How do 2026 CHIP income guidelines differ from Medicaid across states?
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Executive summary
CHIP income limits are set to cover children whose family incomes are too high for Medicaid but still need help; states set CHIP ceilings above their Medicaid limits and states apply a 5% FPL “disregard” when moving between programs (the disregard effectively raises Medicaid’s test by ~5% of FPL) [1] [2]. Medicaid income eligibility varies widely because states may expand Medicaid or use different MAGI-based thresholds; as of January 2025, 40 states plus DC had expanded Medicaid, altering the income cutoff for adults to about 138% FPL in expansion states [3] [4].
1. How the federal rules shape both programs — a single MAGI yardstick with state flexibility
Federal rules require most financial eligibility for Medicaid and CHIP to use Modified Adjusted Gross Income (MAGI) and apply an income adjustment often described as a 5% of FPL disregard; but within those federal bounds states set the specific percent-of-FPL cutoffs for child and adult groups, and they can design CHIP to fill gaps above Medicaid’s limits [2] [1].
2. Practical effect: CHIP sits above Medicaid in the eligibility ladder
States run eligibility determinations in sequence: Medicaid is checked first, then CHIP for incomes above the Medicaid applicable limit. That means CHIP’s lower boundary is effectively anything above the Medicaid ceiling (after the 5% disregard mechanics), so CHIP typically has higher income ceilings for children than Medicaid does [5] [6] [1].
3. The 5% FPL “disregard” and why it matters to families at the margin
The MAGI rules generally adjust income by an amount equivalent to a 5% FPL disregard; agencies use this when applicants’ household income sits near the Medicaid upper limit, which can shift some applicants between Medicaid and CHIP and can trigger referrals between agencies [2] [6].
4. Why state choices produce wide variation in take-up and costs
States exercise flexibility in setting CHIP income ceilings and in implementing Medicaid expansion, resulting in different income cutoffs, premiums and cost-sharing for children and families. Some states also split CHIP into free and low-cost tiers, apply premiums or copays, or cover additional populations like pregnant women under CHIP options [7] [1] [8].
5. Medicaid expansion changed the adult threshold; child tests remain state-specific
Where states adopted Medicaid expansion, adults can qualify based on income alone at roughly 138% FPL (the statutory 133% plus the practical 5% calculation), while in non‑expansion states adult eligibility remains narrower and subject to categorical rules. Children’s Medicaid and CHIP limits remain expressed as percentages of FPL by state and therefore differ state-to-state [4] [3] [9].
6. How families experience the rules in real life — examples from state materials
State guidance frames the process as “If your income is the same or less, your child might be eligible for Children’s Medicaid; if higher, check CHIP limits,” illustrating how states operate the Medicaid-first then CHIP fallback for kids (Texas example) and Pennsylvania’s materials noting that if income is below CHIP’s bottom chart the child may be enrolled in Medicaid [10] [7] [6].
7. Where the data and official summaries are strongest — CMS and HealthCare.gov
CMS publishes tables and fast facts showing MAGI-based eligibility by state and emphasizes that states have flexibility within federal rules; HealthCare.gov underscores Medicaid expansion differences and provides tools to check state-specific eligibility for Medicaid, CHIP or Marketplace savings [2] [3] [11].
8. Limitations in current reporting and what’s not found here
Available sources document the rules, 5% disregard, state flexibility, and that Medicaid expansion status differs by state, but they do not provide a single, consolidated list of 2026 state-by-state numerical income limits for Medicaid and CHIP in this packet of documents — not found in current reporting [2] [3] [1].
9. What a parent should do next to resolve eligibility questions
Because states set the specific percent-of-FPL cutoffs, parents should check their state Medicaid or CHIP webpages or the CMS state tables to get the exact numeric limits and whether CHIP charges premiums or cost-sharing — HealthCare.gov and state agency pages can translate household size and monthly income into likely program fits [11] [3] [10].
Sources cited: CMS and federal summaries on MAGI, FPL and program design [3] [1] [2], state examples and guidance showing Medicaid-first then CHIP, and explanations of expansion effects [5] [10] [7] [6] [4].