because the Federal Poverty Level is updated annually, this article uses percentages rather than fixed dollar amounts. Here's a general framework to help you gauge whether your household income may fall within range:

Up to 133% FPL: Most states cover children through Medicaid at this level, often at no cost to the family.
133%–200% FPL: Many states extend Medicaid coverage to children in this range; others transition to CHIP.
200%–300% FPL: CHIP is typically available in this range in most states, often with small premiums.
Above 300% FPL: Some states — including California and New York — have expanded CHIP eligibility even further. Checking your state's specific rules is worthwhile regardless of income level.

To find current FPL dollar amounts for your household size, visit the HHS Poverty Guidelines page.

Income is generally calculated based on your household's gross monthly or annual income before taxes. Most states do not consider assets when determining children's Medicaid or CHIP eligibility, though rules vary.

---

Who Can Apply?

To potentially be considered for Medicaid or CHIP, a child generally must:

Be 18 years old or younger (some states extend coverage to age 19)
Be a U.S. citizen or meet certain immigration status requirements — rules vary by state, and many states cover lawfully present immigrant children; some cover undocumented children using state-only funds
Reside in the state where you're applying
Meet the income guidelines for that state

Foster children and children involved in the juvenile justice system may have separate eligibility pathways and are often covered regardless of family income. If your child falls into either category, contact your state Medicaid agency directly for guidance.

---

Documents You'll Likely Need

Gathering paperwork before you apply can reduce delays and back-and-forth with your state agency. While exact requirements vary by state, most applications will ask for:

Proof of Identity and Age - Child's birth certificate - Social Security number for the child and, in many cases, the applying parent or guardian

Proof of Residency - Utility bill, lease agreement, or another document showing your current address

Proof of Income - Recent pay stubs (typically covering the last 30 days) - Most recent federal tax return - Documentation of any other income sources — child support, Social Security, unemployment benefits, etc. - Self-employment records if applicable

Immigration or Citizenship Documentation (if applicable) - U.S. passport, birth certificate, or naturalization certificate for citizens - Immigration documents for non-citizens

Current Health Insurance Information (if any) - Some states require disclosure of any existing coverage

One practical note: don't let missing documents stop you from submitting an application. In many states, you can apply first and provide supporting documents afterward. Ask your state agency about their verification timeline and what can be submitted separately.

---

How to Apply: Step-by-Step

Step 1: Find Your State's Medicaid and CHIP Agency

Each state administers its own Medicaid and CHIP program under federal guidelines. The fastest way to locate your state's application portal is through Medicaid.gov's state contact page or through Benefits.gov, which can help identify programs available in your state.

Step 2: Choose Your Application Method

Most states offer multiple ways to apply:

Online: The fastest option in most states. Many process online applications within a few business days.
By phone: Call your state Medicaid office directly. A caseworker can walk you through the application in real time.
In person: Visit your local Department of Social Services, Health Department, or a community health center.
By mail: Download and mail a paper application. This is typically the slowest method.

You can also apply through the Health Insurance Marketplace at HealthCare.gov — if your child may be eligible for Medicaid or CHIP, the Marketplace will route your application to the appropriate state agency automatically.

Step 3: Submit Your Application and Supporting Documents

Complete the application as thoroughly as possible. Incomplete applications are among the most common causes of processing delays. Attach or upload your supporting documents, or ask your caseworker how to submit them separately if needed.

Note: If you submit a form or provide your contact information during this process, you may be contacted by program representatives or outreach organizations. Review any consent terms carefully before submitting personal information.

Step 4: Wait for a Determination

Processing times vary by state, but federal rules generally require states to process children's Medicaid applications within 45 days — or 90 days if disability is a factor. Many states process straightforward applications within one to two weeks, particularly for online submissions.

If approved, coverage may be backdated to the first day of the month in which you applied, or in some cases even earlier. Ask your caseworker specifically about retroactive coverage options.

Step 5: Renew Coverage Annually

Medicaid and CHIP coverage must be renewed, typically once per year. Your state will send a renewal notice — keeping your contact information current with the agency is essential. Missing a renewal deadline is one of the most common reasons children lose coverage they may still be eligible for. If you receive a renewal notice, respond promptly even if your situation hasn't changed.

