NR = not reported   NA = not applicable      -- = the state was not required to complete this section of the state plan             template and did not volunteer the information.

Identifiers				Standards of Eligibility
						Standards Related to Other Coverage
State	Program	Phase or Component	Amend.#	Disability Requirement	Description of Disability Requirement	Any Standards	Mandatory Period of No Coverage	Mandatory Period of No Coverage (Months)	Other Standards	Specify Other Standards
AK	AK Denali KidCare		NA	--		Yes	Yes	12	--
AL	AL SCHIP	Phase 1
AL	AL SCHIP	Phase 1	NA	--		--	--	--	--
AL	AL SCHIP	All Kids (Phase 2)
AL	AL SCHIP	All Kids (Phase 2)	1	No		NR	NR	NR	NR
AL	AL SCHIP	All Kids (Phase 2)	2
AL	AL SCHIP	Plus (Phase 3)
AL	AL SCHIP	Plus (Phase 3)	2	Yes	Special needs and conditions.	Yes	NR	NR	Yes	Child must be enrolled in All Kids Phase 2.
AR	AR SCHIP	Phase I - ARKids A
AR	AR SCHIP	Phase I - ARKids A	NA	--		--	--	--	--
AR	AR SCHIP	Phase II - ARKids B
AR	AR SCHIP	Phase II - ARKids B	1	No		Yes	Yes	6	NR
AS	AS SCHIP		NA	--		--	--	--	No
AZ	KidsCare		NA	No		Yes	Yes	6	No
AZ	KidsCare		1
AZ	KidsCare		2
AZ	KidsCare		3
AZ	KidsCare		4
CA	Healthy Families	Medi-Cal Expansion
CA	Healthy Families	Medi-Cal Expansion	NA	--		--	NR	NR	--
CA	Healthy Families	Medi-Cal Expansion	1
CA	Healthy Families	Medi-Cal Expansion	2
CA	Healthy Families	Health Insurance Plan (MRMIB)
CA	Healthy Families	Health Insurance Plan (MRMIB)	NA	No		Yes	Yes	3	NR
CA	Healthy Families	Health Insurance Plan (MRMIB)	2
CA	Healthy Families	Health Insurance Plan (MRMIB)	3
CA	Healthy Families	Health Insurance Plan (MRMIB)	4
CA	Healthy Families	Health Insurance Plan (MRMIB)	5
CA	Healthy Families	Access for Infants and Mothers (AIM)
CA	Healthy Families	Access for Infants and Mothers (AIM)	NA	No		Yes	NR	NR	Yes	Mother must not have employer-sponsored coverage at time of application.
CA	Healthy Families	Access for Infants and Mothers (AIM)	2
CA	Healthy Families	Access for Infants and Mothers (AIM)	3
CA	Healthy Families	Access for Infants and Mothers (AIM)	4
CA	Healthy Families	Access for Infants and Mothers (AIM)	5
CA	Healthy Families	Child Health and Disability Prevention Program
CA	Healthy Families	Child Health and Disability Prevention Program	NA	NR		NR	NR	NR	NR
CA	Healthy Families	Child Health and Disability Prevention Program	2
CA	Healthy Families	Child Health and Disability Prevention Program	3
CA	Healthy Families	California Children`s Services
CA	Healthy Families	California Children`s Services	NA	Yes	Must have a medical condition covered by CCS.	NR	NR	NR	NR
CA	Healthy Families	California Children`s Services	2
CA	Healthy Families	County Mental Health Program
CA	Healthy Families	County Mental Health Program	NA	Yes	Mental disorders as identified in the most recent edition of the diagnostic and statistical manual of mental disorders	NR	NR	NR	NR
CA	Healthy Families	County Mental Health Program	2
CO	CHP+		NA	No		Yes	Yes	3	Yes	Applicant must not have access to employer-sponsored coverage for which the employer pays at least 50 percent of the premium.
