Healthcare Assistance

Medicaid and CHIP for Children: What Parents Need to Know About Coverage, Eligibility, and How to Enroll

Free or low-cost health coverage may be available for your child regardless of your immigration status, employment, or whether you have other insurance.

April 9, 2026·By Dr. Raymond Torres·✓ Reviewed April 2026

Key Takeaways

✓Medicaid and CHIP cover children in families earning up to 200%–300% of the Federal Poverty Level in most states — some states go higher.
✓Children can enroll in Medicaid or CHIP at any time of year — there is no limited open enrollment window like marketplace plans.
✓Coverage can include doctor visits, dental, vision, mental health services, and prescriptions at little or no cost to the family.
✓Immigration status rules vary: U.S.-born children are citizens regardless of parents' status, and many states cover lawfully present immigrant children.
✓If your child is uninsured right now, you may be able to apply online, by phone, or in person through your state Medicaid agency today.

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 free or low-cost health coverage for children in the United States, together covering more than 40 million kids. If you're a parent wondering whether your child may be eligible, the short answer is: income thresholds are higher than most families expect, enrollment is open year-round, and the application process is more accessible than it used to be. Here is what the research and program rules actually say.

Who Administers Medicaid and CHIP for Children?

Both programs are federally funded but administered at the state level. The Centers for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services (HHS), sets minimum federal standards. Each state then sets its own income limits (at or above the federal floor), covered services, and application procedures.

Medicaid covers children in lower-income households. Federal law requires states to cover children up to at least 133% of the Federal Poverty Level (FPL), but most states have expanded this significantly.
CHIP was created specifically to reach children in families who earn too much for Medicaid but cannot afford private insurance. Most states cover children up to 200%–300% of FPL through CHIP; several states go as high as 400% FPL.

Because income limits vary so widely, a family of four that does not qualify in one state might qualify in another. Always check your specific state's thresholds.

6 Key Facts About Medicaid and CHIP for Children

1. There Is No Annual Enrollment Window

Unlike marketplace plans under the Affordable Care Act (ACA), Medicaid and CHIP have no open enrollment period. Children can apply and be enrolled any month of the year. If your child loses other coverage — for example, because a parent loses a job — you can apply immediately without waiting for a special enrollment period.

2. Income Limits Are Higher Than Most Parents Realize

Federal poverty guidelines change annually, but the income thresholds for children's Medicaid and CHIP are expressed as percentages of FPL:

Medicaid floor: 133% FPL for children ages 6–18; 138% FPL in states that adopted ACA Medicaid expansion
CHIP: Most states cover children up to at least 200% FPL; many cover up to 300% FPL
Some states: New York, California, and others have expanded CHIP to 400% FPL or higher for certain age groups

A working family with two parents and two children may still be within range for CHIP even if both adults are employed. Use your state Medicaid agency's pre-screening tool or Benefits.gov to get a household-specific estimate.

3. Coverage Is Comprehensive

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

Well-child visits and immunizations
Dental and vision care
Mental health and behavioral health services
Prescription medications
Hearing screenings and hearing aids
Physical, occupational, and speech therapy when medically necessary

CHIP benefits vary more by state but generally mirror Medicaid's pediatric coverage. Copayments under CHIP are capped at 5% of family income annually.

4. Immigration Status Is More Complex — But Not Always a Barrier

This is one of the most misunderstood areas of children's Medicaid and CHIP:

U.S.-born children are U.S. citizens regardless of their parents' immigration status and are fully eligible for Medicaid and CHIP based on income.
Lawfully present immigrant children (including those with green cards, certain visa holders, and DACA recipients in some states) may qualify after a five-year waiting period under federal rules — but many states have used their own funds to eliminate that waiting period.
Undocumented children are generally not eligible for full Medicaid, but emergency Medicaid is available in all states, and several states (including California, Illinois, and Washington) have extended full state-funded coverage to undocumented children.

If you are uncertain about your child's eligibility based on immigration status, a certified application counselor or navigator can help you understand your state's specific rules without requiring you to disclose information that could create risk.

5. Having a Parent With Employer Coverage Does Not Automatically Disqualify a Child

Children can be enrolled in Medicaid or CHIP even if a parent has access to employer-sponsored insurance — as long as the child meets the income requirements. This is sometimes called the "crowd-out" provision, and states handle it differently, but in most cases a child's eligibility is evaluated on household income, not on whether coverage is theoretically available through a parent's job.

