CHIP (Children’s Health Insurance Program): Income Limits and What It Covers

Every state runs a CHIP program, but no single income cutoff applies nationwide. In most states, a family of four can earn somewhere between roughly $66,000 and $132,000 a year and still qualify a child for CHIP, depending on where they live — because each state sets its own ceiling as a percentage of the federal poverty level. The program covers routine doctor visits, dental and vision care, hospital stays, prescriptions, and immunizations for kids whose families earn too much for Medicaid but not enough to comfortably afford private insurance.

How CHIP Income Limits Actually Work

CHIP and Medicaid are linked by design. Medicaid covers the lowest-income children, and CHIP picks up where Medicaid leaves off — covering kids in families with somewhat higher earnings. Congress created this structure in 1997 specifically to close the gap for working families who didn’t qualify for Medicaid but also couldn’t get affordable coverage through a job.

Every state measures eligibility against the Federal Poverty Level (FPL), a dollar figure that the Department of Health and Human Services updates each year based on family size. States then set their CHIP ceiling as a percentage of that number — commonly somewhere between 200% and 400% of the FPL, though the exact figure is a state policy choice.

That’s why a family earning $75,000 might qualify for CHIP in one state and fall just above the limit in another. Some states also combine CHIP funding directly into their Medicaid program (these are called “Medicaid expansion CHIP” programs), while others run CHIP as a separate program with its own name, like “Healthy Kids” or “PeachCare.” The coverage rules can differ slightly between the two structures, according to Medicaid.gov.

For 2026, states are applying federal poverty guidelines published by HHS; if you’re checking your own eligibility, confirm the exact current-year dollar cutoff for your state through your state Medicaid/CHIP agency or at InsureKidsNow.gov, since guidelines are republished every January and states can take a few weeks to formally adopt them.

Income Thresholds by Family Size

The table below shows what 200% and 300% of the federal poverty level translate to in annual income, using the 2026 HHS poverty guidelines. Many state CHIP programs set their ceiling somewhere in or near this range — some lower, some higher.

These numbers are for the 48 contiguous states and D.C. Alaska and Hawaii use higher baseline figures, per HHS’s published guidelines. Add $5,680 per additional household member for sizes beyond five.

A handful of states set their ceiling below 200% FPL, and a few go above 300% FPL — New York and a small number of others extend CHIP coverage higher than 300%. Because the variation is real and changes periodically, don’t treat this table as your state’s actual cutoff. Use it to understand the scale, then verify your state’s specific percentage at InsureKidsNow.gov, which has state-by-state program information, contacts, and instructions for applying.

What CHIP Actually Covers

Every state’s CHIP program has to include certain core benefits under federal law, though some states add extras. Standard coverage generally includes:

• Routine checkups and well-child visits
• Immunizations
• Doctor visits, both primary care and specialist
• Prescription drugs
• Dental care, including checkups, fillings, and in most states orthodontics for medical necessity
• Vision care, including eye exams and glasses
• Hospital care, inpatient and outpatient
• Lab work and X-rays
• Emergency room services
• Mental health and substance use treatment

This is comprehensive coverage built around what growing kids actually need — not a bare-bones plan. Dental and vision, in particular, are areas where many private family plans charge extra or skip entirely, but dental coverage is a required CHIP benefit in every state, and most states cover vision as well, according to Medicaid.gov.

Costs Families Pay

CHIP isn’t always free. Some states charge a modest monthly premium, and most charge small co-pays for things like doctor visits or prescriptions. But federal law caps total family cost-sharing — premiums and co-pays combined — at 5% of the family’s annual income, no matter how many kids are enrolled or how often they use care. States with the lowest-income CHIP enrollees (generally those near 150% of FPL) typically charge nothing at all, while higher-income tiers pay modest premiums, with exact amounts set state by state.

