Eligibility Levels for Coverage of Pregnant Women in Medicaid and CHIP
*Chart updated January 30, 2014
This chart provides eligibility levels for states’ coverage of services for pregnant women under Medicaid (Title XIX of the Social Security Act) and the Children’s Health Insurance Program (Title XXI of the Social Security Act) in 2013 and 2014. Coverage levels for 2014 include states’ modified adjusted gross income (MAGI)-converted eligibility levels. Every state provides “pregnancy-related Medicaid” coverage to pregnant women at income levels above the historic AFDC levels in place on May 1, 1988. (Below this level states are required to provide full Medicaid benefits to pregnant women.) Pregnancy-related Medicaid coverage is mandatory up to 133 percent of the federal poverty level (FPL); some states provide optional coverage up to or exceeding 185 percent FPL. States that opt for these higher coverage levels in Medicaid are also allowed to cover pregnant women through their state Children’s Health Insurance Program (CHIP). For CHIP, states also have the option to provide services to pregnant women through the CHIP “unborn child” coverage option.
This chart is based on information collected by the National Academy for State Health Policy (NASHP) from multiple sources.[1] To learn more about some of the new challenges related to pregnant women’s coverage, check out our new blog post: Coverage for Pregnant Women Under the ACA.
Know of something we should add to this chart? Eager to update a fact we’ve included? Your feedback is central to our ongoing, real-time analytical process, so tell us in a comment below, or email the author, Jennifer Dolatshahi, with your suggestion. She can be reached at jdolatshahi@oldsite.nashp.org.
This chart is based on information collected by the National Academy for State Health Policy (NASHP) from multiple sources.[1] To learn more about some of the new challenges related to pregnant women’s coverage, check out our new blog post: Coverage for Pregnant Women Under the ACA.
Know of something we should add to this chart? Eager to update a fact we’ve included? Your feedback is central to our ongoing, real-time analytical process, so tell us in a comment below, or email the author, Jennifer Dolatshahi, with your suggestion. She can be reached at jdolatshahi@oldsite.nashp.org.
| States | Pregnancy-related Medicaid, 2013 [2] (Title XIX) | Pregnancy-related Medicaid, 2014 [3] (Title XIX) | CHIP for pregnant women, 2013 [4] (Title XXI) | CHIP for pregnant women, 2014 [5] (Title XXI) | CHIP unborn child, 2013 [6] (Title XXI) |
|---|---|---|---|---|---|
| Alabama | 133% | 141% | |||
| Alaska | 175% | 200% | |||
| Arizona | 150% | 156% | |||
| Arkansas | 162% | 209% | 0 – 200% | ||
| California | 200% | 208% | 0 – 200%; 200 – 300% [7] |
||
| Colorado | 185% | 195% | 250% | 260% | |
| Connecticut | 250% | 258% | |||
| Delaware | 200% | 209% | |||
| District of Columbia | 185% | 206% [8] | 300% | 319% [8] | |
| Florida | 185% | 191% | |||
| Georgia | 200% | 220% | |||
| Hawaii | 185% | 191% | |||
| Idaho | 133% | 133% | |||
| Illinois | 200% | 208% | 0 – 200% | ||
| Indiana | 200% | 208% | |||
| Iowa | 300% | 375% | |||
| Kansas | 150% | 166% | |||
| Kentucky | 185% | 195% | |||
| Louisiana | 200% | 133% [9] | 0 – 200% | ||
| Maine | 200% | 209% | |||
| Maryland | 250% | 259% | |||
| Massachusetts | 200% | 200% | 0 – 200% | ||
| Michigan | 185% | 195% | 0 – 185% | ||
| Minnesota | 275% | 278% | 0 – 275% | ||
| Mississippi | 185% | 194% | |||
| Missouri | 185% | 205% | |||
| Montana | 150% | 159% | |||
| Nebraska | 185% | 194% | 0 – 185% | ||
| Nevada | 133% | 159% | |||
| New Hampshire | 185% | 196% | |||
| New Jersey | 185% | 194% | 200% | 200% | |
| New Mexico | 235% | 250% | |||
| New York | 200% | 218% | |||
| North Carolina | 185% | 196% | |||
| North Dakota | 133% | 147% | |||
| Ohio | 200% | 200% | |||
| Oklahoma | 185% | 133% [10] | 0 – 185% | ||
| Oregon [11] | 185% | 185% | 0 – 185% | ||
| Pennsylvania | 185% | 215% | |||
| Rhode Island | 185% | 190% | 250% | 253% | 0 – 250% |
| South Carolina | 185% | 194% | |||
| South Dakota | 133% | 133% | |||
| Tennessee | 185% | 195% | 0 – 250% | ||
| Texas | 185% | 198% | 0 – 200% | ||
| Utah | 133% | 139% | |||
| Vermont | 200% | 208% | |||
| Virginia | 133% | 143% | 200% | Stopped enrollment [12] | |
| Washington | 185% | 193% | 0 – 185% | ||
| West Virginia | 150% | 158% | |||
| Wisconsin | 300% | 301% | 0 – 300% | ||
| Wyoming | 133% | 154% | |||
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Notes:
Cells that are left blank indicate that the state does not operate that type of program.
[1] Sources include The Kaiser Family Foundation’s State Health Facts, the Centers for Medicare and Medicaid Services (CMS), and direct communication with state officials.
