Eligibility

Federal SCHIP eligibility rules set the guidelines determining which children states can cover with federal SCHIP funds. In Medicaid-expansion states, children who cannot be covered with SCHIP funds may, in certain situations, be covered with Medicaid funds. The key eligibility rules are:

Income	States have broad flexibility to set their SCHIP income eligibility levels. Most states cover children up to or above 200 percent of the federal poverty level (see federal poverty guidelines). States can establish asset or resource requirements, but they need not do so.
Ages	States may cover children up to 18 years of age.
Insurance Status	Children must be uninsured to qualify for SCHIP-funded coverage. Some states require children to be uninsured for a certain period of time before they can enroll, but this is not a federal requirement.
Coordination	States with separate SCHIP-funded programs must coordinate their enrollment procedures with Medicaid to prevent children from “falling through the cracks” and remaining uninsured, as well as to ensure that children are enrolled in the appropriate program. These coordination rules require state SCHIP programs to screen children who are applying for coverage for Medicaid and SCHIP eligibility and to assure that the Medicaid-eligible children are enrolled into Medicaid, rather than simply turning them away from SCHIP. This “screen and enroll” requirement also applies to Medicaid programs to assure they screen for SCHIP eligibility. Most states with a separate SCHIP-funded program use a joint Medicaid/SCHIP application.
Citizenship/ Immigration Status	SCHIP can cover citizens and certain legal immigrants. Federal funds may not be used to cover undocumented children or lawfully present immigrant children who have not been in the country for five years (with exceptions for refugess). Some states use state funding to provide coverage to legal immigrant children, no matter when they entered the country, and to children regardless of immigration status.
Renewal	Federal law generally requires states to review eligibility circumstances at least every 12 months. States can either review eligibility when financial circumstances change or they can enroll children for periods of up to 12 months, regardless of changes in income, through a continuous eligibility option.
Documentation	States have discretion in requiring families to provide documentation of income or other eligibility requirements. The only eligibility criteria that federal law requires families to document are citizenship and immigration status.
Parents and Adults	Generally, SCHIP law does not allow coverage of parents and adults. However, a handful of states have obtained waivers from the federal government to use their SCHIP funds to cover uninsured adults and parents. See Family Coverage Under SCHIP Waivers.

See the CMS Directive page which provides details on new restrictions placed on states increasing coverage to children in families with income above 250% of the federal poverty level.