Premiums and cost sharing in CHIP

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The Children's Health Insurance Program (CHIP) is a public healthcare program for children in low-income families that make too much to qualify for Medicaid. Under CHIP, states have greater flexibility than in Medicaid to require enrollees to pay monthly premiums or cost-sharing amounts such as copayments. Like in Medicaid, the total cost of these payments for enrollees may not exceed 5 percent of household income, but states do not need a waiver to charge premiums and cost sharing under CHIP like they do under Medicaid.

The tables below display Medicaid and CHIP premium and cost-sharing requirements for families with enrolled children. The tables also show the lowest income level—as a percentage of the federal poverty level—at which such requirements began to apply. For states that did not run a separate CHIP program, but instead served CHIP enrollees through Medicaid, the appropriate data fields are filled with N/A for Not Applicable.

2017

As of January 2017, 14 states charged only premiums to CHIP enrollees, while nine states required only cost sharing. Sixteen states required both premiums and cost sharing. Eleven states did not require either premiums or cost sharing. Because of the tighter restrictions on premiums and cost sharing under Medicaid, just three of the nine states that serve CHIP enrollees exclusively through Medicaid imposed either requirement on enrollees.

Click here to view a table displaying various percentages of the 2016 federal poverty level as dollar amounts.

Premiums and cost sharing for Medicaid and CHIP enrollees, 2017
State	Premiums/enrollment fees			Cost sharing
	Required in Medicaid	Required in CHIP	Income level	Required in Medicaid	Required in CHIP	Income level
Alabama	No	Yes	141% FPL	No	Yes	141% FPL
Alaska	No	No	N/A	No	No	N/A
Arizona	No	Yes	133% FPL	No	No	N/A
Arkansas	No	No	N/A	No	Yes	142% FPL
California	Yes	N/A	160% FPL	No	N/A	N/A
Colorado	No	Yes	157% FPL	No	Yes	142% FPL
Connecticut	No	Yes	249% FPL	No	Yes	196% FPL
Delaware	No	Yes	142% FPL	No	No	No
Florida	No	Yes	133% FPL	No	Yes	133% FPL
Georgia	No	Yes	133% FPL	No	Yes	138% FPL
Hawaii	No	N/A	No	No	N/A	No
Idaho	No	Yes	142% FPL	No	Yes	142% FPL
Illinois	No	Yes	157% FPL	No	Yes	142% FPL
Indiana	No	Yes	158% FPL	No	Yes	158% FPL
Iowa	No	Yes	182% FPL	No	Yes	182% FPL
Kansas	No	Yes	166% FPL	No	No	N/A
Kentucky	No	No	N/A	No	Yes	143% FPL
Louisiana	No	Yes	213% FPL	No	No	N/A
Maine	No	Yes	157% FPL	No	No	N/A
Maryland	Yes	N/A	211% FPL	No	N/A	N/A
Massachusetts	No	Yes	150% FPL	No	No	N/A
Michigan	Yes	N/A	160% FPL	No	N/A	N/A
Minnesota	No	N/A	N/A	No	N/A	N/A
Mississippi	No	No	N/A	No	Yes	150% FPL
Missouri	No	Yes	150% FPL	No	No	No
Montana	No	No	No	No	Yes	143% FPL
Nebraska	No	N/A	N/A	No	N/A	N/A
Nevada	No	Yes	133% FPL	No	No	N/A
New Hampshire	No	N//A	N/A	No	N/A	N/A
New Jersey	No	Yes	200% FPL	No	Yes	150% FPL
New Mexico	No	N/A	N/A	Yes	N/A	190% FPL
New York	No	Yes	160% FPL	No	No	N/A
North Carolina	No	Yes	159% FPL	No	Yes	133% FPL
North Dakota	No	No	N/A	No	Yes	133% FPL
Ohio	No	N/A	N/A	No	N/A	N/A
Oklahoma	No	N/A	N/A	No	N/A	N/A
Oregon	No	No	N/A	No	No	N/A
Pennsylvania	No	Yes	208% FPL	No	Yes	208% FPL
Rhode Island	No	N/A	N/A	No	N/A	N/A
South Carolina	No	N/A	N/A	No	N/A	N/A
South Dakota	No	No	N/A	No	No	N/A
Tennessee	No	No	N/A	Yes	Yes	100% FPL
Texas	No	Yes	150% FPL	No	Yes	133% FPL
Utah	No	Yes	133% FPL	No	Yes	133% FPL
Vermont	Yes	N/A	195% FPL	No	N/A	N/A
Virginia	No	No	N/A	No	Yes	143% FPL
Washington	No	Yes	210% FPL	No	No	N/A
West Virginia	No	Yes	211% FPL	No	Yes	133% FPL
Wisconsin	No	Yes	200% FPL	No	Yes	133% FPL
Wyoming	No	No	N/A	No	Yes	133% FPL
Source: The Henry J. Kaiser Family Foundation, "Premium, Enrollment Fee, and Cost Sharing Requirements for Children, January 2017"

2017 federal poverty levels as dollar amounts

Incomes as percentage of 2017 federal poverty level
Family size	100% FPL	138% FPL	200% FPL	250% FPL	300% FPL	400% FPL
1	$12,060	$16,643	$24,120	$30,150	$36,180	$48,240
2	$16,240	$22,411	$32,480	$40,600	$48,720	$64,960
3	$20,420	$28,180	$40,840	$51,050	$61,260	$81,680
4	$24,600	$33,948	$49,200	$61,500	$73,800	$98,400
Source: Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, "Poverty Guidelines" Amounts above 100 percent FPL calculated by Ballotpedia.

