What is the income limit for Medicaid for children in 2026?

Income limits vary by state. Most states cover children up to 200–300% of the Federal Poverty Level (FPL). At 200% FPL, a family of four can earn up to approximately $62,400 per year. CHIP extends coverage further in states with higher thresholds. Some states cover children up to 400% FPL.

What is the difference between Medicaid and CHIP for children?

Medicaid is a joint federal-state program for the lowest-income families — children typically qualify at 133–138% FPL. CHIP (Children's Health Insurance Program) fills the gap for children in families that earn too much for Medicaid but cannot afford private insurance, generally covering up to 200–300% FPL depending on the state.

How do I apply for Medicaid or CHIP for my child?

You can apply through your state's Medicaid agency, through HealthCare.gov, by calling 1-800-318-2596, or in person at your local Medicaid office. Many states also allow same-day presumptive eligibility so your child can receive care while the full application is processed.

Can my child get Medicaid if I am undocumented?

Children who are US citizens (including children born in the US to undocumented parents) are eligible for Medicaid based on their own citizenship status, not their parents'. Undocumented children may qualify for emergency Medicaid in most states, and some states offer full state-funded coverage regardless of immigration status.

Is there a cost for children's Medicaid?

Standard Medicaid for children has no premiums and no copayments for most services. CHIP may have modest premiums (typically $0–$50/month per child) and small copayments for some services. Costs depend on the state and the family's income level.

Medicaid for Children 2026: Eligibility, Income Limits & How to Apply

Q: What does Medicaid cover for children?

Medicaid for children covers well-child visits, immunizations, doctor visits, hospital care, prescription drugs, mental health services, dental care, vision care including glasses, and hearing aids. The EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) benefit ensures broad coverage for all medically necessary services.

Health insurance for children is not a luxury — it is a necessity that determines whether kids receive timely care or fall through the cracks. For millions of American families, Medicaid and CHIP (Children's Health Insurance Program) provide free or low-cost comprehensive coverage for children under 19, regardless of pre-existing conditions.

In 2026, approximately 37 million children are enrolled in Medicaid or CHIP, making it the largest source of health coverage for American kids. Yet millions more who qualify have never applied. This guide covers eligibility rules, income limits, what's covered, and exactly how to enroll.

Medicaid vs. CHIP: Understanding the Two Programs

Both Medicaid and CHIP are jointly funded by the federal government and states, but they serve different income levels:

Program	Who It Covers	Typical Income Range	Cost to Family
Medicaid	Lowest-income children	Up to 133–138% FPL	Free (no premiums, no copays)
CHIP	Low-to-moderate income	138% to 200–300% FPL	Low premiums, small copays
Medicaid expansion (some states)	Higher thresholds	Up to 400% FPL	Varies

FPL (Federal Poverty Level) for 2026:

Family of 1: $15,650
Family of 2: $21,150
Family of 3: $26,650
Family of 4: $32,150
Each additional person: +$5,500

Income Limits by Family Size (2026)

Most states cover children at 200% FPL or higher. Here are the annual gross income thresholds at common coverage levels:

Family Size	138% FPL (Medicaid)	200% FPL (CHIP common)	300% FPL (higher states)
2	$29,187	$42,300	$63,450
3	$36,777	$53,300	$79,950
4	$44,367	$64,300	$96,450
5	$51,957	$75,300	$112,950
6	$59,547	$86,300	$129,450

States with the highest CHIP income limits (as of 2026): New York (400% FPL), New Jersey (350% FPL), and California (266% FPL) provide the most generous coverage. Always check your specific state's thresholds, as they are updated annually.

What Does Medicaid Cover for Children?

Children enrolled in Medicaid are entitled to EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) services — a comprehensive benefit unique to Medicaid for those under 21. EPSDT requires states to cover all medically necessary services, even services not covered for adults.

