Healthcare Assistance

Medicaid and CHIP Enrollment by State: What the Latest Data Means for Your Family's Coverage

Georgetown University's Center for Children and Families tracks millions of enrolled children and adults — here's how to read state-by-state figures and understand what coverage options may be available to your household.

June 13, 2026·MSBy Michael Spitaleri, Editor-in-Chief·✓ Reviewed July 2025

Top view of credit card and application documents on wooden surface.

Key Takeaways

✓Medicaid and CHIP together cover more than 90 million Americans, with enrollment numbers varying significantly by state based on eligibility rules and Medicaid expansion status.
✓Children may be able to access CHIP at higher income levels than adults qualify for Medicaid — in many states, CHIP covers children in households earning up to 200–300% of the Federal Poverty Level (FPL).
✓States that expanded Medicaid under the Affordable Care Act generally cover adults up to 138% FPL; non-expansion states may have much narrower eligibility windows for non-disabled adults without dependent children.
✓If your family lost Medicaid coverage during the 2023–2024 post-pandemic 'unwinding' period, you may be able to re-enroll immediately — there is no waiting period to reapply.
✓Free, trained enrollment assisters are available through HealthCare.gov Navigators and Federally Qualified Health Centers (FQHCs) at no cost to you.

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.

What State-by-State Medicaid and CHIP Enrollment Data Actually Tells You

Medicaid and CHIP enrollment data — compiled annually by Georgetown University's Center for Children and Families and tracked federally by the Centers for Medicare & Medicaid Services (CMS) — shows which states are reaching the most eligible residents and where significant coverage gaps remain. For families navigating healthcare assistance options, this data is more than a policy footnote. It signals whether your state's program is actively connecting people in situations like yours to coverage, and what income thresholds may apply where you live.

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Data Snapshot: Medicaid and CHIP by the Numbers

As of the most recent federal reporting period, total Medicaid and CHIP enrollment across the United States exceeded 90 million individuals, according to CMS enrollment data published at Medicaid.gov. Children represent a substantial share of that total — CHIP alone covers approximately 7 to 8 million children in a typical enrollment year.

Georgetown University's Center for Children and Families compiles state-by-state breakdowns to identify where coverage gaps are widest. Their research has consistently found that states that expanded Medicaid under the Affordable Care Act (ACA) cover a significantly higher share of low-income adults — with uninsured rates among low-income adults running roughly 60% lower in expansion states compared to non-expansion states, based on Kaiser Family Foundation analysis cross-referenced with CMS data.

For income threshold context: Medicaid expansion covers adults up to 138% FPL. CHIP income limits vary by state but commonly range from 200% to 300% FPL for children, and several states — including New York and California — extend CHIP eligibility to 400% FPL for children. These figures are benchmarked to the Federal Poverty Level, which is updated annually by the Department of Health and Human Services (HHS).

During the 2023–2024 Medicaid unwinding period, CMS reported that more than 20 million people were disenrolled from Medicaid nationwide — a significant share of whom were removed for procedural reasons rather than actual ineligibility, according to KFF tracking data. That figure underscores why understanding your state's enrollment landscape matters in practical terms, not just policy ones.

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Medicaid vs. CHIP: Understanding the Difference

These two programs are related but serve different populations, and the distinction matters when you're figuring out which one your household may be able to access.

Medicaid

Medicaid is a joint federal-state program that provides free or very low-cost health coverage to eligible low-income adults, children, pregnant women, elderly individuals, and people with disabilities. Eligibility rules, covered services, and application processes vary by state.

Adults in expansion states: Generally covered up to 138% FPL
Adults in non-expansion states: Coverage may be limited to specific categories — pregnant women, parents with dependent children, or people with qualifying disabilities
Children: Covered at varying income thresholds, often up to 138–200% FPL under Medicaid before CHIP eligibility begins
Pregnant women: Many states cover up to 185–200% FPL or higher, and some states have extended coverage regardless of immigration status

Children's Health Insurance Program (CHIP)

CHIP fills the gap for children whose families earn too much for Medicaid but cannot afford private insurance. It is specifically designed for uninsured children and, in some states, pregnant women.

