How Medicaid Works for Children: What Parents Need to Know

Medicaid covers children in your household if your income is low enough, and the income limit is usually higher for kids than for adults

Medicaid is a joint federal and state insurance program that pays for medical care. For children, it works differently than it does for adults in your household — your state sets a separate income limit just for kids, and that limit is almost always higher. This means your child might be covered by Medicaid even if you as a parent are not.

Each state runs its own Medicaid program, so the income cutoff, what services are covered, and how you enroll all depend on where you live. There is no national phone number or website where you apply to "Medicaid" — you apply through your state's program, usually called something like "Medicaid" or "[Your State] Health" or "CHIP" (which stands for Children's Health Insurance Program, a related program for kids whose families earn slightly too much for Medicaid).

Your child can be covered even if they were born outside the United States, as long as they live with you and meet your state's income rules. Immigration status does not automatically disqualify a child, though the rules vary by state.

Key Takeaways

• Your state sets the income limit for children's Medicaid separately from the adult limit, and the child limit is usually higher.
• You enroll through your state's Medicaid office or health department website, not through a federal office, and the process takes two to four weeks.
• Medicaid covers doctor visits, hospital care, prescriptions, dental care, and vision care for children, though the exact list varies by state.
• Your child can stay on Medicaid through age 18 or 19 depending on your state, even if your income goes up slightly after enrollment.

How to find your state's Medicaid program and enroll

Start by going to your state's health department or Medicaid website. The easiest way to find it is to search "[Your State] Medicaid" or "[Your State] CHIP" — both will take you to the right place. You can also call 211 (a free referral line) and say you are looking to enroll a child in Medicaid; they will give you the exact website and phone number for your state.

When you contact your state program, you will need to provide your household income (usually your last tax return or recent pay stubs), the number of people in your household, and your child's birth certificate or proof of residency. Some states let you start the process online; others require you to call or visit an office in person. Most states process enrollment within two to four weeks.

If your child is already in the hospital or seeing a doctor, you can enroll while care is happening — you do not have to wait until enrollment is complete for emergency services to be covered. Tell the hospital or clinic that you are in the process of enrolling your child, and they can often help you fill out paperwork on the spot.

What Medicaid covers for children

Medicaid covers the basics: doctor visits, hospital stays, emergency care, lab work, X-rays, and prescription medications. It also covers services that are specific to children, like well-child checkups (the routine visits at ages 2 weeks, 2 months, 4 months, and so on), vaccines, and developmental screening.

Most state Medicaid programs also cover dental care and vision care for children under 21, including cleanings, fillings, glasses, and eye exams. Mental health services and therapy are covered in most states. Some states cover speech therapy, occupational therapy, and physical therapy if a doctor says your child needs them.

What is not usually covered includes cosmetic procedures, experimental treatments, and some brand-name medications if a generic version exists. Your state's Medicaid website lists what is covered in detail; if you are unsure whether a specific service is covered, call your state's Medicaid office before your child has the service done.

Income limits and how they work

Your state's income limit for children's Medicaid is set as a percentage of the federal poverty line. The poverty line changes each year, so the income limit changes too. Most states cover children in families earning up to 200 percent of the poverty line, though some go higher and a few go lower. For 2024, 200 percent of the poverty line for a family of three is roughly $52,000 a year before taxes, but this varies by state and by family size.

The income limit is based on your household's gross income — that is, your income before taxes and deductions are taken out. If you are self-employed, you report your net business income. If you receive child support, that counts as income. Unemployment benefits and some other government payments count too, though the rules vary.

Once your child is enrolled, their coverage usually stays in place for a full year, even if your income goes up during that year. After the year is over, you will need to renew their coverage by providing updated income information. If your income rises above your state's limit, your child's coverage will end, but you will usually get a notice before that happens.

The difference between Medicaid and CHIP

CHIP (Children's Health Insurance Program) is a separate program for children whose families earn too much for Medicaid but not enough to afford private insurance. The income cutoff for CHIP is higher than for Medicaid — it usually covers families earning up to 200 to 400 percent of the poverty line, depending on your state. Some states combine Medicaid and CHIP into one program; others run them separately.

If your child does not meet your state's Medicaid income limit, you will automatically be told whether they meet the CHIP limit when you apply. The enrollment process is the same, and CHIP covers similar services. The main difference is that CHIP sometimes has a small monthly premium (usually $5 to $50 per child per month), while Medicaid for children is free.

What happens when your child turns 18 or 19

Medicaid coverage for children ends at age 18 in most states, though some states extend it to age 19. When your child ages out, their coverage stops unless they meet Medicaid rules for adults — which usually means they have very low income and few resources of their own. A teenager who starts working may lose Medicaid coverage because their income is now too high.

Before your child's coverage ends, ask your state's Medicaid office what options are available. Some states have programs for young adults, and your child might be able to stay on a parent's private insurance plan until age 26 if your family has that coverage. If your child will be in college, some colleges offer student health plans.

Keeping coverage active and renewing each year

Once your child is enrolled, you will receive a renewal notice in the mail before their coverage year ends. The notice will tell you what information you need to provide to renew — usually just updated income information and confirmation that your household size has not changed. You can renew online, by mail, or by phone, depending on your state.

If you move to a different state, your child's Medicaid coverage ends in your old state. You will need to enroll in your new state's program. Start the process as soon as you know you are moving, because there can be a gap in coverage between states.

If you do not renew by the deadline, your child's coverage will end. Some states give you a grace period to renew after the deadline; others do not. If coverage ends, you can enroll again, but there may be a waiting period. Check your renewal notice for the exact deadline and instructions for your state.

Frequently Asked Questions

Can my child be on Medicaid if I am not?

Yes. Your state sets income limits separately for children and adults, and the child limit is almost always higher. Your child can be covered by Medicaid even if your income is too high for you to be covered. You will need to provide your household income when you enroll your child, but your own coverage status does not affect theirs.

What if my child was born outside the United States?

Immigration status does not automatically disqualify a child from Medicaid. Rules vary by state, but most states cover children regardless of immigration status if they meet the income and residency requirements. When you enroll, your state will tell you what documents they need. Call your state's Medicaid office before you apply if you have questions about your child's specific situation.

Do I have to pay anything for Medicaid coverage?

Medicaid for children is free in most states — there is no monthly premium. A few states charge a small premium for children in families earning above a certain income level, but it is usually very low. When you enroll, your state will tell you whether there is a premium. You may have a small copay (usually $1 to $3) when your child sees a doctor or fills a prescription, but many states waive copays for children.

What if I think my child was denied unfairly?

You have the right to appeal a denial. Your state's Medicaid office will include appeal instructions in the denial letter. You usually have 30 to 60 days to file an appeal, and you can ask for a hearing where you can explain your situation. You can also contact your state's Medicaid ombudsman (a free advocate) for help with the appeal process.

Can my child stay on Medicaid if we move to a different state?

No. Medicaid is run by each state separately, so coverage ends when you move. You will need to enroll in your new state's program. Start the process as soon as you know you are moving to avoid a gap in coverage. Some states have expedited enrollment for people who are moving, so ask when you call.