Information for Families:
Eligibility Requirements
Income & Assets
The family size/budget group consists of members of the household whose income and resources are used to determine a child’s eligibility for CHIP/Children's Medicaid. This group includes: The eligible child and the siblings under age 19, parents (natural/adoptive) or step-parents living in the home, spouse of married children and their mutual children and independent children.
Families with income above 150% FPL have a countable asset limit of $10,000. Countable assets include vehicles and assets that can be readily converted to cash such as bank accounts, cash-on-hand, and stocks, bonds and savings certificates. Assets of all members of the family size/budget group should be counted. Families with income above 150% FPL and countable assets exceeding $10,000 must complete a CHIP Asset Questionnaire. Families with income at or below 150% FPL are not subject to this assets test.
A family’s income, after allowable expenses are deducted, must be below 200% FPL. This includes the income of all people included in the family size/budget group. Verification must be provided for all countable income at both application and renewal. Countable income includes wages, self-employment, Social Security (retirement, survivor and disability), child support, alimony, unemployment, Veterans Administration benefits. All countable income is converted 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 |
Third Party Insurance
Children cannot be covered by CHIP/Children's Medicaid and other health insurance at the same time. Families with private insurance that cost greater than 10% 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 10% of the family’s gross income are not eligible for CHIP.
Residency
CHIP provides coverage to U.S. citizens, Legal Permanent Residents (LPR) ineligible for Medicaid, and non-citizens who meet Alien Status requirements for Medicaid but are over the income and/or the resource limits for Medicaid.
When filing an application, the family must provide a Social Security number or proof of legal residency for all eligible children. There are exceptions for children who are six months old or younger and certain independent children.
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.”
Complete Application
Before eligibility can be determined, the family must submit a complete application. A complete application contains the following: All data fields completed, signature and date, all required verification documents attached reflecting income, expenses, and immigration status, if required.
The family receives a missing information notice when the application is incomplete. An application is considered incomplete when some data fields are blank, when a signature is not included, or when verification documents that are needed are not attached.
Verification
Self-declaration is acceptable for: Age, family size, relationship, residence, and assets.
Written verification is required for: U.S. citizenship, immigration status, countable income, dependent care costs claimed, child support and alimony costs claimed, payments made to dependents outside the home claimed, termination of private health insurance and conflicting information.