CHIPRA Section 214: Lawfully Residing Children and Pregnant Women

CHIPRA Section 214 is a federal option that lets states cover lawfully residing immigrant children and pregnant women through Medicaid and CHIP without making them wait the standard five years that usually applies to noncitizens seeking federal benefits. If your state has adopted this option, an eligible child or pregnant woman can enroll right away through the regular Medicaid or CHIP application. About 38 states have taken up the option for children and roughly 32 for pregnant women, so whether you can use it depends heavily on where you live.

What Section 214 Actually Does

Since 1996, most lawfully present noncitizens have faced a five-year waiting period before qualifying for major federal means-tested benefits, including Medicaid and CHIP. That rule came from the Personal Responsibility and Work Opportunity Reconciliation Act.¹

Section 214 of the Children’s Health Insurance Program Reauthorization Act, signed in 2009, carved out a targeted exception. Codified at 42 U.S.C. § 1396b(v)(4), it lets a state disregard the five-year bar for two groups: people under age 21, and pregnant women during pregnancy and through a postpartum period.²

The word to notice is “option.” Section 214 does not require any state to waive the bar. It only permits them to. Whether the coverage is available to you depends entirely on whether your state has filed the necessary plan amendment with the Centers for Medicare & Medicaid Services.

Who Counts as Lawfully Residing

The statute uses the phrase “lawfully residing in the United States” without listing the specific statuses that count. CMS filled that gap through State Health Official Letter 10-006, and the definition is broader than most people expect.³ You qualify if you fall into any of these categories:

Qualified aliens, including lawful permanent residents, refugees, asylees, people granted withholding of deportation or removal, Cuban and Haitian entrants, certain trafficking victims, and people paroled into the U.S. for at least one year
Nonimmigrants in valid status, such as people on student, work, or tourist visas who have not violated their terms of admission
People paroled for less than a year, except those paroled for prosecution, deferred inspection, or pending removal
Current TPS holders and TPS applicants who have received employment authorization
People with approved deferred action (with the DACA exception noted below)
People granted Deferred Enforced Departure by presidential decision
Asylum or withholding-of-removal applicants who have received employment authorization, or who are under 14 with an application pending at least 180 days
Children with a pending Special Immigrant Juvenile application
Family Unity beneficiaries, people with an approved visa petition and a pending adjustment application, and certain others granted employment authorization under specific regulations

One important boundary: DACA recipients are not eligible for Section 214 Medicaid or CHIP coverage. A 2024 HHS rule expanded “lawfully present” to include DACA recipients for Marketplace and Basic Health Program purposes, but CMS explicitly declined to extend that change to the Medicaid and CHIP definition used for Section 214.⁴

What Children Get

The federal statute covers individuals under 21 for Medicaid purposes, while CHIP covers children under 19.⁵ So the upper age limit in your state may be 19 or 21 depending on which program is providing the coverage. Income eligibility varies by state, generally running from 138% to over 300% of the federal poverty level depending on the program and the child’s age.

Automatic Coverage for Newborns

If a mother is enrolled in Medicaid or CHIP at the time of birth, her newborn is automatically deemed eligible for Medicaid for the first year of life with no separate application. That coverage continues no matter what changes in the family’s circumstances. It ends only if the child turns one, dies, leaves the state, or the family requests termination.⁶

Twelve Months of Continuous Coverage

Once a child is determined eligible for Medicaid, federal rules require the state to keep coverage in place for 12 months regardless of changes in income or household size. The only exits are the child turning 19, moving out of state, dying, or the family asking to end coverage.⁷ For immigrant families whose jobs or living arrangements may shift during early years in the country, that stability matters.

What Pregnant Women Get

A pregnant woman who is lawfully residing and otherwise eligible receives full Medicaid or CHIP coverage during pregnancy and through at least a 60-day postpartum period, running from the last day of pregnancy through the end of the month in which the 60th day falls.⁸

Since 2022, states have also had the option to extend postpartum coverage to a full 12 months, first authorized by the American Rescue Plan Act and made permanent by the Consolidated Appropriations Act of 2023. As of early 2026, 49 states plus the District of Columbia have implemented the 12-month extension.⁹ So in practice, a woman newly enrolled through Section 214 in most states will have a full year of postpartum care.

Whether Your State Has Adopted It

A state adopts Section 214 by filing a state plan amendment with CMS. It can pick up the option for Medicaid only, or for Medicaid and CHIP together, but it cannot cover only its separate CHIP program without also covering the Medicaid side.³ Some states cover children only, some cover both children and pregnant women, and some have adopted the option in Medicaid but not in their separate CHIP program.

Approximately 38 states have adopted the option for children in Medicaid and about 32 for pregnant women as of 2025. The most reliable place to confirm your state’s status is your state Medicaid or CHIP agency’s website, which will list covered populations and income thresholds. If your state has not opted in, the five-year bar still applies to lawfully residing children and pregnant women.

How to Apply

Applying uses the same Medicaid or CHIP application process as any other applicant, submitted through your state’s health and human services agency online, by mail, or in person. The application asks for household size, income, and immigration status.