CO	CHP+		1
CO	CHP+		2
CT	HUSKY Program	Part A
CT	HUSKY Program	Part A	NA	--		--	--	--	--
CT	HUSKY Program	Part A	0
CT	HUSKY Program	Part A	1
CT	HUSKY Program	Part B
CT	HUSKY Program	Part B	NA	No		Yes	Yes	6	NR
CT	HUSKY Program	Part B	1
CT	HUSKY Program	HUSKY Plus Plan for Children with Special Physical Health Needs	NA	Yes	Documentation that child is at elevated risk for chronic physical, developmental, behavioral or emotional conditions and requires health and related services of a type and amount not usually required by children of the same age. (Same eligibility criteria as for the state’s Title V program for Children with Special Health Needs.)	Yes	Yes	6	Yes	Child must be enrolled in HUSKY Part B
CT	HUSKY Program	HUSKY Plus Plan for Children with Special Physical Health Needs	1
CT	HUSKY Program	HUSKY Plus Behavioral Health Plan	NA	Yes	Clinical determination of eligibility based on severe psychiatric and/or substance abuse symptoms, substantial evidence of marked impairment in functioning across multiple areas, and treatment needs that cannot be reasonably met within the standard HUSKY benefit package.	Yes	Yes	6	Yes	Child must be enrolled in HUSKY Part B.
CT	HUSKY Program	HUSKY Plus Behavioral Health Plan	1
DC	DC Healthy Kids		NA	--		--	No	NA	--
DE	Delaware Healthy Children`s Program		NA	No		Yes	Yes	6	Yes	Applicant must be ineligible for enrollment in any public group health plan.
DE	Delaware Healthy Children`s Program		1
FL	FL KidCare	Medicaid expansion
FL	FL KidCare	Medicaid expansion	NA	--		Yes	--	--	No
FL	FL KidCare	Medicaid expansion	1
FL	FL KidCare	Healthy Kids
FL	FL KidCare	Healthy Kids	NA	No		Yes	NR	NR	No
FL	FL KidCare	Healthy Kids	1
FL	FL KidCare	Healthy Kids	3
FL	FL KidCare	Healthy Kids	4
FL	FL KidCare	Medi-Kids	1	No		Yes	NR	NR	No
FL	FL KidCare	Medi-Kids	4
FL	FL KidCare	CMS	1	Yes	Children with special health care needs--those with chronic physical developmental conditions and serious emotional disturbances.	Yes	NR	NR	No
FL	FL KidCare	CMS	4
GA	Peach Care for Kids		NA	No		Yes	Yes	3	NR
GA	Peach Care for Kids		0
GA	Peach Care for Kids		1
GU	Guam SCHIP		NA	--		NR	NR	NR	NR
HI	HI SCHIP	Phase I	NA	--		Yes	Yes	3	--
HI	HI SCHIP	Phase I	1
IA	Hawk-I	Medicaid Expansion	NA	--		--	--	--	--
IA	Hawk-I	Medicaid Expansion	4
IA	Hawk-I	Separate State Program	1	No		Yes	Yes	6	Yes	A child who is covered under other health insurance is not eligible for coverage under HAWK-I unless the coverage is a single service coverage such as dental or vision only policy.
IA	Hawk-I	Separate State Program	2
IA	Hawk-I	Separate State Program	3
IA	Hawk-I	Separate State Program	4
ID	ID SCHIP		NA	--		--	--	--	--
ID	ID SCHIP		1
ID	ID SCHIP		2
IL	Kidcare	Phase 1	NA	--		--	--	--	--
IL	Kidcare	Phase 2	1	No		Yes	Yes	3	No
IN	Hoosier Healthwise	Phase 1	NA	--		Yes	--	--	--
IN	Hoosier Healthwise	Phase 1	0
IN	Hoosier Healthwise	Phase 2	2	No		Yes	Yes	3	No
KS	HealthWave		NA	No		Yes	Yes	6	NR
KS	HealthWave		1
KY	KCHIP	Medicaid Expansion
KY	KCHIP	Medicaid Expansion	NA	--		--	--	--	--
KY	KCHIP	Medicaid Expansion	1
KY	KCHIP	Insurance Product
KY	KCHIP	Insurance Product	NA	No		Yes	Yes	6	NR
KY	KCHIP	Insurance Product	1
KY	KCHIP	Insurance Product	2
LA	LaCHIP		NA	--		Yes	Yes	3	--
LA	LaCHIP		1
MA	MassHealth	Standard	NA	No		NR	No	NA	NR
MA	MassHealth	Family Assistance Direct Coverage	NA	No		Yes	No	NA	Yes	Family must not have, or have access to, employer-sponsored insurance that meets the requirements for the state's Premium Assistance program.
MA	MassHealth	Family Assistance Premium Assistance	NA	No		Yes	No	NA	Yes	Family must have access to employer-sponsored insurance that meets benchmark benefit level and for which employer pays at least 50 % of premium cost.
