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When Is Your Child Eligible for Medicaid?

When we think of government programs like Medicare, Social Security, and Medicaid, we often think of older adults. But children can also be eligible for Medicaid benefits in New York and nationwide. 

Whether or not other family members receive benefits, children in New York may still qualify for additional support. Your family’s monthly income and family size will determine whether your child is eligible and to what extent you’ll be expected to pay for services.

Key Takeaways

  • Medicaid eligibility for children isn’t too different from the criteria adults must meet. Qualifying children must come from a family with a gross income below established limits. They must also reside in New York and be under the age of 19.
  • The costs that come with Medicaid insurance coverage vary depending on household size and family income levels. However, most families who qualify won’t have to pay out-of-pocket for any services. Still, some families may be expected to pay monthly premiums.
  • Even if your child is not eligible for Medicaid, other state and federal government programs may still help you manage care costs.

When Is Your Child Eligible for Medicaid in NYC?

New York offers a health insurance plan program for children called Child Health Plus. If your family’s income is below a certain threshold, your child may be eligible for either Child Health Plus A (previously known as Children’s Medicaid) or Child Health Plus B. 

You may also see these insurance plans referred to as New York’s version of the Children’s Health Insurance Program, or CHIP program.

As is true for adults, a child who receives Medicaid in New York must meet certain criteria. In this case, children must be:

  • Under the age of 19
  • Residents of New York State

A child’s eligibility is based on their family’s gross income for either insurance option. Family size is another important factor, as larger families have a higher income limit than smaller families. 

In other words, the more people living in one household, the more income that family unit can generate (without making too much to receive coverage).

Another reason a child may be eligible for Medicaid is their status as a Social Security beneficiary. 

Children with disabilities who receive supplemental security income (SSI) payments can receive Medicaid coverage in most states, as being eligible for SSI also means the child comes from a low-income household.

A Quick Look at Child Health Plus

As the name likely implies, Child Health Plus is intended specifically for children, not adults. This Medicaid program helps families pay little to nothing for health services like doctor’s appointments and emergency care. 

Like eligibility, the monthly premiums associated with Child Health Plus depend on household income and family size. 

Families with lower incomes pay no premiums at all. Regardless of income level, participating families have no annual deductible or co-payments.

Who Is Eligible?

Again, children must come from low-income families to be eligible for either child health insurance plan option. But children who aren’t eligible for Medicaid (Child Health Plus A) may still be eligible for Child Health Plus B as long as they:

  • Don’t already have health insurance
  • Are not eligible for coverage under the public employees’ state health benefit plans
  • Meet other preliminary criteria (being under the age of 19 and living in New York)

How Much Does It Cost?

There is no upfront cost for Child Health Plus. And, since the plan doesn’t require beneficiaries to pay any deductibles or copayments, most families don’t have to manage any out-of-pocket costs. 

However, monthly premiums exist, and families may be expected to pay them depending on their income.

There is no monthly premium for families with income below 2.2 times the federal poverty level (FPL). This adds up to around $1150 a week in income for a three-person family. 

This figure rises to about $1387 a week for a four-person family. If your family’s income totals below these estimates, you won’t have to pay for premiums, deductibles, or co-payments.

According to the New York Department of Health, families with “somewhat higher incomes” may be expected to pay a monthly premium of either $15, $30, $45, or $60 per child per month, depending on income and family size. 

Meanwhile, families whose income is more than four times the poverty level must pay the full monthly premium charged by their health plan.

What Is Covered?

One of the great things about the health coverage offered by Child Health Plus is just how many services it spans. If your child is eligible and enrolls in the program, you’ll receive a list of nearby providers you can choose from. 

These providers may offer covered medical services including, but not limited to:

  • Physical exams
  • Diagnosis and treatment of injuries and illnesses
  • Immunizations
  • Lab tests and X-rays
  • Emergency care, including emergency ambulance transportation
  • Vision care
  • Dental care, including medically necessary orthodontic treatment
  • Speech therapy and hearing services
  • Medical equipment and supplies
  • Inpatient and outpatient treatment for mental health
  • Outpatient surgery

Another Medicaid program that children may be eligible for is the Consumer Directed Personal Assistance Program (CDPAP), which provides services for individuals with disabilities or chronic illnesses who need help with activities of daily living. 

CDPAP allows parents of children with disabilities or chronic illnesses to assume responsibility for (and receive compensation for) hiring or providing services. 

The program can help families cover the cost of home care services, potentially in addition to other Medicaid-covered services.

Children’s Medicaid Income Eligibility

Income levels and cutoffs depend not only on the amount you make but also on how many people live in your household. Below is a breakdown of the monthly income limits that determine Medicaid eligibility. 

Notice that each household size has its own respective income limit.

New York Children’s Medicaid Income Eligibility Source: New York Department of Health
Age CategoriesMonthly Income by Family Size*
For each additional person, add: 
Children Under 1 Year; Pregnant Women*$2,710$3,665`$4,630$5,575$6,531$7,486$8,441$9,396$956
Children 1-18 Years$1,872$2,531$3,191$3,850$4,510$5,170$5,829$6,489$660

*Pregnant women should also be considered in family size, as total household size calculations include all expected children.

Child Health Resources in NYC (Medicaid)

If you’re looking to learn more about New York State Medicaid for children or state programs that can help you cover the cost of health care, the following resources may be useful.

  • NYS Provider & Health Plan Look-Up: Here, you can look up which providers — both doctors and hospitals — are included in your Medicaid health plan.
  • NY State of Health: You can find specific enrollment instructions for Child Health Plus by visiting the New York State of Health, a health insurance marketplace hosted by the official website.
  • Medicare: If your child is ineligible for Medicaid in New York, they may still be able to receive Medicare benefits. A key difference between Medicare and Medicaid is who’s in charge of the program: while Medicaid is controlled and provided by state governments, the U.S. federal government is responsible for Medicare. That means there may be different requirements and benefits for each program.
  • Local Department of Social Services Offices (Children’s Medicaid): Use this list to find the address and contact information for your local Social Services office, where you can find more information about Medicaid and other government programs. Any questions or concerns you may have about your child’s health insurance can be directed here, too.
  • NY State of Health Instant Quotes: This tool from the State of Health allows you to view which health insurance options are available to you. You can also use it to see if your income qualifies your child for Medicaid.

Overall, Child Health Plus and Children’s Medicaid help the State of New York offer life-changing support to families who need it most. 

Applying for and enrolling in either program can allow your child to receive Medicaid services that help them live a happy, healthy life.

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