You’ll need documentation of your immigration status. Common documents include a Permanent Resident Card, an I-94 Arrival/Departure Record, an Employment Authorization Document, or a foreign passport with an asylum or refugee stamp. Your Alien Registration Number or USCIS number needs to match exactly between your documents and the application; mismatches are a frequent cause of delays.

Often you won’t need to send paper at all. State agencies verify immigration status electronically through the Federal Data Services Hub, which connects to the Department of Homeland Security’s SAVE system and returns indicators showing whether lawful presence is verified and whether the five-year bar applies or has been met.¹⁰

Beyond immigration status, expect to show proof of state residency, proof of age for children, and proof of household income. For pregnant women, a written statement from a doctor or clinic confirming the pregnancy and estimated due date is typically required.

If Your Status Cannot Be Verified Right Away

Federal regulations require states to provide Medicaid during a reasonable opportunity period of at least 90 days while immigration status is being confirmed, as long as you meet all other eligibility requirements and have attested to satisfactory immigration status.¹¹ Coverage should not be delayed simply because verification is still in process.

Public Charge and Enrolling Your Family

Many immigrant families avoid public benefits out of concern that using them will hurt a future green card application through the public charge ground of inadmissibility. Under the regulations in effect as of early 2026, that concern does not apply to CHIP at all, and does not apply to Medicaid except for long-term institutional care such as a nursing home stay paid by Medicaid.¹² Enrolling a child in CHIP or receiving pregnancy-related Medicaid does not count against you under current rules.

This area is in flux. In November 2025, the Department of Homeland Security published a proposed rule that would rescind the current framework and could allow immigration officers to consider a broader range of benefits, including Medicaid, CHIP, and SNAP, in public charge determinations.¹³ That proposed rule has not been finalized as of this writing. If public charge is a concern for you, check the current status of the rulemaking with USCIS or consult an immigration attorney before enrolling.

If Your State Has Not Adopted Section 214

If you live in a state that hasn’t opted in, the five-year bar still runs, and regular Medicaid and CHIP are not available until it ends. A few fallback paths remain.

Emergency Medicaid is required in every state. It covers emergency medical conditions, including labor and delivery, for people who meet all other Medicaid eligibility requirements. It does not cover routine prenatal care, well-child visits, or ongoing treatment for chronic conditions.²

The Health Insurance Marketplace is open to lawfully present immigrants, including many of the categories that Section 214 would cover, and premium tax credits and cost-sharing reductions are available based on income. Marketplace plans do not carry Medicaid’s or CHIP’s cost-sharing protections for low-income families, and children on a Marketplace plan don’t receive Medicaid’s Early and Periodic Screening, Diagnostic and Treatment benefit.

Some states run their own coverage programs with state-only funds for populations that don’t qualify for federally funded Medicaid. Eligibility, benefits, and enrollment caps vary.

What Changes on October 1, 2026

Section 71109 of the Working Families Tax Cut legislation, Public Law 119-21, tightens federal Medicaid and CHIP funding for noncitizens starting October 1, 2026. After that date, federal matching funds for non-emergency Medicaid and CHIP are generally limited to U.S. citizens, U.S. nationals, lawful permanent residents, Cuban and Haitian entrants, and Compact of Free Association migrants.¹⁰

Section 214 coverage is explicitly exempted from the new restrictions. Federal funding is preserved for the CHIPRA 214 option in states that have elected it, along with Emergency Medicaid and CHIP Health Services Initiatives.¹⁴ For families in states that already use Section 214, nothing changes. For those in states that haven’t adopted it, and for noncitizens who fall outside the protected categories listed above, the paths to federally funded coverage narrow considerably after October 2026.

1
National Immigration Law Center. Overview of Immigrant Eligibility for Federal Programs
2
Office of the Law Revision Counsel. 42 USC 1396b – Payment to States
3
Centers for Medicare & Medicaid Services. SHO 10-006 – Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Women
4
Centers for Medicare & Medicaid Services. HHS Final Rule Clarifying the Eligibility of DACA Recipients and Certain Other Noncitizens
5
Medicaid.gov. CHIP Eligibility and Enrollment
6
Medicaid.gov. Implementation Guide – Medicaid State Plan Eligibility, Deemed Newborns
7
eCFR. 42 CFR 435.926 – Continuous Eligibility for Children
8
Medicaid.gov. SHO 21-007 – Improving Maternal Health and Extending Postpartum Coverage in Medicaid and CHIP
9
KFF. Medicaid Postpartum Coverage Extension Tracker
10
Medicaid.gov. SHO 26-001 – Implementation of Section 71109 Alien Medicaid Eligibility
11
Medicaid.gov. Implementation Guide – Citizenship and Non-Citizen Eligibility
12
U.S. Citizenship and Immigration Services. Consideration of Current and/or Past Receipt of Public Cash Assistance for Income Maintenance or Long-term Institutionalization at Government Expense
13
Federal Register. Public Charge Ground of Inadmissibility
14
Centers for Medicare & Medicaid Services. CMS Issues Guidance to Implement New Limits on Federal Medicaid CHIP Funding for Certain Noncitizens