MA	MassHealth	Common Health	NA	Yes	Permanent and total disability, as verified by certification of legal blindness from MCB or a determination of disability by the Social Security Administration or by the division's disability determination unit.	NR	No	NA	NR
MD	Maryland Children`s Health Program	Phase I	NA	--		Yes	Yes	6	No
MD	Maryland Children`s Health Program	Phase I	1
MD	Maryland Children`s Health Program	Phase II	2	No		Yes	Yes	6	Yes	If a parent or guardian is insured under qualifying ESI coverage, the MCHP-eligible applicant must enroll in the ESI component of Phase II, which provides premium assistance. If the parent or guardian of an eligible applicant is not insured by qualifying ESI coverage, the individual will be enrolled in the Phase II state-designed program.
MD	Maryland Children`s Health Program	Phase II- ESI	2	No		Yes	Yes	6	Yes	If a parent or guardian is insured under qualifying ESI coverage, the MCHP-eligible applicant must enroll in the ESI component of Phase II, which provides premium assistance. Employers participating in the ESI program must pay at least 50% of the cost of family coverage.
ME	ME CHIP Medicaid Expansion		NA	--		Yes	Yes	3	--
ME	Cubcare		NA	No		Yes	Yes	3	NR
ME	Cubcare		1
MI	MI SCHIP	MI CHILD	NA	No		Yes	Yes	6	Yes	Applicant must not have access to or coverage under other health insurance.
MI	MI SCHIP	MI CHILD	1
MI	MI SCHIP	MI CHILD	2
MI	MI SCHIP	Medicaid Expansion	1	--		--	--	--	--
MI	MI SCHIP	Medicaid Expansion	2
MN	Minnesota Medical Assistance Program		NA	--		--	--	--	--
MO	MC+ for Kids		NA	--		Yes	Yes	6	NR
MO	MC+ for Kids		1
MP	CNMI SCHIP		NA	--		Yes	--	--	Yes	Applicant must not have other health insurance.
MS	MS SCHIP	Phase I
MS	MS SCHIP	Phase I	NA	--		--	--	--	--
MS	MS SCHIP	Phase II
MS	MS SCHIP	Phase II	1	No		Yes	Yes	3	No
MS	MS SCHIP	Phase II	2					6
MS	MS SCHIP	Phase II	3				No	NA
MS	MS SCHIP	Employer-sponsored coverage	1	No		Yes	Yes	3	Yes	The employer must be willing to participate in SCHIP; the employer must contribute at least 50% of the premium for family coverage; the cost to SCHIP for purchasing coverage must not be greater than the payment the program would make if the children were enrolled in the state's plan; and the family must apply for the full premium contribution available from the employer.
MT	MT SCHIP		NA	No		Yes	Yes	3	NR
MT	MT SCHIP		1
NC	NC SCHIP		NA	No		Yes	Yes	6	NR
NC	NC SCHIP		1
NC	NC SCHIP		2
NC	NC SCHIP		3
NC	NC SCHIP		4
NC	NC SCHIP		5
ND	Healthy Steps	Phase I
ND	Healthy Steps	Phase I	NA	--		--	--	--	--
ND	Healthy Steps	Phase II
ND	Healthy Steps	Phase II	1	No		Yes	Yes	6	No
NE	Kid`s Connection		NA	--		--	--	--	--
NE	Kid`s Connection		1
NH	Healthy Kids	Gold	NA	--		--	--	--	--
NH	Healthy Kids	Gold	1
NH	Healthy Kids	Silver	NA	No		Yes	Yes	6	No
NJ	KidCare	Plan A	NA	--		Yes	No	NA	No
NJ	KidCare	Plan B	NA			Yes	Yes	12	NR
NJ	KidCare	Plan B	1					6
NJ	KidCare	Plan B	3
NJ	KidCare	Plan B	4
NJ	KidCare	Plan C	NA			Yes	Yes	12	NR
NJ	KidCare	Plan C	1					6
NJ	KidCare	Plan C	3
NJ	KidCare	Plan C	4
NJ	KidCare	Plan D	2			Yes	Yes	6	NR
NJ	KidCare	Plan D	3
NJ	KidCare	Plan D	4
NJ	KidCare	1115 Demonstration	NA
NM	NM SCHIP		NA	--		Yes	Yes	12	NR
NM	NM SCHIP		2
NM	NM SCHIP	1115 Demonstration	NA
NV	Nevada Check-Up		NA	No		Yes	Yes	6	Yes	Applicant must not have "credible" health insurance.