---

What Medicaid and CHIP Cover for Children

Federal law requires that children enrolled in Medicaid receive Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services — a comprehensive benefit package that includes:

Regular well-child checkups on a schedule appropriate to the child's age
Vision screening and corrective eyeglasses
Dental checkups, cleanings, and treatment
Hearing screening and hearing aids
Mental health and substance use disorder services
Any medically necessary treatment identified during a screening, even if that specific service isn't typically covered for adults under the same state plan

CHIP benefits are generally comparable to Medicaid's EPSDT package, though they may vary slightly by state and may include modest cost-sharing requirements such as copays or premiums.

---

If Your Child Recently Lost Coverage

If your child lost Medicaid or CHIP coverage recently — including during the post-pandemic "unwinding" period when states resumed eligibility redeterminations after the continuous enrollment requirement ended — they may still be eligible to re-enroll. Contact your state Medicaid agency directly, or connect with a local navigator or enrollment assister through LocalHelp.HealthCare.gov.

Children do not have to wait for an open enrollment period to apply for Medicaid or CHIP. Both programs accept applications year-round, every day of the year.

---

Program eligibility and availability vary by state. Not affiliated with any government agency.

Last reviewed: July 2025

Sources & Further Reading

Frequently Asked Questions

What is the income limit for CHIP in most states?

Most states cover children through CHIP in families earning between 200% and 300% of the Federal Poverty Level (FPL), though some states set higher limits. Because FPL thresholds change annually and vary by household size, check your specific state's Medicaid or CHIP agency for current figures. Benefits.gov can help you locate your state's program and income guidelines.

Can my child get Medicaid if I have a job or employer-sponsored insurance?

Possibly. Having a job or employer-sponsored insurance does not automatically disqualify your child. If your household income falls within your state's eligibility range, your child may still be considered for Medicaid or CHIP. Some states also allow CHIP to serve as secondary coverage even when a child has other insurance. Submitting an application lets the state make that determination.

How long does it take to get approved for children's Medicaid or CHIP?

Federal rules require states to process children's Medicaid applications within 45 days in most cases. Many states process straightforward applications within one to two weeks, especially for online submissions. If approved, coverage may be backdated to the application date. Contact your state agency if you haven't received a decision within 30 days of applying.

Does my child's immigration status affect Medicaid or CHIP eligibility?

Immigration status rules vary by state and program. U.S. citizen children are generally eligible if income requirements are met. Many states also cover lawfully present immigrant children. Some states use state-only funds to extend coverage regardless of immigration status. Check your state's specific rules — immigration status alone should not stop you from exploring what options may be available.

What happens if my child loses Medicaid coverage during a renewal?

If your child loses Medicaid or CHIP coverage at renewal, you can reapply at any time — there is no waiting period. Contact your state Medicaid agency promptly to understand why coverage ended and whether an appeal or immediate reapplication is possible. Unlike Marketplace plans, children's Medicaid and CHIP accept applications year-round with no open enrollment window.

About the Author

Michael Spitaleri, Editor-in-Chief — Founder & Editor-in-Chief. Michael Spitaleri is the founder and editor-in-chief of Hardship Authority. He oversees all editorial content on the site, ensuring every article meets rigorous standards for accuracy, clarity, and practical usefulness before publication.

Disclaimer: This article is for informational purposes only. It does not constitute legal, financial, or benefits advice. Program eligibility and availability vary by state. Not affiliated with any government agency. Verify information with official sources including Benefits.gov, USDA, HUD, and your state program office.

MedicaidCHIPchildren's health insurancehealthcare assistancelow-income familiesEPSDTFederal Poverty Levelhealth coverage for kidsgovernment health programshow to apply for Medicaid

Stay Informed on Benefits Updates

Get free weekly updates on SNAP, housing, energy, and healthcare assistance programs. No spam — unsubscribe any time.

By subscribing, you consent to receive email communications from Hardship Authority. Message frequency may vary. Reply STOP or click unsubscribe to opt out at any time. Not affiliated with any government agency.