Covered Services

Preventive care:

Well-child exams at recommended intervals (14 visits from birth through age 21)
Immunizations and vaccines
Developmental screenings
Lead level testing

Medical care:

Inpatient and outpatient hospital care
Doctor visits (primary care and specialists)
Prescription drugs
Lab tests and X-rays
Mental health and behavioral health services
Substance use disorder treatment

Dental care:

Routine checkups and cleanings
Fillings and extractions
Orthodontia if medically necessary

Vision care:

Annual eye exams
Eyeglasses (frames and lenses)
Contact lenses when medically indicated

Hearing:

Hearing evaluations
Hearing aids
Follow-up services

Therapy:

Speech therapy
Physical therapy
Occupational therapy

How to Apply for Medicaid or CHIP

Option 1: Apply Online at HealthCare.gov

Go to healthcare.gov and complete a coverage application. The system will automatically determine if your child qualifies for Medicaid, CHIP, or a subsidized marketplace plan.

Option 2: Apply Directly Through Your State

Every state has a Medicaid agency with an online portal. Search "your state Medicaid application" or go to medicaid.gov/state-overviews for direct links to all 50 states.

Option 3: Call the Marketplace

Call 1-800-318-2596 (24/7) to apply by phone and get enrollment assistance.

Option 4: In-Person Assistance

Local Medicaid offices, community health centers, hospitals, and school-based clinics often have enrollment counselors who can help you apply for free.

Documents You May Need

Proof of child's identity (birth certificate)
Proof of citizenship or immigration status (for the child)
Social Security Numbers for the child and applying parent
Proof of household income (pay stubs, tax returns, benefits letters)
Proof of address (utility bill, lease)

Presumptive eligibility: Many states offer same-day or immediate temporary coverage while your full application is reviewed, so your child can see a doctor the same day you apply.

Enrollment Periods and Special Rules

Unlike marketplace insurance, Medicaid and CHIP have no open enrollment period. You can apply any time of year, and coverage begins quickly — often within days of approval.

Special situations:

A newborn baby is automatically enrolled in Medicaid at birth if the mother is enrolled, and coverage is retroactive to the date of birth
A child who loses other health insurance (job-based, COBRA, etc.) qualifies for a Special Enrollment Period
Foster children and children in state custody are automatically eligible for Medicaid regardless of income

CHIP may involve small costs depending on your state and income:

Income Level	Typical Monthly Premium	Copays
Below 150% FPL	Usually $0	Little or none
150–200% FPL	$0–$25 per family	$1–$5 per visit
200–300% FPL	$25–$50 per family	$5–$10 per visit
Above 300% FPL	Varies widely	Varies

Federal rule: CHIP cost-sharing cannot exceed 5% of annual family income for families enrolled in CHIP. For most families, the out-of-pocket costs remain very low.

Maintaining Coverage: Renewal

Medicaid and CHIP eligibility is reviewed annually. Most states now conduct automatic renewals using data from other government sources (IRS, SSA, state wage records). If your income hasn't changed significantly, you may be renewed without doing anything.

If your state cannot automatically verify eligibility, you will receive a renewal notice asking you to provide updated information. Missing this deadline causes a coverage gap — return the renewal paperwork promptly.

Medicaid for children is often just the starting point. Eligible families frequently qualify for additional support:

WIC Benefits 2026 — free nutrition support for children under 5 and pregnant mothers, free regardless of Medicaid status
SNAP Benefits Calculator 2026 — food assistance for the whole household
Child Tax Credit 2026 — up to $2,000 per child in tax refunds

Use our Family Benefits Calculator to estimate your total benefit entitlement.

WIC Benefits 2026 — nutrition assistance for children under 5
Child Tax Credit 2026 — federal tax credit for families with children
SNAP Benefits Calculator 2026 — food assistance eligibility and amounts

Medicaid for Children 2026: Eligibility, Income Limits & How to Apply

Medicaid for Children 2026: Eligibility, Income Limits & How to Apply

Frequently Asked Questions