If your family earns too much for Medicaid but still struggles to afford private health coverage for your kids, CHIP may cover them at little or no cost. The Children's Health Insurance Program sets income limits as a percentage of the federal poverty level, and those limits vary significantly by state. In 2026, most states cover children in families earning anywhere from 200% to 317% of the federal poverty level, with a handful of states reaching as high as 405% FPL. This guide breaks down what those numbers mean in actual dollars, which states have the highest limits, and exactly how to apply.
What Is CHIP?
CHIP stands for the Children's Health Insurance Program. It was created in 1997 to cover children in families who earn too much to qualify for Medicaid but cannot afford private insurance. The federal government funds CHIP jointly with each state, and states set their own income limits within federal guidelines.
Coverage under CHIP is comprehensive. All states must provide:
- Regular well-child checkups and immunizations
- Doctor visits
- Prescription drugs
- Dental and vision care
- Emergency services
- Mental health and substance use disorder treatment
- Hospitalization
The cost depends on your income. Families at the lower end of the eligibility range often pay nothing. Those closer to the upper income limit may pay small premiums (typically under $50 per month) and modest copays. Federal law caps out-of-pocket costs at no more than 5% of family income per year.
2026 Federal Poverty Level Reference Table
CHIP eligibility is expressed as a percentage of the federal poverty level (FPL). The 2026 FPL guidelines, which took effect January 2026, are listed below for the 48 contiguous states and Washington D.C.
| Household Size | Annual Income (100% FPL) |
|---|
| 1 person | $15,960 |
| 2 people | $21,640 |
| 3 people | $27,320 |
| 4 people | $33,000 |
| 5 people | $38,680 |
| 6 people | $44,360 |
| 7 people | $50,040 |
| 8 people | $55,720 |
For each additional person beyond 8, add $5,680. Alaska and Hawaii use higher FPL figures due to cost of living differences.
CHIP Income Limits at a Glance: What 200% to 400% FPL Looks Like
Most families want to know one thing: does our income qualify? The table below shows annual income limits at common CHIP percentage thresholds for a family of four.
| FPL Percentage | Annual Income (Family of 4) | Monthly Income (Family of 4) |
|---|
| 150% FPL | $49,500 | $4,125 |
| 175% FPL | $57,750 | $4,813 |
| 200% FPL | $66,000 | $5,500 |
| 250% FPL | $82,500 | $6,875 |
| 300% FPL | $99,000 | $8,250 |
| 317% FPL | $104,610 | $8,718 |
| 355% FPL | $117,150 | $9,763 |
| 400% FPL | $132,000 | $11,000 |
Note: These figures use 2026 FPL for the 48 contiguous states. Income is measured using Modified Adjusted Gross Income (MAGI).
CHIP Income Limits by State (2025-2026)
Each state sets its own CHIP income ceiling. The following table shows the upper income limit for CHIP eligibility by state, expressed as a percentage of FPL. Most of these figures reflect 2025 data that carries into 2026 program years; states update limits when they revise their state plans.
| State | Upper CHIP Income Limit (% FPL) |
|---|
| Alabama | 317% |
| Alaska | 175% |
| Arizona | 230% |
| Arkansas | 211% |
| California | 317% |
| Colorado | 260% |
| Connecticut | 323% |
| Delaware | 212% |
| Florida | 215% |
| Georgia | 247% |
| Hawaii | 317% |
| Idaho | 190% |
| Illinois | 317% |
| Indiana | 250% |
| Iowa | 307% |
| Kansas | 238% |
| Kentucky | 218% |
| Louisiana | 250% |
| Maine | 208% |
| Maryland | 317% |
| Massachusetts | 317% |
| Michigan | 212% |
| Minnesota | 275% |
| Mississippi | 209% |
| Missouri | 225% |
| Montana | 261% |
| Nebraska | 209% |
| Nevada | 200% |
| New Hampshire | 317% |
| New Jersey | 355% |
| New Mexico | 235% |
| New York | 405% |
| North Carolina | 217% |
| North Dakota | 175% |
| Ohio | 212% |
| Oklahoma | 215% |
| Oregon | 300% |
| Pennsylvania | 317% |
| Rhode Island | 261% |
| South Carolina | 209% |
| South Dakota | 211% |
| Tennessee | 250% |
| Texas | 206% |
| Utah | 205% |
| Vermont | 317% |
| Virginia | 200% |
| Washington | 312% |
| West Virginia | 218% |
| Wisconsin | 306% |
| Wyoming | 200% |
| Washington D.C. | 323% |
Source: KFF State Health Facts, based on January 2025 eligibility updates. States may update limits during 2026.