NV	Nevada Check-Up		1
NY	NY SCHIP	CHPLUS
NY	NY SCHIP	CHPLUS
NY	NY SCHIP	CHPLUS	NA	No		Yes	NR	NR	No
NY	NY SCHIP	CHPLUS	2
NY	NY SCHIP	Medicaid Expansion	2	--		--	--	--	--
OH	OH Child Health Plan		NA	--		--	--	--	--
OH	OH Child Health Plan		1
OK	SoonerCare		NA	--		Yes	--	--	Yes	Applicant must not have "credible" health insurance.
OK	SoonerCare		1
OR	OR SCHIP		NA	No		Yes	Yes	6	NR
OR	OR SCHIP		2
OR	OR SCHIP		3
PA	PA SCHIP		NA	No		Yes	NR	NR	No
PA	PA SCHIP		1
PA	PA SCHIP		2
PA	PA SCHIP		3
PA	PA SCHIP		4
PR	PR SCHIP		NA	--		--	--	--	--
RI	RIte Care		NA	Yes	Not eligible if on SSI or in foster care.	Yes	Yes	12	--
RI	RIte Care		1					4	Yes	Applicant must be uninsured and not have dropped coverage which would have cost less than $50 per month in premiums per family within 4 months prior to the application date if the family income is greater than 185% FPL.
RI	RIte Care	1115 Demonstration	NA
SC	Partners for Healthy Children		NA	--		--	--	--	--
SD	SD SCHIP		NA	--		Yes	--	--	Yes	Children covered under non-comprehensive, high-deductible private health insurance are enrolled in Medicaid, not SCHIP.
SD	SD SCHIP		1
SD	SD SCHIP		2
SD	SD SCHIP	CHIP NM	3	No		Yes	Yes	3	No
TN	Tennessee`s CHIP	Phase I	NA	--		Yes	--	--	Yes	Applicant must not have access to health insurance through an employer or family member as of a specified date.
TX	Texas Healthy Steps	Phase I
TX	Texas Healthy Steps	Phase I	NA	--		--	--	--	--
TX	Texas Healthy Steps	Phase II
TX	Texas Healthy Steps	Phase II	1	No		Yes	Yes	3	No
UT	UT SCHIP		NA	No		Yes	Yes	3	Yes	If the child is not enrolled but has access to a parent's employer-sponsored coverage (where the employer pays at least 50% of the premium), the child is not eligible for SCHIP. If a child must wait for an open enrollment period before enrolling in employer-sponsored coverage, the child may enroll in SCHIP until the next open enrollment period.
VA	VA SCHIP	Children's Medical Security Insurance Plan/Family Access to Medical Insurance Security Plan	NA	No		Yes	Yes	12	No
VA	VA SCHIP	Children's Medical Security Insurance Plan/Family Access to Medical Insurance Security Plan	1					6
VA	VA SCHIP	Family Access to Medical Insurance Security Plan (FAMIS) - ESI	1	No		Yes	Yes	6	Yes	The employer contribution must be at least 40% of the cost of family coverage.
VI	Virgin Island`s SCHIP		NA	--		--	--	--	--
VI	Virgin Island`s SCHIP		1
VT	VT SCHIP		NA	No		Yes	Yes	1	Yes	Applicant must not have dropped coverage without good cause in the month prior to application.
VT	VT SCHIP		1
VT	VT SCHIP		2
VT	VT SCHIP		3
WA	WA SCHIP		NA	No		Yes	Yes	1	Yes	Applicant must not have "credible" health insurance.
WA	WA SCHIP		1					4
WI	BadgerCare	Medicaid expansion
WI	BadgerCare	Medicaid expansion	NA	--		Yes	Yes	6	Yes	Applicant must not have access to 80% employer-subsidized insurance or have coverage under a health plan defined in HIPPA.
WI	BadgerCare	Medicaid expansion	1	No				3	Yes	Applicant must not have access to 80% employer-subsidized insurance or have coverage under a health plan defined in HIPPA.
WI	BadgerCare	Employer-sponsored Coverage	1	--		Yes	Yes	3	Yes	Access to 80% employer subsidized insurance precludes eligibility; Cannot have coverage under a health plan defined in HIPPA; BadgerCare will not buy into employer-sponsored coverage if the employer pays less than 60% of premium cost.
WI	BadgerCare		NA
WV	WV SCHIP	Phase I	NA	--		--	Yes	6	--
WV	WV SCHIP	Phase I	2
WV	WV SCHIP	Phase II	1	No		Yes	Yes	6	NR
WV	WV SCHIP	Phase II	2
WV	WV SCHIP	Phase II	3
WY	WY SCHIP	CHIP One	NA	No		Yes	Yes	1	NR