Frequently Asked Questions

Eligibility Information

Question: Is my child eligible for Medicaid or the Children's Health Insurance Program (CHIP)?

Answer: States have different income eligibility rules, but in most states, children up to age 19 with family income up to $80,000 per year (for a family of four; income levels vary by state) may qualify for Medicaid or the CHIP. In many states, family income can be even higher and children can still qualify. Young people up to 21 may be eligible for Medicaid. Youth who have "aged out" of foster care can be covered under Medicaid until they reach 26; there is no income limit for these youth.

Medicaid and CHIP coverage is for U.S. citizens and certain lawfully present immigrants. To find information about the Medicaid and CHIP programs in your state, go to Learn About Programs in Your State or call 1-877-KIDS-NOW (1-877-543-7669). When you call the free and confidential hotline, you’ll be connected to someone in your state who can help you learn whether your children may qualify and help you enroll them.

Question: What is “Medicaid Unwinding” and why is it happening?

Answer: During the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) temporarily waived certain Medicaid and Children’s Health Insurance Program (CHIP) requirements and conditions. The easing of these rules helped prevent people with Medicaid and CHIP—in all 50 states, the District of Columbia, and the five U.S. territories—from losing their health coverage during the pandemic. Now that states are returning to normal operations, they’re restarting these eligibility reviews and can disenroll people as soon as April 1, 2023.

Question: Are teenagers eligible for coverage?

Answer: Yes, in every state, children from birth until their 19^th birthday may be eligible for coverage.

Question: I have a job. Can my children and teens still qualify?

Answer: Yes, many children who are eligible for Medicaid and CHIP are in families where one or both parents are working. Working parents may not have health coverage through their jobs or the health plans they're offered may not cover their children. Many working families can't afford health insurance on their own.

Question: Who can apply for Medicaid or CHIP for a child?

Answer: A parent, grandparent, guardian or other authorized representative can apply on behalf of a child. If you're a teenager living on your own, your state may allow you to apply for Medicaid on your own behalf or any adult may apply for you.

Question: What if my children and teens are covered by Medicaid or CHIP already?

Answer: That's great! They already have comprehensive health insurance. If you're looking for a dentist for your child, use our dentist locator.

Question: Is there a limit on the amount of time my child or teen can remain enrolled in Medicaid or CHIP?

Answer: Children and teens can stay covered as long as they qualify. You'll need to renew their coverage once a year.

Question: How do I know when to renew Medicaid or CHIP coverage for my child or teen?

Answer: The program will contact you to let you know that it is time to renew your child's coverage.  Enrollment for Medicaid and CHIP is open year-round and must be renewed annually to maintain continuous coverage. Families who are already enrolled should make sure their contact information is up to date to ensure they do not miss important notices and can avoid gaps in coverage.

Question: What should families do to make sure they stay enrolled in Medicaid or CHIP during the unwinding?

Answer:

• Update your contact information. Make sure your state has your current mailing address, phone number, email, or other contact information. This will, they’ll be able to contact you about your Medicaid or CHIP coverage.
• Check your mail. Your state will mail you a letter about their Medicaid or CHIP coverage. This letter will also let you know if you need to complete a renewal form to see if  you still qualify for Medicaid or CHIP.
• Complete your renewal form (if you get one). Fill out the form and return it to your state right away to help avoid a gap in your Medicaid or CHIP coverage.

Question: Does receiving Medicaid or CHIP benefits affect someone’s immigration status?

Answer: The Department of Homeland Security will not consider applying for or receiving Medicaid or CHIP when making a “public charge” determination (except Medicaid for long-term institutionalization, such as nursing home care). Having Medicaid or CHIP won’t affect someone’s chances of becoming a Lawful Permanent Resident or U.S. citizen.

Question: Can pregnant people qualify for Medicaid or CHIP?

Answer: Yes if certain eligibility criteria are met. Medicaid and the Children’s Health Insurance Program (CHIP) offer free or low-cost health coverage for pregnant individuals and offer a range of services including prenatal visits, postpartum care and other comprehensive services.

Postpartum care is covered in all 50 states at least through the first 60 days. Many states have extended Medicaid and CHIP coverage to include the first 12 months of the postpartum period.

When pregnant people are enrolled in Medicaid or CHIP, their newborns are automatically enrolled.

Covered Services

Question: What do Medicaid or CHIP cover?

Answer: All states provide comprehensive coverage for children, including:

• Well-child and other routine check-ups
• Immunizations
• Mental health services
• Dental and vision care
• Doctor visits
• Prescriptions
• Inpatient and outpatient hospital care
• Laboratory and X-ray services
• Emergency services

Some specific benefits may be different from state to state.

Question: How do I find a health care provider (doctor, dentist or pharmacist) in my area who accepts Medicaid or CHIP?

Answer: There are several things you can do to find a health care provider:

• If you already have a health care provider for your child, ask if he or she accepts Medicaid, CHIP, or the health plan you selected. If you've been getting care from a provider that doesn't accept Medicaid, CHIP, or any of its health plans, you may be able to keep using that provider for a short time until you can find another provider, but you need to ask your state's Medicaid or CHIP program, or the health plan you selected.
• Most Medicaid and CHIP programs and health plans have websites that tell you which providers are available.
• Call your state Medicaid or CHIP agency or your health plan's member services department for help. The phone number is typically on eligibility letters or on the back of program enrollment cards. This information should also be available on your health plan's website or your state Medicaid or CHIP agency website.
• Be sure to let your provider know that you're enrolled in Medicaid or CHIP, or give the name of your health plan when you make an appointment for care. If you're having trouble getting an appointment to see a doctor, call your state Medicaid or CHIP agency or your health plan's member services department for help.
• Find a dentist in your area by using our online dentist finder search application.

Costs for Families

Question: What do families pay for coverage under Medicaid or CHIP?

Answer: Depending on their income, many families will get free health coverage for their children and teens. Other families may be required to pay a modest enrollment fee or premiums, and copayments for specific services. The rest of the coverage is paid for by the federal government and your state.

Application Process

Question: When can I apply for Medicaid or CHIP? Is there a certain time of year I should apply?

Answer: You can enroll in Medicaid or CHIP any time. There's no special open enrollment period for Medicaid or CHIP. You can apply at HealthCare.gov or directly with your state's Medicaid or CHIP agency.

Question: How do I apply for Medicaid or CHIP?

Answer: You can apply online, by phone, by mail or in person. You can apply using the HealthCare.gov online application  or directly at your state's Medicaid or CHIP agency. To get more information and help call 1-877-KIDS-NOW (1-877-543-7669), a free and confidential hotline, to be connected directly to your state's program.