Who Qualifies for CHIP?
Income is only one part of eligibility. Your child also needs to meet these requirements:
Age: CHIP covers children up to age 19. Some states also offer CHIP coverage to pregnant women.
Residency: Your child must live in the state where you apply.
Citizenship or immigration status: U.S. citizens qualify automatically. Lawful permanent residents and certain other qualified immigrants can also enroll, though some states have waiting periods for new immigrants.
No other qualifying coverage: Children who are already enrolled in employer-sponsored insurance or another qualifying health plan generally do not qualify. There are exceptions in some states, and CHIP can sometimes supplement other coverage.
Not Medicaid-eligible: Medicaid covers lower-income children. CHIP fills the gap for families earning too much for Medicaid but below the CHIP income ceiling.
How CHIP Handles Medicaid vs. CHIP Coverage
When you apply for CHIP, the state will first check whether your child qualifies for Medicaid. If your income is low enough (typically under 138% FPL in expansion states, but higher for children in most states), your child will be enrolled in Medicaid instead. If your income is above the Medicaid limit but below the CHIP limit, your child will be enrolled in CHIP.
The practical difference: Medicaid is usually free. CHIP may involve small premiums and copays depending on your income. Both programs provide comprehensive coverage.
How to Apply for CHIP in 2026
Applying is free and can be done online, by phone, or in person. Here is the step-by-step process:
Step 1: Gather your documents. You will need proof of income (pay stubs, W-2s, or a recent tax return), proof of your child's age (birth certificate or passport), proof of residency (a utility bill or lease), and Social Security numbers for household members.
Step 2: Choose how to apply.
- Online: Go to HealthCare.gov and complete the application there. The site checks eligibility for Medicaid, CHIP, and Marketplace plans in one form. You can also apply directly through your state's Medicaid or CHIP website.
- By phone: Call the federal Marketplace at 1-800-318-2596 (TTY: 1-855-889-4325). Representatives can walk you through the application and help determine which program your child qualifies for.
- In person: Find a local enrollment assister through HealthCare.gov's "Find Local Help" tool. Community health centers, social service agencies, and hospital social workers can often help.
Step 3: Submit your application. The application asks for household size, income, existing health coverage, and basic information about your child.
Step 4: Receive a determination. Most states process CHIP applications within 30 to 45 days. Some states provide expedited decisions for children without any current coverage. You will receive written notice of approval or denial.
Step 5: Enroll your child. Once approved, you will receive information about choosing a plan (if your state uses a managed care model) and your child's coverage start date. Coverage is typically approved for 12 months.
Step 6: Renew annually. Each year, the state will send renewal paperwork. Respond promptly to avoid a gap in coverage. Many states now use passive renewal if your income information is available through tax records.
What CHIP Covers
CHIP benefits are comprehensive by law. All states must cover these services:
- Well-child visits and preventive care
- Immunizations
- Doctor visits (primary and specialty care)
- Inpatient and outpatient hospital care
- Prescription drugs
- Dental care
- Vision care, including eye exams and glasses
- Emergency room visits
- Mental health services
- Substance use disorder treatment
- Lab work and X-rays
States can add extra benefits, and many do. Some states include hearing services, physical therapy, and home health services.
