What families qualify for CHIP versus Medicaid at 138% and 250% FPL in 2026?
Executive summary
Medicaid expansion states generally cover most adults up to 138% of the federal poverty level (FPL), while CHIP must cover children whose family income is above the Medicaid threshold but limited by statute to at least the higher of 200% FPL or “50 percentage points above the Medicaid applicable income level” (the pre‑CHIP 1997 Medicaid upper level) — this statutory floor often results in CHIP eligibility extending into the 200–250% FPL range for many states [1] [2]. State practice varies: some states set children’s CHIP eligibility at or near 250% FPL (median historically around 250%), while Medicaid child limits and adult limits differ by state [3] [2].
1. Who hits 138% FPL — the Medicaid cutoff in expansion states
138% FPL is the practical Medicaid income ceiling in states that adopted the ACA expansion; adults under 65 in those states qualify for Medicaid based on income alone at that threshold (the statute’s 133% translates to ~138% under rules), and that is the dividing line where marketplace premium tax credit eligibility typically begins above Medicaid [1] [4]. Sources emphasize that a handful of states use different limits, so 138% is a general rule for expansion states, not a universal number [1] [5].
2. What CHIP covers above Medicaid and the statutory minimums
CHIP exists to insure children in families “too rich for Medicaid but too poor to afford private coverage.” Federal law requires CHIP eligibility to reach at least the higher of 200% FPL or Medicaid’s old 1997 upper level (expressed as “50 percentage points above the Medicaid applicable income level”), which effectively forces CHIP upper limits to sit at or above 200% FPL in most states [2] [6]. MACPAC and CMS reporting note that states often set CHIP cutoffs substantially above that floor — historically medians have been around 250% FPL for children [3].
3. How 138% and 250% FPL operate together for families with children
When a family’s income is at 138% FPL in an expansion state, non‑elderly adults generally qualify for Medicaid; children in the same household may be eligible for Medicaid as well if state child thresholds reach that level. If family income exceeds the state’s Medicaid ceiling but is below the state’s CHIP ceiling (often 200–250% FPL), children are eligible for CHIP while adults are not — that is the fundamental Medicaid/CHIP split created by federal rules [1] [6] [7].
4. State variation matters — examples and caveats
States determine exact cutoffs for child Medicaid and CHIP within federal bounds. Some states (e.g., New York) have child coverage thresholds much higher than federal minimums — sources cite New York’s Child Health Plus reaching very high FPL percentages [8] [9]. Other states use the 5% MAGI disregard and determine eligibility first for Medicaid, then for CHIP; Mississippi’s guidance shows that operational detail matters at application [10] [7]. Therefore a family at 138% in one state may be fully on Medicaid, while a family at 250% in another state may still have children on CHIP — specifics require the state’s income charts [10] [11].
5. Pregnant women and special groups alter the lines
Federal guidance and state practice create special, higher thresholds for some groups: pregnant women frequently qualify at substantially higher percentages (examples show pregnant women qualifying at 205% in New Jersey and other states with elevated limits), so the simple “138% adult / 200–250% CHIP” rule does not apply uniformly to pregnant people or to some child‑specific pathways [12] [13]. MACPAC also notes maintenance‑of‑effort protections for children up to certain FPL levels that preserve more generous state rules through specified years [3].
6. What the numbers mean for a family deciding where they qualify in 2026
If your household income is at or below 138% FPL in a Medicaid expansion state, adults and many children will be eligible for Medicaid; if income is above Medicaid but below your state’s CHIP ceiling (which must be at least 200% FPL and in practice is commonly around 250% for many states), children can get CHIP while adults will look to the marketplace for subsidies starting above the Medicaid line [1] [2] [3]. To determine exact eligibility for a specific family size in 2026 you must consult that state’s 2025 FPL‑based tables and the state Medicaid/CHIP income charts because states apply the federal poverty guidelines and the MAGI rules with state‑specific cutoffs and occasional disregards [14] [10].
Limitations and next steps: available sources do not supply a single nationwide table mapping 138% and 250% to every family size in every state; use your state Medicaid/CHIP website or KFF’s state data to get exact dollar thresholds and program names for 2026 [10] [15].