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Who Can Get CHIP/Children's Medicaid?

Income

The size of the family includes people in the household who bring in money (income) and who own things like real estate, stocks, or certificates of deposit. Family size and household are further defined by each person's tax status, tax relationships, living arrangement, and family relationships.

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
  • People living in the home who have a tax relationship to the child applying for benefits

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 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 certain expenses that are allowed on an income tax return, things such as alimony, moving expenses, and tuition or GI Bill deduction.

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 5 percent 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 5 percent of the family’s gross income are not eligible for CHIP.

Citizenship and Immigration Status

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 for Medicaid.

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

Residency

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.”