Income limits for children commonly range from 200% to 300% FPL, with some states extending coverage to 400% FPL
Premiums and cost-sharing are minimal — often $0 to $50 per month depending on household income
Coverage typically includes doctor visits, immunizations, dental care, vision care, hospital care, and mental health services
CHIP is administered by states under federal guidelines, so benefits and cost-sharing structures differ from state to state

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Why State Enrollment Gaps Matter to Your Family

Georgetown's enrollment tracking is not just an academic exercise. When a state shows lower-than-expected enrollment relative to its estimated eligible population, it typically points to one or more real-world barriers that affect families directly:

Complicated application processes that discourage first-time applicants or those with limited English proficiency
Documentation requirements that are difficult for working families to gather quickly, particularly those with irregular income
Language access gaps in states with large non-English-speaking populations
Post-pandemic unwinding effects, where millions were disenrolled during the 2023–2024 Medicaid redetermination process — many for procedural reasons such as outdated addresses or unreturned paperwork
Outreach shortfalls in rural areas where awareness of available programs remains low

If your state shows a documented coverage gap in Georgetown's data, it may mean eligible families in your area are going without coverage they could potentially access — and that includes yours.

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Who May Want to Explore Medicaid or CHIP

The following situations may be worth exploring further with your state Medicaid agency or a free enrollment assister:

Low to moderate income: Households earning under 138% FPL (adults in expansion states) or under 200–300% FPL (children in most states)
Recent job loss or income drop: A change in income can make a household newly eligible for programs that were not previously accessible
Pregnancy: Many states have expanded Medicaid for pregnant women, and some cover prenatal care regardless of immigration status
Children without insurance: Even when parents do not qualify, children in the same household may be able to access CHIP
Recently disenrolled: Families who lost Medicaid coverage during the 2023–2024 unwinding period may reapply immediately — there is no waiting period
Aging off a parent's plan: Young adults who lose coverage at age 26 may want to explore Medicaid eligibility based on their own income

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Documents You'll Likely Need to Apply

Having these documents ready before starting an application can significantly reduce processing time:

Proof of identity: Driver's license, state-issued ID, or passport
Proof of residency: Utility bill, lease agreement, or bank statement showing your current address
Proof of income: Pay stubs from the last 30 days, an employer letter, or your most recent federal tax return
Social Security numbers: For all household members included in the application
Immigration documents (if applicable): Permanent resident card, visa, or other status documentation
Current health insurance information: If any household member already has coverage
Birth certificates for children: Required for CHIP applications in most states

Not every state requires all of these documents upfront. Many states now use electronic data matching to verify income and residency automatically, which can speed up the process.

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How to Apply: Step-by-Step

Step 1: Check Your State's Income Limits

Before applying, look up your state's specific Medicaid and CHIP income thresholds. These vary — sometimes significantly — from state to state. Your state Medicaid agency's website and HealthCare.gov are the most reliable sources for current figures.

Step 2: Choose Your Application Method

Most states offer three ways to apply: - Online: Through your state Medicaid agency's website or HealthCare.gov - By phone: By calling your state Medicaid office directly - In person: At your local Department of Social Services, community health center, or FQHC

Step 3: Complete the Application Carefully

Be thorough and accurate. Incomplete applications are among the most common causes of processing delays. List all household members and all sources of income, including irregular or seasonal income.

Step 4: Submit Required Documents

Upload or mail supporting documents as directed by your state agency. Keep copies of everything you submit, including confirmation of submission.

Step 5: Wait for a Determination

Federal rules require most states to process Medicaid applications within 45 days of submission, or 90 days when a disability determination is involved. CHIP applications for children are often processed faster — sometimes within a few business days.

Step 6: Respond to Any Requests Promptly

If your state agency requests additional information, respond as quickly as possible. Delays in responding can result in your application being closed without a determination.

