Back 

Medicaid Eligibility Table by State (State Activit

Medicaid and CHIP Eligibility Table by State

Doctor with clipboard

Under the new federal health reform legislation, Medicaid will be expanded to all Americans with incomes up to 133 percent of federal poverty guidelines ($29,327 a year for a family of four in 2010) effective in 2014. This represents a significant change for state Medicaid programs, which will expand to cover additional people who do not currently qualify. The new law provides states with 100 percent federal financing for all those who are newly eligible for Medicaid for the first three years through 2016. The federal match decreases to 95 percent in 2017; 94 percent in 2018; 93 percent in 2019 and 90 percent for 2020 and beyond. Currently the states share the cost of the Medicaid program with the federal government. The federal government share, called the federal medical assistance percentage or FMAP, is calculated based on a three-year average of state per capita personal income compared to the national average. A state with average per capita personal income receives an FMAP of 55 percent; no state may receive less than 50 percent.

The Children's Health Insurance Program (CHIP), provides insurance for certain children who are ineligible for Medicaid but cannot afford private insurance. States receive a higher federal match to pay for CHIP coverage than for their Medicaid programs. This match can either be used to create a separate CHIP program or to create an expansion of the state's Medicaid program, which raises the Medicaid eligibility level for children.

Listed below are the Medicaid (M) and CHIP (C) eligibility levels for eligible populations in each state as of July 1, 2010.

 

State

Infants
% FPL

Children
1-5 % FPL

Children
6-19 % FPL

Pregnant 
Women % FPL

Parents of
Medicaid
Eligible kids % FPL

Childless Adults % FPL

Federal Minimum level                                                  

133

133

100

133

N/A

N/A

Alabama

133 M
300 C

133 M
300 C

100 M
300 C

133

24

 

Alaska

175 M+

175 M+

175 M+

175

81

 

Arizona

140 M
200 C

133 M
200 C

100 M
200 C

150

106

110

Arkansas

200 M+

200 M+

200 M+

200

200#

200#

California

200 M
250 C

133 M
250 C

100 M
250 C

200

106

 

Colorado

133 M 
205 C

133 M
205 C

100 M
205 C

200

66

 

Connecticut

185 M
300 C

185 M
300 C

185 M
300 C

250

300#

 **

Delaware

200 M

133 M
200 C

100 M
200 C

200

121

110

Florida

200 M

133 M
200 C

100 M
200 C

185

53

 

Georgia

200 M
235 C

133  M
235 C

100  M
235 C

200

50

 

Hawaii

300 M+

300 M+

300 M+

185

200#

200# (closed)

Idaho

133 M
185 C

133 M
185 C

133 M
185 C

133

185#

185#

Illinois

200 M

133 M
200 C

133 M
200 C

200

185

 

Indiana

200 M
250 C

150 M
250 C

150 M
250 C

200

200#

200# (closed)

Iowa

300 M

133 M
300 C

133 M*
300 C

300

250#

250# 

Kansas

150 M
241 C

133 M
241 C

100 M
241 C

150

32

 

Kentucky

185 M
200 C

150  M
200 C

150  M
200 C

185

62

 

Louisiana

200 M
250 C

200 M
250 C

200 M
250 C

200

25

 

Maine

200 M

150 M
200 C

150 M*
200 C

200

206

100# (closed)  

Maryland

300 M+

300 M+

300 M+

250

116

116#

Massachusetts

200 M
300 C

150  M
300 C

150  M
300 C

200

133#

100#

Michigan

185 M
200 C

150  M
200 C

150  M
200 C

185

64

 

Minnesota

280 M+

275 M+

275 M+

275

275#

 

Mississippi

185 M
200 C

133 M
200 C

100 M
200 C

185

44

 

Missouri

185 M
300 C

150 M
300 C

150 M
300 C

185

25

 

Montana

133 M
250 C

133 M
250 C

133 M
250 C

150

56

 

Nebraska

200 M+

200 M+

200 M+

185

58

 

Nevada

133 M
200 C

133 M
200 C

100 M
200 C

185

200#

 

New Hampshire

300 M

185 M
300 C

185 M
300 C

185

49

 

New Jersey

200 M
250 C

133 M
250 C

133 M
250 C

200

200

 

New Mexico

235 M+

235 M+

235 M+

235

250#

250# (closed)

New York

200 M
400 C

133 M
400 C

100 M
400 C

200

150

100

North Carolina

200 M

200 M

100 M
200 C

185

49

 