6. Renewals Require Action — and Gaps Can Happen

Medicaid and CHIP eligibility must be renewed, typically every 12 months. During the COVID-19 pandemic, continuous enrollment protections kept children enrolled without renewal. Those protections ended in 2023, and states completed a "unwinding" process that resulted in millions of children being disenrolled — in many cases due to paperwork issues rather than actual ineligibility.

What this means for parents: Make sure your state Medicaid agency has your current mailing address and email. Respond promptly to any renewal notices. If your child was recently disenrolled, you may be able to re-enroll immediately if income still qualifies.

How to Apply for Medicaid or CHIP for Your Child

Step 1: Gather Required Documents

Most states will ask for: - Proof of the child's age and identity (birth certificate or passport) - Proof of state residency (utility bill, lease, or school enrollment record) - Proof of household income (recent pay stubs, tax return, or employer letter) - Social Security numbers for the child and applying parent (some states allow application without SSN for the child in certain circumstances) - Immigration documents if applicable (green card, visa, or employment authorization)

Step 2: Choose Your Application Method

Online: Apply through your state's Medicaid agency website or through HealthCare.gov, which screens for both marketplace and Medicaid/CHIP eligibility simultaneously.
By phone: Call your state Medicaid agency directly. Most have dedicated children's coverage lines.
In person: Community health centers, school-based health programs, and local social services offices often have certified application assisters on site.
By mail: Paper applications are still accepted in all states.

Step 3: Track Your Application

Federal rules require states to process Medicaid applications within 45 days (90 days if disability is involved). CHIP timelines vary by state. Keep your application confirmation number and follow up if you have not received a determination within that window.

If Your Child Is Denied: Know Your Appeal Rights

If your child's application is denied or coverage is terminated, you have the right to a fair hearing — a formal review process administered by your state. You typically have 90 days from the notice date to request a hearing. A legal aid organization or benefits counselor can help you prepare.

Community Health Centers as a Backup Option

If your child is currently uninsured and you are in the middle of the application process, Federally Qualified Health Centers (FQHCs) — funded by the Health Resources and Services Administration (HRSA) — provide care on a sliding-fee scale based on income, regardless of insurance status. Find the nearest FQHC at findahealthcenter.hrsa.gov.

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

Last reviewed: April 2026

Sources & Further Reading

Frequently Asked Questions

What is the income limit for CHIP in most states?

Most states cover children through CHIP up to 200%–300% of the Federal Poverty Level. Several states, including California and New York, have expanded eligibility to 400% FPL or higher for certain age groups. Because thresholds vary by state and household size, checking your specific state's Medicaid agency website or Benefits.gov will give you the most accurate figure for your family.

Can my child get Medicaid if I am undocumented?

U.S.-born children are citizens and fully eligible for Medicaid and CHIP based on income, regardless of parents' immigration status. Several states — including California, Illinois, and Washington — have also extended full state-funded coverage to undocumented children. Emergency Medicaid is available in all states. A certified application counselor can help you understand your state's specific rules.

Is there an open enrollment period for children's Medicaid and CHIP?

No. Unlike ACA marketplace plans, Medicaid and CHIP accept applications year-round. There is no deadline or limited enrollment window. If your child loses coverage for any reason — such as a parent losing a job — you can apply immediately without waiting for a special enrollment period.

What does CHIP cover for children?

CHIP benefits vary by state but generally include doctor visits, immunizations, dental and vision care, mental health services, prescriptions, and emergency care. Copayments are capped at 5% of annual family income. Children enrolled in Medicaid also receive EPSDT services, a federally mandated comprehensive benefit package covering virtually all medically necessary pediatric care.

My child was recently dropped from Medicaid. Can they re-enroll?

Yes. If your child was disenrolled — which happened to millions of families during the 2023–2024 Medicaid unwinding — and your household income still falls within your state's eligibility range, you can reapply immediately. Contact your state Medicaid agency, apply online through HealthCare.gov, or visit a local community health center for application assistance.

About the Author

Written by the Hardship Authority editorial team.

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 assistanceEPSDTlow-income familiesuninsured childrenMedicaid enrollmentCHIP eligibilityFederal Poverty Level

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