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. Some children who were covered by employer-based health insurance within the past six months may be subject to a waiting period before they can be enrolled in Child Health Plus. Determining whether your child is subject to a waiting period will depend on your household income and the reason your child(ren) lost employer-based coverage. 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 1.6 times the poverty level. That's about $600 a week for a three-person family, about $724 a week for a family of four. Families with somewhat higher incomes pay a monthly premium of $9, $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.

Child Health Plus
2013 Family Contributions by Income and Household Size
Premium Categories Monthly Income by Family Size* Each Additional
Person, Add:
1 2 3 4 5 6 7 8
Free Insurance $1,531 $2,067 $2,603 $3,139 $3,675 $4,211 $4,747 $5,283 $536
$9/Child/Month
(Max $27/Family)
$2,126 $2,870 $3,614 $4,357 $5,101 $5,845 $6,585 $7,332 $744
$15/Child/Month
(Max $45/Family)
$2,394 $3,232 $4,069 $4,907 $5,744 $6,582 $7,419 $8,257 $838
$30/Child/Month
(Max $90/Family)
$2,873 $3,878 $4,883 $5,888 $6,893 $7,898 $8,903 $9,908 $1,005
$45/Child/Month
(Max $135/Family)
$3,352 $4,524 $5,697 $6,869 $8,042 $9,214 $10,387 $11,559 $1,173
$60/Child/Month
(Max $180/Family)
$3,830 $5,170 $6,510 $7,850 $9,190 $10,530 $11,870 $13,210 $1,340
Full Premium*/
Child/Month
Over
$3,830
Over
$5,170
Over
$6,510
Over
$7,850
Over
$9,190
Over
$10,530
Over
$11,870
Over
$13,210

*The full premium varies, depending on the health plan chosen by the family.

Medicaid
2013 Income Eligibility Levels
Age Categories for Children Monthly Income by Family Size Each Additional
Person, Add:
1 2 3 4 5 6 7 8
Children under 1 yr; Pregnant Women** $1,915 $2,585 $3,255 $3,925 $4,595 $5,265 $5,935 $6,605 $670
Children 1-18 yrs $1,274 $1,720 $2,165 $2,611 $3,056 $3,502 $3,947 $4,393 $446

**Pregnant women count as two