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If You Were Disenrolled During the Medicaid Unwinding

Between April 2023 and late 2024, states conducted mandatory eligibility redeterminations for all Medicaid enrollees — a process required by federal law after the continuous enrollment protections put in place during the COVID-19 public health emergency ended. CMS data indicates that more than 20 million people were disenrolled during this period, and a significant share of those disenrollments were procedural rather than based on actual ineligibility.

Common procedural reasons for disenrollment included outdated mailing addresses, paperwork that was sent but not returned in time, and income data that could not be automatically verified.

If this affected your family: - Reapply immediately — there is no waiting period to reapply for Medicaid or CHIP after disenrollment - Check for Special Enrollment Periods on HealthCare.gov if you now need Marketplace coverage as an alternative - Contact your state Medicaid agency directly to ask whether your case can be reinstated if the disenrollment was the result of a procedural error - Ask about continuous eligibility protections for children, which some states have adopted to reduce churn in CHIP enrollment

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Where to Get Free Help Applying

If the application process feels overwhelming, trained help is available at no cost:

Navigators and Certified Application Counselors: Available through HealthCare.gov, these trained helpers can assist with Medicaid and CHIP applications at no charge
Federally Qualified Health Centers (FQHCs): Community health centers funded by HHS often have enrollment assisters on staff who can help regardless of whether you become a patient
2-1-1: Dialing 211 connects you with local social services, including enrollment assistance for health coverage programs
Benefits.gov: Offers a screening tool to help identify programs that may be available based on your household's situation
State Medicaid agency websites: Each state's agency maintains current eligibility information, application portals, and contact information for local offices

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

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Last reviewed: July 2025

Sources & Further Reading

Frequently Asked Questions

What is the income limit for Medicaid in 2025?

In states that expanded Medicaid under the ACA, adults may be able to access coverage with household income up to 138% of the Federal Poverty Level (FPL). Non-expansion states have narrower thresholds, often covering only specific groups such as pregnant women, parents with dependent children, or people with qualifying disabilities. Children may be eligible at higher thresholds — often 200–300% FPL — through CHIP. Check your state Medicaid agency for current figures, as FPL dollar amounts are updated annually.

How is CHIP different from Medicaid for children?

CHIP is designed for children in families who earn too much for Medicaid but cannot afford private insurance. It generally has higher income limits — commonly 200–300% FPL — and may involve small premiums or copays depending on income. Medicaid for children is typically free with no cost-sharing. Both programs cover similar services including doctor visits, dental care, vision care, and hospital care. Specific benefits and cost-sharing structures vary by state.

Can I reapply for Medicaid if I was disenrolled during the unwinding period?

Yes. There is no waiting period to reapply for Medicaid after disenrollment. If your family lost coverage during the 2023–2024 redetermination process, you may reapply immediately through your state Medicaid agency or HealthCare.gov. If your disenrollment resulted from a procedural error — such as a missed notice or outdated address — contact your state agency directly to ask about reinstatement options.

How long does it take to get a Medicaid eligibility determination?

Federal rules require most states to process Medicaid applications within 45 days of submission, or 90 days when a disability determination is involved. CHIP applications for children are often processed more quickly — sometimes within a few business days. Submitting complete documentation upfront and responding promptly to any requests for additional information can help avoid delays in processing.

Does Georgetown's enrollment data affect my state's Medicaid program directly?

Georgetown's Center for Children and Families data is used by advocates, policymakers, and state agencies to identify coverage gaps and target outreach efforts. While it does not directly change your eligibility, states with documented enrollment gaps sometimes respond with simplified application processes, expanded navigator programs, or policy changes — all of which can make it more accessible for eligible families to learn about and pursue coverage options.

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.

MedicaidCHIPhealthcare assistancehealth insurancelow-income familieschildren's health coverageMedicaid enrollmentMedicaid eligibilitystate Medicaid programsACA Medicaid expansion

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