2016

Nationwide, nine states charged only premiums to CHIP enrollees in 2016, while eight states required cost sharing. Seventeen states required both premiums and cost sharing. Two states, Oregon and South Dakota, did not require either premiums or cost sharing. Because of the tighter restrictions on premiums and cost sharing under Medicaid, just five of the 15 states that serve CHIP enrollees exclusively through Medicaid impose either requirement on enrollees.

Click [show] on the red bar below to view the data. Click here to view a table displaying various percentages of the 2016 federal poverty level as dollar amounts.

Premiums and cost sharing for Medicaid and CHIP enrollees, 2016
State	Premiums/enrollment fees			Cost sharing
	Required in Medicaid	Required in CHIP	Income level	Required in Medicaid	Required in CHIP	Income level
Alabama	No	Yes	141%	No	Yes	141%
Alaska	No	N/A	N/A	No	N/A	N/A
Arizona	No	Yes	133%	No	No	N/A
Arkansas	No	No	N/A	No	Yes	142%
California	Yes	N/A	160%	No	N/A	N/A
Colorado	No	Yes	157%	No	Yes	142%
Connecticut	No	Yes	249%	No	Yes	196%
Delaware	No	Yes	142%	No	Yes	142%
District of Columbia	No	N/A	N/A	No	N/A	N/A
Florida	No	Yes	133%	No	Yes	133%
Georgia	No	Yes	133%	No	Yes	133%
Hawaii	No	N/A	N/A	No	N/A	N/A
Idaho	No	Yes	142%	No	Yes	142%
Illinois	No	Yes	157%	No	Yes	142%
Indiana	No	Yes	158%	No	Yes	158%
Iowa	No	Yes	182%	No	Yes	182%
Kansas	No	Yes	166%	No	No	N/A
Kentucky	No	No	N/A	No	Yes	139%
Louisiana	No	Yes	212%	No	No	N/A
Maine	No	Yes	157%	No	No	N/A
Maryland	Yes	N/A	211%	No	N/A	N/A
Massachusetts	No	Yes	150%	No	No	N/A
Michigan	Yes	N/A	160%	No	N/A	N/A
Minnesota	No	N/A	N/A	No	N/A	N/A
Mississippi	No	No	N/A	No	Yes	150%
Missouri	No	Yes	150%	No	No	N/A
Montana	No	No	N/A	No	Yes	142%
Nebraska	No	N/A	N/A	No	N/A	N/A
Nevada	No	Yes	133%	No	No	N/A
New Hampshire	No	N/A	N/A	No	N/A	N/A
New Jersey	No	Yes	200%	No	Yes	150%
New Mexico	No	N/A	N/A	Yes	N/A	190%
New York	No	Yes	160%	No	No	N/A
North Carolina	No	Yes	159%	No	Yes	133%
North Dakota	No	No	N/A	No	Yes	133%
Ohio	No	N/A	N/A	No	N/A	N/A
Oklahoma	No	N/A	N/A	No	N/A	N/A
Oregon	No	No	N/A	No	No	N/A
Pennsylvania	No	Yes	208%	No	Yes	208%
Rhode Island	No	N/A	N/A	No	N/A	N/A
South Carolina	No	N/A	N/A	No	N/A	N/A
South Dakota	No	No	N/A	No	No	N/A
Tennessee	No	No	N/A	Yes	Yes	100%
Texas	No	Yes	150%	No	Yes	133%
Utah	No	Yes	133%	No	Yes	133%
Vermont	Yes	N/A	195%	No	N/A	N/A
Virginia	No	No	N/A	No	Yes	143%
Washington	No	Yes	210%	No	No	N/A
West Virginia	No	Yes	211%	No	Yes	133%
Wisconsin	No	Yes	200%	Yes	Yes	133%
Wyoming	No	No	N/A	No	Yes	133%
United States	4 Yes	26 Yes	N/A	3 Yes	25 Yes	N/A
Source: The Henry J. Kaiser Family Foundation, "Premiums, Enrollment Fees, and Cost-Sharing Requirements for Children"

2016 federal poverty levels as dollar amounts

Click [show] on the red bar below to view the data.

Incomes as percentage of 2016 federal poverty level
Family size	100% FPL	138% FPL	200% FPL	250% FPL	300% FPL	400% FPL
1	$11,880	$16,394	$23,760	$29,700	$35,640	$47,520
2	$16,020	$22,108	$32,040	$40,050	$48,060	$64,080
3	$20,160	$27,821	$40,320	$50,400	$60,480	$80,640
4	$24,300	$33,534	$48,600	$60,750	$72,900	$97,200
Source: Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, "Poverty Guidelines" Amounts above 100 percent FPL calculated by Ballotpedia.

See also

• 

  Children's Health Insurance Program

• 

  Medicaid

• 

  Centers for Medicare and Medicaid Services

External links

• National Conference of State Legislatures, "Children's Health Insurance Program Overview"
• The Henry J. Kaiser Family Foundation, "Children’s Health Coverage: Medicaid, CHIP and the ACA"
• Centers for Medicare and Medicaid Services

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