North Dakota

133 M
160 C

133 M
160 C

100 M
160 C

133

59

 

Ohio

200 M+

200 M+

200 M+

200

90

 

Oklahoma

185 M+

185 M+

185 M+

185

200#

213#

Oregon

133 M
300 C

133 M
300 C

100 M
300 C

185

185#

185#

Pennsylvania

185 M
300 C

133 M
300 C 

100 M
300 C 

185

34

 

Rhode Island

250 M+

250 M+

250 M+

250

181

 

South Carolina

185 M
200 C

150 M
200 C

150 M
200 C

185

89

 

South Dakota

140 M
200 C

140 M
200 C

140  M
200 C 

133

52

 

Tennessee

185 M
250 C

133 M
250 C

100 M
250 C

250

$55,000/year#

 $55,000/year#

Texas

185 M
200 C

133  M
200 C 

100  M
200 C 

185

26

 

Utah

133 M
200 C

133 M
200 C

100 M
200 C

133

44
150#

 150#

Vermont

225 M
300 C

225 M
300 C

225 M
300 C

200

191~#

160~#

Virginia

133 M
200 C

133 M
200 C

133 M
200 C

200

29

 

Washington

200 M
300 C

200 M
300 C

200 M
300 C

185

74

 

West Virginia           

150 M
250 C

133 M
250 C

100 M
250 C

150

33

 

Wisconsin

300 M+

300 M+

300 M+

300

200#

200#^ (closed)

Wyoming

133 M
200 C

133 M
200 C

133 M
200 C

100

52

 

District of Columbia                                  

300 M+

300  M+

300  M+

300

207

 211#**

** These states are rolling elgible individuals from a state-only funded program into the early Medicaid expansion option offered through the Affordable Care Act, more information to come.
# Waiver program, limited coverage program, and/or premium assistance program.
M Medicaid offers coverage to children up to this percentage of the federal poverty guidelines.
M+ State's Medicaid program has a CHIP expansion.
C State has a separate CHIP program offers coverage to children up to this percent of the federal poverty guidelines.
* Children up to age 21 are eligible.
~ The state also has a premium subsidy plan, called Catamount Health that is offered to parents and childless adults up to 300 percent of the federal poverty guidelines.
^ Wisconsin offers a more limited coverage plan called the BadgerCare Plus Core Plan for Childless Adults which is currently at maximum capacity and is closed for enrollment. The governor has a 2010 bill to allow those on this waiting list to fully purchase the coverage.

Federal Standards for Medicaid

Categorically eligible populations:

  • Pregnant women up to 133 percent of federal poverty guidelines.
  • Infants under age one are covered if their mother is on Medicaid at the time of birth or up to 133 percent of federal poverty guidelines; children ages 1 through 5 are covered up to 133 percent; and children ages 6 through 18 are covered up to 100 percent.
  • Parent/guardian below Aid to Families with Dependent Children (AFDC) levels in 1996. There is no federal standard for income eligibility for this group. (National average of approximately 40 percent of federal poverty guidelines).
  • People who receive Supplemental Security Income (SSI) due to a disability.
  • Children who are adopted or in foster care are covered.
  • Low-income recipients of Medicare are eligible.  Once enrolled these people are known as "dual-eligible" enrollees. 

Federal Matching Funds

In addition to these mandatory coverage categories of people, several optional populations can be covered with federal matching funds:

  • Infants and pregnant women up to 185 percent of federal poverty guidelines.
  • Parents of eligible children.
  • Medicare recipients at higher income levels than required.
  • Those who have high medical expenses relative to their income.
  • Those with disabilities but who would lose eligibility based on income.
  • Low-income, uninsured women diagnosed with breast or cervical cancer by the National Breast and Cervical Cancer Early Detection Program can be covered for cancer-related treatment.
  • Through the Children's Health Insurance Program (CHIP), children can be covered, through Medicaid, up to 200 percent of federal poverty guidelines.
Share this: 
NCSL Summit 2014
We are the nation's most respected bipartisan organization providing states support, ideas, connections and a strong voice on Capitol Hill.

NCSL Member Toolbox

Denver

7700 East First Place
Denver, CO 80230
Tel: 303-364-7700 | Fax: 303-364-7800

Washington

444 North Capitol Street, N.W., Suite 515
Washington, D.C. 20001
Tel: 202-624-5400 | Fax: 202-737-1069

Copyright 2014 by National Conference of State Legislatures