[2] The Kaiser Family Foundation, State Health Facts. “Income Eligibility Limits for Pregnant Women as a Percent of Federal Poverty Level (FPL), January 2013.” Accessed December 18, 2013. https://kff.org/Medicaid/state-indicator/income-eligibility-fpl-pregnant-women
[3] Unless otherwise noted, information is from: Centers for Medicare and Medicaid Services. “State Medicaid and CHIP Income Eligibility Standards Effective January 1, 2014.” Accessed December 18, 2013. https://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/D…. Eligibility levels include states’ modified adjusted gross income (MAGI) converted eligibility levels.
[4] Based on data collected from and confirmed by state CHIP officials by the National Academy for State Health Policy (NASHP) for the March of Dimes. Data is current as of October 30, 2013.
[5] Unless otherwise noted, information is from: Centers for Medicare and Medicaid Services. “State Medicaid and CHIP Income Eligibility Standards Effective January 1, 2014.” Accessed December 18, 2013. https://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/D…. Eligibility levels include states’ MAGI-converted eligibility levels.
[6] Based on data collected from and confirmed by state CHIP officials by NASHP for the March of Dimes. Data is current as of October 30, 2013. Unlike CHIP for pregnant women, eligibility levels for the unborn child coverage option can begin at 0% FPL and go up to the state’s upper CHIP eligibility level for children. All states listed here are continuing their unborn child coverage programs in 2014.
[7] California operates two programs under the CHIP unborn child coverage option with different state funding streams for the two income eligibility levels.
[8] Due to its MAGI-converted eligibility levels, in 2014, DC will claim Medicaid Title XIX match for pregnant women up to 206% FPL and enhanced CHIP Title XXI match for pregnant women with incomes 206% – 319% FPL. DC operates a Medicaid expansion CHIP program, which is identical to Medicaid. This information was confirmed through email correspondence with Colleen Sonosky, District of Columbia CHIP Director, on December 19, 2013.
[9] Louisiana reduced its eligibility level for pregnancy-related Medicaid to 133% FPL. Beginning January 1, 2014, pregnant women that were covered in Medicaid will be covered through the state’s CHIP unborn child coverage program.
[10] Oklahoma reduced its eligibility level for pregnancy-related Medicaid to 133% FPL. Beginning January 1, 2014, pregnant women that were covered in Medicaid will be covered through the state’s CHIP unborn child coverage program.
[11] Oregon provides coverage to pregnant women in its CHIP program only through the unborn child coverage option.
[12] On January 1, 2014, Virginia stopped new enrollment into its section 1115 waiver program that covers pregnant women in CHIP.
[1] Sources include The Kaiser Family Foundation’s State Health Facts, the Centers for Medicare and Medicaid Services (CMS), and direct communication with state officials.
[2] The Kaiser Family Foundation, State Health Facts. “Income Eligibility Limits for Pregnant Women as a Percent of Federal Poverty Level (FPL), January 2013.” Accessed December 18, 2013. https://kff.org/Medicaid/state-indicator/income-eligibility-fpl-pregnant-women
[3] Unless otherwise noted, information is from: Centers for Medicare and Medicaid Services. “State Medicaid and CHIP Income Eligibility Standards Effective January 1, 2014.” Accessed December 18, 2013. https://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/D…. Eligibility levels include states’ modified adjusted gross income (MAGI) converted eligibility levels.
[4] Based on data collected from and confirmed by state CHIP officials by the National Academy for State Health Policy (NASHP) for the March of Dimes. Data is current as of October 30, 2013.
[5] Unless otherwise noted, information is from: Centers for Medicare and Medicaid Services. “State Medicaid and CHIP Income Eligibility Standards Effective January 1, 2014.” Accessed December 18, 2013. https://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/D…. Eligibility levels include states’ MAGI-converted eligibility levels.
[6] Based on data collected from and confirmed by state CHIP officials by NASHP for the March of Dimes. Data is current as of October 30, 2013. Unlike CHIP for pregnant women, eligibility levels for the unborn child coverage option can begin at 0% FPL and go up to the state’s upper CHIP eligibility level for children. All states listed here are continuing their unborn child coverage programs in 2014.
[7] California operates two programs under the CHIP unborn child coverage option with different state funding streams for the two income eligibility levels.
[8] Due to its MAGI-converted eligibility levels, in 2014, DC will claim Medicaid Title XIX match for pregnant women up to 206% FPL and enhanced CHIP Title XXI match for pregnant women with incomes 206% – 319% FPL. DC operates a Medicaid expansion CHIP program, which is identical to Medicaid. This information was confirmed through email correspondence with Colleen Sonosky, District of Columbia CHIP Director, on December 19, 2013.
[9] Louisiana reduced its eligibility level for pregnancy-related Medicaid to 133% FPL. Beginning January 1, 2014, pregnant women that were covered in Medicaid will be covered through the state’s CHIP unborn child coverage program.
[10] Oklahoma reduced its eligibility level for pregnancy-related Medicaid to 133% FPL. Beginning January 1, 2014, pregnant women that were covered in Medicaid will be covered through the state’s CHIP unborn child coverage program.
[11] Oregon provides coverage to pregnant women in its CHIP program only through the unborn child coverage option.
[12] On January 1, 2014, Virginia stopped new enrollment into its section 1115 waiver program that covers pregnant women in CHIP.
Chart produced by Jennifer Dolatshahi.
NASHP’s research on coverage of services for pregnant women in CHIP was funded by the March of Dimes. Support for this chart was provided by Maximizing Enrollment: Transforming State Health Coverage, a Robert Wood Johnson Foundation national initiative.
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