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Explore key characteristics of Medicaid and CHIP in , including documents and information relevant to how the programs have been implemented by within federal guidelines.
has expanded coverage to low-income adults.
As of December 2019, has enrolled 985,201 individuals in Medicaid and CHIP — a net increase of 57.29% since the first Marketplace Open Enrollment Period and related Medicaid program changes in October 2013. has adopted one or more of the targeted enrollment strategies outlined in guidance CMS issued on May 17, 2013, designed to facilitate enrollment in Medicaid and CHIP.
In federal fiscal year (FFY) XXXX, reported XXX health care quality measures in the CMS Medicaid and CHIP Child Core Set, includingXXX out of XXX frequently reported measures. These counts do not include the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Health Plan Survey 5.0H – Child Version Including Medicaid and Children with Chronic Conditions Supplemental Items (CPC-CH) or the Central Line-associated Bloodstream Infection (CLABSI-CH) measures. In federal fiscal year (FFY)XXXX, reportedXXX health care quality measures in the CMS Medicaid and CHIP Adult Core Set, includingXXX out of XXX frequently reported measures. These counts do not include the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Health Plan Survey 5.0H, Adult Version (Medicaid) (CPA-AD) measure.
Source: Medicaid Quality of Care Performance Measurement
More detailed information and source references are available on each of these topics.
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Eligibility in
Information about how determines whether a person is eligible for Medicaid and CHIP.
Most Medicaid eligibility and all CHIP eligibility is based on modified adjusted gross income (MAGI). Income eligibility levels are tied to the federal poverty level (FPL).
The following table provides a more detailed view of 's MAGI-based eligibility levels, expressed as a percentage of the FPL, for several key groups: children, pregnant women, parents/caretaker relatives, and, other adults
Medicaid & CHIP Eligibility1 as of
Children Eligibility Level Children Medicaid Ages 0-12 Eligibility Level Children Medicaid Ages 1-52 Eligibility Level Children Medicaid Ages 6-182 Eligibility Level Children Separate CHIP3 Eligibility Level Pregnant Women Eligibility Level Pregnant Women Medicaid Eligibility Level Pregnant Women CHIP4 Eligibility Level Adults (Medicaid) Eligibility Level Adults (Medicaid) Parent/Caretaker5 Eligibility Level Adults (Medicaid) Expansion to Adults Eligibility Level 1. This table reflects the principal but not all MAGI coverage groups. All income standards are expressed as a percentage of the federal poverty level (FPL). For the eligibility groups reflected in the table, an individual’s income, computed using the Modified Adjusted Gross Income (MAGI)-based income rules described in 42 CFR 435.603, is compared to the income standards identified in this table to determine if they are income eligible for Medicaid or CHIP. The MAGI-based rules generally include adjusting an individual’s income by an amount equivalent to 5% FPL disregard. Other eligibility criteria also apply, for example, with respect to citizenship, immigration status and residency.
2. These eligibility standards include CHIP-funded Medicaid expansions.
3. CHIP covers birth through age 18 unless otherwise noted in parentheses.
4. States have the option to cover pregnant women under CHIP. This table does not include notations of states that have elected to provide CHIP coverage of unborn children from conception to birth.
5. Reflects Medicaid state plan coverage of the eligibility group for parents and other caretaker relatives. Parents and caretaker relatives with income over the income standard for coverage under this group may be eligible for coverage in the adult group in states that have expanded to cover the adult group. In states that use dollar amounts based on household size, rather than percentages of the FPL, to determine eligibility for parents, we converted those amounts to a percentage of the FPL and selected the highest percentage to reflect the eligibility level for the group.
Source: Medicaid Eligibility.
Learn more about how states determine Medicaid eligibility for other populations.
View available state's eligibility verifications plans, MAGI Conversion Plans and Results.
Medicaid and CHIP agencies now rely primarily on information available through data sources (for example, the Social Security Administration, the Departments of Homeland Security and Labor) rather than paper documentation from families for purposes of verifying eligibility for Medicaid and CHIP.
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Enrollment in
Information about efforts to enroll eligible individuals in Medicaid and CHIP in .
Medicaid & CHIP Enrollment Data
The table below presents the most recent, point-in-time count of total Medicaid and CHIP enrollment in for the last day of the indicated month, and is not solely a count of those newly enrolled during the reporting period. For purpose of comparison, the table also presents (a)the change in enrollment since the initial open of the Health Insurance Marketplaces, and (b)national counts and change statistics for the same period.
Medicaid & CHIP Enrollment as of December 2019
Metric National Totals Metric Total Medicaid & CHIP Enrollment (Preliminary) National Totals Metric Net Change in Enrollment July-September 2013 National Totals Metric % Change in Enrollment July-September 2013 National Totals Source: Medicaid/CHIP Enrollment.
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Quality of Care in
Information about performance on frequently-reported health care quality measures in the CMS Medicaid and CHIP Child and Adult Core Sets and additional data sources in .
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Child Quality Measure Data
In federal fiscal year (FFY)2019, reported XXX health care quality measures in the CMS Medicaid and CHIP Child Core Set, including XXX out of XXX frequently reported measures. When a state used non-Core Set specifications, the measure is included in the count of measures reported by the state but not included in the state profile. The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Health Plan Survey 5.0H – Child Version Including Medicaid and Children with Chronic Conditions Supplemental Items (CPC-CH) measure is included in the count of measures reported by the state (if applicable) but not included in the state profile because it uses a different summary statistic.
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Adult Quality Measure Data
In federal fiscal year (FFY) 2019, reported XXX health care quality measures in the CMS Medicaid and CHIP Adult Core Set, including XXX out of XXX frequently reported measures. When a state used non-Core Set specifications, the measure is included in the count of measures reported by the state but not included in the state profile. These counts do not include the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Health Plan Survey 5.0H, Adult Version (Medicaid) (CPA-AD) measure, which is publicly reported by CMS but uses a different summary statistic. When a state did not report a measure or used non-Core Set specifications, the measure is not included below or in the count of measures reported by the state.
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Additional Quality Measure Data
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Program Documents for
