Revision 17-2; Effective April 1, 2017
A child may be eligible from birth through the month of the child’s 19th birthday. Age is self-declared.
The certified group contains only the Children’s Health Insurance Program (CHIP) eligible child. Only one child is certified per Eligibility Determination Group (EDG).
A pregnant woman of any age may qualify for perinatal coverage.
When the pregnant woman is age 18 and it is anticipated that she will turn age 19 before her CHIP enrollment start date, the CHIP coverage is denied. She is tested for Pregnant Women Medicaid (TP 40) and then for CHIP perinatal, if ineligible for Pregnant Women Medicaid (TP 40). If eligible for CHIP perinatal, her enrollment start date is the first day of the eligibility determination month.
Only one pregnant woman is certified per EDG.
If the mother’s income is:
- Above the applicable income limit for Pregnant Women Medicaid (TP 40), as defined in C-131.1, Federal Poverty Income Limits (FPIL), the mother will be the only individual on the EDG for the majority of the certification period. During the month the child is born, the mother and the child are certified on the same EDG. After the month the child is born, the child is the only individual certified on the EDG.
- At or below the applicable income limit for Pregnant Women Medicaid (TP 40), as defined in C-131.1, and the mother receives Emergency Medicaid (TP 36) to cover the birth, the child will be certified on their own Medicaid for Newborn Children (TP 45) EDG.
CHIP, CHIP Perinatal
The following individuals are not eligible to receive CHIP or CHIP perinatal:
- Medicare recipients;
- inmates of a public institution; and
- residents of state supported living centers or institutions.
Exception: A child who is institutionalized (except for inmates of a public institution) during the child's continuous enrollment period remains eligible until the CHIP redetermination.