Who Qualifies Besides Income

Income is the headline number, but CHIP has a few other baseline requirements:

• The child must be under 19 (some states cover pregnant women too, under separate rules).
• The child must be a U.S. citizen or fall into an eligible immigrant category — many states cover lawfully residing immigrant children without the five-year waiting period that applies to some other programs, under the CHIPRA law.
• The child generally must be uninsured — not currently covered by Medicaid, a group health plan, or other creditable coverage. Some states also apply a waiting period after a child drops employer coverage, so rules vary by state.
• Residency in the state where you’re applying.

Unlike ACA marketplace plans, there’s no annual open enrollment window for CHIP. You can apply any time of year, and coverage can often start the same month you apply.

A Worked Example

Consider a family of four — two parents and two kids — earning $70,000 a year in combined wages. Against the 2026 federal poverty guideline of $33,000 for a family of four, that income works out to about 212% of the FPL.

If this family lives in a state where the CHIP ceiling is set at 250% of FPL (about $82,500 for a family of four), their kids would likely qualify for CHIP, since their income falls below that line but above the state’s Medicaid cutoff for a family that size. They might pay a small monthly premium, perhaps $30 to $50 total for both kids, and modest co-pays for doctor visits — well below what the same family would pay for a private marketplace plan covering two children.

If this same family lived in a state with a lower CHIP ceiling, say 200% of FPL ($66,000 for a family of four), their $70,000 income would put them above the cutoff, and they’d likely need to look at subsidized marketplace coverage through HealthCare.gov instead. This is exactly why checking your specific state’s threshold matters more than any national average.

How to Apply

1. Start at InsureKidsNow.gov or Healthcare.gov. Both sites let you check eligibility and route you to your state’s application. Applying through HealthCare.gov also automatically checks whether your child qualifies for Medicaid or CHIP, even if you were originally shopping for marketplace coverage.
2. Gather proof of income — recent pay stubs, a tax return, or an employer letter — along with Social Security numbers and proof of residency for each child.
3. Submit the application through your state’s Medicaid/CHIP agency, either online, by phone, by mail, or in person. There’s no deadline or enrollment period; you can apply any month of the year.
4. Wait for a determination. Most states process CHIP applications within 45 days, often faster.
5. Report income changes. Because eligibility is income-based, a raise, new job, or change in household size can shift which program — Medicaid, CHIP, or marketplace subsidies — your child qualifies for. States typically ask for a redetermination once a year.

FAQ

Can my child get CHIP if I already have insurance for myself?

Yes. CHIP eligibility is based on the child’s coverage status, not the parents’. It’s common for parents to have employer coverage while their kids are enrolled in CHIP, particularly if the employer plan doesn’t offer an affordable family tier. Some states do ask whether a child has recently dropped employer coverage, so check your state’s specific rule.

Does CHIP income eligibility include child support or unemployment benefits?

Generally, yes — most states use a methodology called Modified Adjusted Gross Income (MAGI), which counts most taxable income and some non-taxable income similarly to how it’s counted for ACA subsidies. Child support received is typically excluded, but unemployment benefits are typically counted. Because treatment of specific income types can vary slightly, your state Medicaid/CHIP office can confirm exactly what counts on your application.

What happens if my income changes mid-year and I go over the CHIP limit?

Effective January 1, 2024, federal law requires all states to provide 12 months of continuous eligibility for children under 19 in Medicaid and CHIP, so income is reviewed at renewal, usually once a year, rather than monitored month to month. If your income rises mid-year, you’re generally not immediately disenrolled; you’ll report the change at your next renewal, and the state will determine whether your child still qualifies for CHIP, needs to move to Medicaid, or should transition to a marketplace plan with subsidies.

Sources

• Medicaid.gov, Children’s Health Insurance Program (CHIP): https://www.medicaid.gov/chip
• InsureKidsNow.gov: https://www.insurekidsnow.gov
• HealthCare.gov: https://www.healthcare.gov
• U.S. Department of Health and Human Services, Poverty Guidelines (ASPE): https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines

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