What CHIP Costs
Cost-sharing under CHIP depends on your state and income level.
For families below 150% FPL: Most states charge no premiums and no copays for most services. Routine well-child visits are free in all states.
For families between 150% and 200% FPL: Some states charge small monthly premiums, typically under $20 per child. Copays for office visits are often $5 or less.
For families above 200% FPL: Premiums and copays are generally higher but still far below private insurance. Federal law caps total CHIP cost-sharing at 5% of family income annually.
Copay examples (varies by state):
- Well-child visits: usually $0
- Sick visits: $3 to $10
- Specialty visits: $5 to $20
- Emergency room (non-emergency use): up to $15
- Prescription drugs: $3 to $10 per prescription
If Your Child Is Denied
If your child is denied CHIP coverage, you have options:
- Request a fair hearing. Every state must offer an appeals process. The denial notice will include instructions on how to file an appeal.
- Check for Medicaid. If income dropped or was calculated differently, your child might qualify for Medicaid instead.
- Check the Marketplace. Children who don't qualify for CHIP or Medicaid can be covered through a Marketplace plan. Premium tax credits may significantly reduce the cost.
- Look at state programs. Some states have additional children's health programs outside of federal CHIP funding.
Use the Benefits Screener
Not sure which programs your child qualifies for? The Benefits Navigator screener checks eligibility for CHIP, Medicaid, and 11 other federal and state programs based on your household size, income, and location. It takes about 3 minutes and shows estimated benefits at no cost.
Frequently Asked Questions
What are the CHIP income limits for 2026?
CHIP income limits vary by state and range from roughly 170% to 405% of the federal poverty level. For a family of four, that translates to approximately $56,100 to $133,650 per year, depending on where you live. States set their own limits within federal guidelines, so the limit in your state may be higher or lower than the national range.
Does CHIP cover dental and vision?
Yes. All state CHIP programs must cover dental care and the majority cover vision services including eye exams and corrective lenses. Specific services covered and any associated copays vary by state.
Can a child qualify for CHIP if a parent has insurance through work?
In most cases, children who are enrolled in or eligible for employer-sponsored insurance do not qualify for CHIP. However, some states allow children to enroll in CHIP even if a parent has employer coverage, particularly if that coverage is unaffordable or doesn't cover children. Check your state's specific rules.
How long does it take to get approved for CHIP?
Most states process CHIP applications within 30 to 45 days. Some states have expedited processes for uninsured children. Once approved, coverage typically starts within a few weeks and lasts 12 months.
Is there an open enrollment period for CHIP?
No. CHIP has year-round enrollment. You can apply any time during the year and your child can start coverage immediately upon approval, with no waiting for an enrollment window.
What is the difference between Medicaid and CHIP?
Medicaid covers lower-income children, usually free of charge. CHIP covers children in families with somewhat higher incomes who still can't afford private insurance. Both programs provide comprehensive coverage, but CHIP may involve small premiums and copays that Medicaid does not charge. When you apply, the state determines which program your child qualifies for.
Does immigration status affect CHIP eligibility?
U.S. citizens are fully eligible. Lawful permanent residents and certain qualified immigrants can generally enroll in CHIP, though some states have a 5-year waiting period for newly arrived immigrants. Undocumented children are not eligible for federally funded CHIP, but some states have state-funded programs that provide coverage regardless of immigration status.
My income changed mid-year. Do I need to report it?
Yes. If your income changes significantly, report it to your state's CHIP or Medicaid office. A decrease in income may make your child eligible for Medicaid (which is typically free). An increase that puts your family above the CHIP limit means your child's coverage may not be renewed at the next annual redetermination.
Can children age out of CHIP?
CHIP covers children up to age 19. When a child turns 19, CHIP coverage ends. At that point, young adults may qualify for Medicaid (in expansion states, adults qualify up to 138% FPL), a parent's employer plan until age 26, or a Marketplace plan with potential premium subsidies.
