Eligibility and Cost
To be eligible for either Children's Medicaid or Child Health Plus, children must be under the age of 19 and be residents of New York State. Whether a child qualifies for Children's Medicaid or Child Health Plus depends on gross family income. Children who are not eligible for Medicaid can enroll in Child Health Plus if they don't already have health insurance and are not eligible for coverage under the public employees' state health benefits plan. Check the following income charts to see whether your child qualifies for Child Health Plus or Children's Medicaid.
There is no monthly premium for families whose income is less than 2.2 times the poverty level. That's about $1,263 a week for a three-person family, about $1,526 a week for a family of four. Families with somewhat higher incomes pay a monthly premium of $15, $30, $45, or $60 per child per month, depending on their income and family size. For larger families, the monthly fee is capped at three children. If the family's income is more than 4 times the poverty level, they pay the full monthly premium charged by the health plan. There are no co-payments for services under Child Health Plus, so you don't have to pay anything when your child receives care through these plans.
To see whether you would have to pay a premium for coverage, consult the Child Health Plus eligibility tables below.
| Family Contributions | Monthly Income by Family Size* | Each Additional Person, Add: |
|||||||
|---|---|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | ||
| Free Insurance | $2,953 | $4,004 | $5,055 | $6,105 | $7,156 | $8,207 | $9,258 | $10,309 | $1,051 |
| $15 Per Child Per Month (Maximum of $45 per family) | $3,325 | $4,509 | $5,692 | $6,875 | $8,059 | $9,242 | $10,425 | $11,609 | $1,184 |
| $30 Per Child Per Month (Maximum of $90 per family) | $3,990 | $5,410 | $6,830 | $8,250 | $9,670 | $11,090 | $12,510 | $13,930 | $1,420 |
| $45 Per Child Per Month (Maximum of $135 per family) | $4,655 | $6,312 | $7,969 | $9,625 | $11,282 | $12,939 | $14,595 | $16,252 | $1,657 |
| $60 Per Child Per Month (Maximum of $180 per family) | $5,320 | $7,214 | $9,107 | $11,000 | $12,894 | $14,787 | $16,680 | $18,574 | $1,894 |
| Full Premium Per Child Per Month | Over $5,320 |
Over $7,214 |
Over $9,107 |
Over $11,000 |
Over $12,894 |
Over $14,787 |
Over $16,680 |
Over $18,574 |
Over $1,894 |
- *Pregnant Women: Household size calculation includes all expected children.
| Age Categories for Children | Monthly Income by Family Size* | Each Additional Person, Add: |
|||||||
|---|---|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | ||
| Children Under 1 Year; Pregnant Women* | $2,966 | $4,022 | $5,077 | $6,133 | $7,189 | $8,244 | $9,300 | $10,355 | $1,056 |
| Children 1 - 18 Years | $2,049 | $2,778 | $3,507 | $4,235 | $4,964 | $5,693 | $6,422 | $7,151 | $729 |
- *Pregnant Women: Household size calculation includes all expected children.
