How long does Medicaid last for a child?

Health insurance represents peace of mind for all those who hire this service, but many times acquiring health insurance can be very expensive for families. It is for this reason (and some others) that our national government offers programs so that low-income families can acquire this type of service at a price that suits their budgets, but without ceasing to receive quality health care. In this article, you will find key information about Medicaid for children.

Medicaid offers health coverage services throughout the U.S’ state agencies that receive and administer applications and benefits.

To know more about how to request these benefits for your children, read until the end of this article and your doubts will surely be dispelled.

What is CHIP?

The Children’s Health Insurance Program (CHIP) is a federal and state program that offers health coverage to children (from birth to 19 years of age) belonging to families who have very high incomes to receive Medicaid, but at the same time, not enough to hire private health insurance.

Once families apply and it is approved, they will receive benefits such as doctor visits and routine check-ups, immunizations and x-ray services, laboratory exams, and even dental and vision care.

Families who benefit from this program, at a low cost, also receive mental health services, inpatient and outpatient hospital care, and emergency services for their children.

Although CHIP is a federal program, state agencies are in charge of administering these benefits. Therefore, depending on the state where you live, there may be more benefits.

CHIP effective dates

A very common question when it comes to programs that offer assistance to families with children is how long the children are eligible or qualify for these benefits.

Generally, in the case of Medicaid for a child or CHIP, children will be covered until the last day of the month on which they turn 19 years of age (until that, they remain as qualified children). For example: if you have a child who turns 19 on January 15th, the coverage will be effective until January 31st, as of February they will not have coverage anymore.

All you have to do is renew the coverage once a year. The agency itself will contact you when it is time.

However, there are specific cases where 20-year-olds still have Medicaid coverage, for example, 19 or 20-year-olds with disabilities. But this will depend on family income and other circumstances from each case, in addition to the regulations of the state where you make your application. On this page, you can select your state of residence and you will see the contact information on the screen.

medicaid contact us

What is the eligibility to receive Medicaid for a child?

The first thing you should pay attention to when applying is the amount of your income. Through the Affordable Care Act of 2010, it was established that for this type of program, income must be calculated based on your Modified Adjusted Gross Income (MAGI), which is nothing more than your Adjusted Gross Income (AGI) plus non-taxable Social Security benefits, untaxed foreign income, and tax-exempt interest.

The second step is checking if your income is within the range of income limits for the state where you live. Generally, eligibility based on income limits for Medicaid for a child is assessed depending on the level of the Federal Poverty Level (FPL).

On the official Medicaid page, you can find the income limits expressed in percentages with respect to the FPL. Some states do not use percentages but the amount in dollars ($), so you may check the official page of the state where you are going to make the request.

Once you’ve calculated your income, the third thing to check is the number of people who live with you, as income limits also vary depending on the number of dependents you have.

For example, in the state of Texas, income-based eligibility limits are expressed in dollars. In the following picture (taken from the Texas Health and Human Services website), you can verify this information.

texas income limites for child medicaid

Next, the child whose coverage you are requesting must be under 18 years of age (remember the exceptions that we explained above), be a US citizen or, if a foreigner, meet the immigration requirements, and be a resident of the state where they apply for benefits.

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Applicant requirements

Any parent who wants to apply to Medicaid for a child is allowed to do it. Similarly, any adult who is in charge of a child can do so (legal guardians, grandparents, step-parents).

Likewise, if you are a child under 18 years of age living on your own, you can also apply (this will depend on the regulations of your state). If you cannot, an adult can do it on your behalf.

Pregnant women

This program is also meant for pregnant women who do not have health insurance and are considered low-income based on the FPL. There is no age limit in these cases.

Generally, your income should be about 185% of the FPL. However, remember that each state sets its income limits based on the cost of living in each area.

For the baby who has been born under this type of coverage, an extension on the insurance plan is made until they turn one year of age, and to continue receiving benefits, the mother must apply normally.

How to apply for Medicaid for a Child

You can do it in 2 ways, through the Medicaid State Agency in the area where you live or through the Health Insurance Marketplace by creating an account and following the steps.