CHIP Eligibility by State 2026: Who Qualifies and Income Limits

The Federal CHIP Framework: How Income Limits Are Set

Congress created CHIP in 1997 (Title XXI of the Social Security Act) to cover children whose families earn too much for Medicaid but cannot afford private insurance. The federal government sets a floor, not a ceiling. The statutory minimum is the higher of 200% FPL or 50 percentage points above the state's 1997 Medicaid level. States that want to cover children above 200% FPL can apply for a federal waiver, and most do. The result is a patchwork of income limits ranging from about 200% FPL at the low end (Texas, Florida at current limits) to 400% FPL at the high end (New York).

Medicaid and CHIP work as a seamless ladder. Medicaid covers children with family income below the state Medicaid cutoff, typically 138% to 205% FPL for children, though several states cover children higher through Medicaid itself. CHIP picks up above that cutoff. In practice, families do not need to know which program their child lands in; a single application at the state portal or HealthCare.gov determines eligibility for both.

• Age: children from birth to age 18 (up to 19th birthday) in most states
• Income: family income above the state Medicaid cutoff but at or below the state CHIP cap (200%-400% FPL depending on state)
• Residency: must live in the state where applying
• Citizenship: U.S. citizens and certain qualified immigrants qualify; some states cover all children regardless of immigration status using state funds
• No insurance rule: most states require the child to be uninsured (or to have been uninsured for a short waiting period, often 90 days)

12-Month Continuous Eligibility: The 2024 Federal Mandate

Effective January 1, 2024, all states must provide 12 months of continuous eligibility for children enrolled in Medicaid and CHIP. This is required by Section 5112 of the Consolidated Appropriations Act, 2023, which amended Titles XIX and XXI of the Social Security Act. Before this mandate, only about 33 states offered 12-month continuous eligibility voluntarily; the other states would re-check income every 6 months and could terminate coverage mid-year if a family's income rose.

What this means for your family in 2026: once your child is enrolled in CHIP, coverage is guaranteed for the full 12-month benefit year even if you get a raise, change jobs, or your household income increases. The child's coverage cannot be terminated mid-year for income reasons. Renewals still happen annually; if income remains within the CHIP range at renewal, coverage continues. Florida has challenged this mandate in court, but federal law controls.

What CHIP Covers: Benefits by State

Federal law requires CHIP programs to cover a comprehensive set of children's services. States must cover at minimum: well-child visits and immunizations, doctor visits (both sick and preventive), emergency care, hospitalizations, dental care, vision care, mental health and substance use services, and prescriptions. In practice, CHIP in most states is comparable to a solid commercial health plan, with low or zero premiums and modest copays.

CHIP premiums and cost-sharing are limited by federal law. Families with income below 150% FPL pay no premiums. For families between 150% and the state CHIP cap, monthly premiums typically range from $15 to $50 per child depending on the state. Total out-of-pocket costs for a CHIP family cannot exceed 5% of annual household income.

• Well-child checkups and immunizations (required)
• Outpatient and inpatient care (required)
• Dental care (required; this is a key advantage over many private plans)
• Vision care and eyeglasses (required)
• Mental health and substance use disorder services (required under federal parity law)
• Prescription drugs (required)
• Emergency services (required; no prior authorization for true emergencies)

How to Apply for CHIP in 2026

There is no open enrollment period for CHIP. You can apply any time of year, and coverage can begin within days of approval. Every state offers online, phone, mail, and in-person application options. The fastest route for most families is online at HealthCare.gov, which screens for both Medicaid and CHIP simultaneously and routes you to your state's program.

CHIP and Medicaid Together: The Income Ladder Explained

Medicaid and CHIP are not competing programs. They are two rungs on the same ladder for children's coverage. Medicaid is free (no premiums, minimal copays) and covers children in families with the lowest incomes. The Medicaid income cutoff for children varies by state: most states cover children up to 138% to 205% FPL under Medicaid. CHIP then picks up where Medicaid leaves off and covers children up to the state's CHIP cap. Families do not pick which program to apply to; the eligibility determination is automatic.

For families close to a program boundary, a small income change will not cause a coverage gap because of the 12-month continuous eligibility rule. If a child is enrolled in either Medicaid or CHIP, the 12-month coverage period holds. The one exception: if the child ages out (turns 19), coverage ends at the birthday regardless of the benefit year.

What is the income limit for CHIP in 2026?

CHIP income limits vary by state. The federal minimum is 200% of the federal poverty level (FPL). For a family of four in 2026, that is $66,000 per year. States can and often do set higher limits: New York covers up to 400% FPL ($132,000/yr for a family of 4), New Jersey up to 355% FPL, and Illinois up to 318% FPL. Texas and Florida are near the federal floor at 201% and 200% FPL, respectively.

What is CHIP called in different states?

Each state brands its CHIP program differently. Common names include: Texas CHIP (Texas), Florida KidCare (Florida), PeachCare for Kids (Georgia), Medi-Cal (California, children's CHIP tier), AllKids (Illinois), NJ FamilyCare (New Jersey), and Child Health Plus (New York). Despite different names, all programs follow federal CHIP rules and cover the same core benefits.

Can my child get CHIP if I have a job?

Yes. CHIP is specifically designed for working families. Having a job does not disqualify your child. Only income level matters. Many CHIP families have two working parents. However, if your employer offers affordable family health coverage, your child may not qualify for CHIP. 'Affordable' is defined by federal rules (the coverage must cost more than a set percentage of household income to be considered unaffordable).

How is CHIP different from Medicaid?

Medicaid covers children in the lowest-income families, typically below 138% to 205% FPL depending on the state. CHIP covers children above the Medicaid cutoff, up to the state's CHIP cap (200% to 400% FPL). Medicaid is fully free (no premiums); CHIP may charge small premiums for families above 150% FPL. Both programs are year-round, comprehensive, and guarantee 12 months of coverage once enrolled.

Does CHIP cover dental and vision?

Yes. Federal law requires CHIP programs to cover dental and vision care for children. This is a meaningful advantage over many private health plans, which often charge extra for dental and vision. CHIP dental coverage typically includes preventive cleanings, X-rays, fillings, and extractions. Vision coverage includes annual eye exams and eyeglasses.

Can my child lose CHIP coverage mid-year if our income goes up?

No, not since January 1, 2024. Federal law now requires all states to provide 12 months of continuous eligibility for children in CHIP and Medicaid. Once enrolled, your child's CHIP coverage cannot be terminated mid-year due to an income increase. Coverage continues until the 12-month renewal date, at which point your state will re-check eligibility.

How do I apply for CHIP for my child?

Apply online at HealthCare.gov or your state's CHIP portal. You can also call 1-877-KIDS-NOW (1-877-543-7669) for help. There is no open enrollment period for CHIP. You can apply any time of year. A single application screens for both Medicaid and CHIP at once. Most states approve applications within 30 to 45 days.

Is there a waiting period before CHIP coverage starts?

Most states do not have a waiting period before CHIP coverage begins. However, some states impose a waiting period (typically 90 days) for children who voluntarily dropped private insurance before applying for CHIP. Children from families with very low income (below 150% FPL) are usually exempt from any waiting period. Check your state's specific rules at InsureKidsNow.gov.