Child Health Plus is not Medicaid. The two are separate New York State programs that both cover children under 19, and your household income determines which one your child qualifies for. Children in lower-income families generally get Children’s Medicaid; children in households that earn too much for Medicaid get free or low-cost coverage through Child Health Plus, New York’s version of the federal Children’s Health Insurance Program (CHIP).
How the Two Programs Differ
Medicaid is a joint federal-state program authorized under Title XIX of the Social Security Act. Child Health Plus is authorized under Title XXI, the CHIP statute, which Congress designed specifically to reach children whose families earn too much for Medicaid but not enough to comfortably afford private insurance.
For families, the practical differences come down to three things: cost, income limits, and who is eligible. Medicaid charges nothing. Child Health Plus is free up to a certain income and then charges a monthly premium on a sliding scale. A child cannot be enrolled in both at once. When you apply through NY State of Health, the system places your child in the correct program based on the income you report.1New York State Department of Health. Child Health Plus
One difference matters if your child already has unpaid medical bills. Medicaid can pay for care your child received up to three months before you applied, as long as the child would have been eligible during that period.2New York State Department of Health. Retroactive Eligibility Period Child Health Plus does not. If your child has pre-application bills, raise them during the Medicaid application so the state can evaluate retroactive coverage.
Which Program Your Child Qualifies For
Both programs use the Federal Poverty Level as the yardstick. For 2026, the FPL for a family of four in the contiguous United States is $33,000 per year.3U.S. Department of Health and Human Services. 2026 Poverty Guidelines New York draws its Medicaid-versus-CHP line as a multiple of that figure, and the line depends on the child’s age:4NY State of Health. Income Levels for Medicaid, Child Health Plus and Essential Plan
- Infants under age 1 qualify for Medicaid in families earning up to 223 percent of the FPL.
- Children ages 1 through 18 qualify for Medicaid in families earning up to 154 percent of the FPL.
If your household income is above the Medicaid threshold for your child’s age, Child Health Plus picks up coverage. Subsidized premiums are available up to 400 percent of the FPL. Families above that line can still enroll, but they pay the full premium set by the health plan they choose.5New York State Department of Health. Child Health Plus Eligibility and Cost
Two other eligibility rules apply only to Child Health Plus: the child cannot already have health insurance, and the child cannot be eligible for coverage under the New York State public employees’ health benefits plan.5New York State Department of Health. Child Health Plus Eligibility and Cost Both programs require the child to be under 19 and a New York resident.
Immigration Status Is Where the Two Programs Diverge Most
In New York, children under 19 can enroll in Child Health Plus regardless of immigration status.6NYC Human Resources Administration-Office of Citywide Health Insurance Access. Child Health Plus A Social Security number, green card, or specific immigration documentation is not required. If the child lives in New York and meets the income rules, Child Health Plus is available.
Children’s Medicaid is more restrictive. Under federal law, most lawful permanent residents face a five-year waiting period before they can get Medicaid.7HealthCare.gov. Health Coverage for Lawfully Present Immigrants New York has opted into a federal provision under the Children’s Health Insurance Program Reauthorization Act of 2009 that lets states waive the waiting period for children who are “lawfully residing” in the country.8Centers for Medicare and Medicaid Services. Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Women For undocumented children who do not qualify for Medicaid, Child Health Plus is the primary safety net.
What Each Program Costs Your Family
Children’s Medicaid has no premiums, no co-payments, and no deductibles. It is free for every family who qualifies.
Child Health Plus has no co-payments and no deductible either, but it charges a monthly premium once household income exceeds about 222 percent of the FPL.9NY State of Health. Child Health Plus At a Glance 2026 The 2026 schedule, by family income relative to the FPL, is:
- Up to 222% FPL: $0 per child
- 222% to 250% FPL: $15 per child (family maximum $45)
- 250% to 300% FPL: $30 per child (family maximum $90)
- 300% to 350% FPL: $45 per child (family maximum $135)
- 350% to 400% FPL: $60 per child (family maximum $180)
- Above 400% FPL: the full premium set by the health plan
For a family of four in 2026, the free-premium threshold works out to roughly $71,373 in annual income, and the $60 tier tops out around $128,600.10NY State of Health. Child Health Plus At a Glance 2026 The family maximum caps at three children, so if you have four enrolled you only pay for three.5New York State Department of Health. Child Health Plus Eligibility and Cost
Federal law caps total CHIP cost sharing at five percent of household income. Because New York charges no co-payments for Child Health Plus, premiums are the only expense families face.
What the Two Programs Cover
The benefit packages are broadly similar. Both cover well-child visits, immunizations, sick visits, hospital and emergency care, prescriptions, dental, vision, hearing, mental health and substance use treatment, speech and occupational and physical therapy, lab work, X-rays, and emergency ambulance transport.11New York State Department of Health. What Benefits Can You Get for Your Children
Children’s Medicaid covers all of that and, in many cases, goes further through the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, which requires states to cover any medically necessary service for children under 21, even services the state does not normally cover for adults. For a child with significant medical needs, that difference can matter.
Enrollment Is Open Year-Round
Neither program uses an annual open enrollment window. You can apply any month of the year through NY State of Health, and coverage can start without waiting for a qualifying life event. Federal rules require Medicaid eligibility decisions for children under 19 within 30 days of your application.
When Your Child Turns 19
Both Children’s Medicaid and Child Health Plus end at 19. This catches families off guard, so plan ahead. Before terminating a child’s Medicaid coverage, the state must check whether the young adult qualifies under another Medicaid category. In New York, adults ages 19 and 20 living with a parent can qualify for Medicaid with incomes up to 155 percent of the FPL.4NY State of Health. Income Levels for Medicaid, Child Health Plus and Essential Plan Adults earning more than the Medicaid limit but up to 200 percent of the FPL may qualify for New York’s Essential Plan. Higher-income young adults can enroll in a qualified health plan through the NY State of Health marketplace, and losing child coverage counts as a qualifying life event that opens a 60-day enrollment window. Start looking at options a few months before the 19th birthday so coverage does not lapse.