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Who Can Get CHIP/Children's Medicaid?

Income & Assets

The size of the family includes people in the household who bring in money (income) and who own things like real estate, bank accounts, stocks, or certificates of deposit.

A family can include:

  • Children age 18 or younger living in the home, even if they are married
  • Parents – both natural and adoptive – who are living in the home
  • Stepparents living in the home

A child age 18 or younger living outside the home may be considered a family of one, even if the child is living with another family.

Income

HHSC asks for gross income when filling out the CHIP/Children’s Medicaid application form. Gross income is the amount you make before taxes or other deductions are taken out. A family’s gross income must be below 200 percent federal poverty level (FPL) for the children to get CHIP coverage. Generally, a family’s gross income must be below 133 percent FPL for children age one to five years to get Medicaid. The family’s gross income must be below 100 percent FPL for children age six to 18 to get Medicaid. Family income includes the income of all children age 18 or younger, all parents, and all stepparents living in the home. These people must verify their income when they first apply and when they renew their coverage. Income includes:

  • Wages
  • Self-employment income
  • Social Security (retirement, survivor and disability)
  • Child support
  • Alimony
  • Unemployment
  • Veterans Administration benefits

HHSC staff will convert each person’s income to a monthly amount:

Income Frequency Conversion Factor
Weekly Multiply by 4.33
Bi-weekly Multiply by 2.17
Semi-monthly Multiply by 2
Annually Divide by 12

See the income limit chart

Can I Get It?

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Deductions

HHSC may allow a person applying to deduct the cost of child care or the cost of providing care for an adult with a disability. HHSC can deduct the cost if the care is necessary to allow someone in the home to work, look for work, or go to work-related training. The care deduction is up to $200 for each child up to age 2 years old and $175 for each person age 2 and older. Children’s Medicaid may also allow deductions for alimony, child support payments, medical bills, and health insurance that anyone in the home pays for a child outside the home.

Assets

For their children to get CHIP, families with income above 150 percent of the Federal Poverty Level (FPL) can have no more than $10,000 in assets. In this case, assets do not include the family’s primary residence or primary vehicle if the car or truck is used for work. Assets do include other vehicles and things that can be easily converted to cash such as bank accounts, cash-on-hand, and stocks, bonds and savings certificates. Assets of all members of the family living in the home should be counted. Families with income above 150 percent FPL and countable assets exceeding $10,000 must complete a CHIP Asset Questionnaire. Families with income at or below 150 percent FPL are not subject to this assets test.

Third-Party Insurance

In some cases, children can qualify for Medicaid even if they are covered by other private health insurance. Children cannot, however, be covered by CHIP and other health insurance at the same time. Families that otherwise qualify for CHIP but have private insurance that costs greater than 10% of the family’s gross income must be able to drop the insurance before CHIP coverage can begin. Families with private insurance that costs less than 10% of the family’s gross income are not eligible for CHIP.

Residency

CHIP is available to U.S. citizens, Legal Permanent Residents (LPR) who are not eligible for Medicaid, and non-citizens who meet Alien Status requirements for Medicaid but are over the income and/or the asset limits for Medicaid.

When submitting an application, the family must provide a Social Security number or proof of legal residency for all the children they want to receive benefits. There are exceptions for children who are six months old or younger and certain independent children.

Children meet the residency requirement if they live in Texas or if they intend to make Texas their home. By including a Texas residence on their application, a family indicates its intention to “make Texas their home.”