Eligibility and Enrollment Options
Find information about a range of eligibility and enrollment options that states have elected to promote enrollment of eligible children in Medicaid and CHIP. Many of these options were created by CHIPRA while others have been available to states for several years.
CHIPRA Performance BonusesCHIPRA Performance Bonuses are available to states that simplify their eligibility and enrollment processes for Medicaid and CHIP and also significantly increase enrollment among children in Medicaid each year.
Presumptive Eligibility provides states the opportunity to authorize health care providers, community-based organizations, schools, and other entities to screen for Medicaid and CHIP eligibility and to “presumptively” enroll children who appear to be eligible.
Express Lane Eligibility
Express Lane Eligibility enables states to use data and findings from other programs and databases to facilitate children’s enrollment in Medicaid and CHIP.
Continuous Eligibility provides states the opportunity to enroll children in Medicaid and CHIP coverage for 12 months and keep them enrolled regardless of a change in circumstances.
Lawfully Residing Immigrant Children and Pregnant Women
Lawfully Residing Immigrant Children and Pregnant Women enroll children and pregnant women who are lawfully residing in the United States in Medicaid or CHIP within their first five years in the country. There was previously a 5-year waiting period on coverage of legal immigrants in Medicaid and CHIP. This eligibility option may be applied to pregnant women in Medicaid and CHIP and/or to children up to age 19 for CHIP or up to age 21 for Medicaid.