7 min read · Last updated August 20, 2026

In this article

• What the 12-month rule actually guarantees
• Who qualifies, and how to renew without a gap
• What can end coverage during the year, and what cannot
• The renewal notice most families miss
• If your state charges a CHIP premium
• Frequently asked questions

When Marisol Ortiz picked up an extra weekend shift at the distribution center in June, her monthly pay went from $2,850 to $3,250. She braced for a letter saying her kids, ages 6 and 9, no longer qualified for the Children’s Health Insurance Program (CHIP). CHIP is the joint federal-state program that covers medical and dental care for kids in families who earn too much for Medicaid but not enough for private insurance. The letter never came. Since January 1, 2024, federal law has required every state to keep an enrolled child covered for a full 12 months, regardless of what happens to the family’s income in between.

What the 12-month rule actually guarantees

The requirement comes from Section 5112 of the Consolidated Appropriations Act, 2023, the federal spending law that made 12-month continuous eligibility mandatory nationwide starting January 1, 2024. Before that date, states could offer it, but were not required to. The Centers for Medicare & Medicaid Services (CMS) explained the change plainly when the requirement took effect. “Families of children enrolled in Medicaid and CHIP will have peace of mind knowing their children will have uninterrupted access to health care coverage for a year, regardless of any changes in their family’s financial circumstances.”

That single sentence is the whole point for a family like Marisol’s. Once a child is approved, the state locks in that coverage for a full year. The agency cannot re-check income mid-period and cannot pull the child off the rolls because a paycheck went up. This matters because health coverage churn hurts kids. Losing and regaining coverage within the same year has been linked to worse access to routine and preventive care, according to research cited in the Kaiser Family Foundation (KFF)’s overview of Medicaid’s role for children.

Before 2024, this protection was a state option rather than a nationwide floor. As of January 2022, 24 states had already chosen to offer 12-month continuous eligibility to all children in Medicaid on their own, roughly half the country, according to KFF’s tracking of state policy. The other half left families exposed to exactly the scenario Marisol worried about: a routine income check mid-year that could end a child’s coverage over a raise of a few hundred dollars a month. The Consolidated Appropriations Act, 2023, closed that gap for every state at once. That is why a policy change most parents never heard about now protects nearly every child enrolled in Medicaid or CHIP nationwide. It is not just the children lucky enough to live in a state that had already adopted the protection voluntarily.

Who qualifies, and how to renew without a gap

CHIP income limits are set state by state, not nationally, which is part of why so few parents can quote their own number. According to KFF’s state-by-state eligibility tracker, separate CHIP programs commonly start around 200% of the federal poverty level, the income line where many state Medicaid programs for children stop. They run as high as 405% of the federal poverty level in New York, the highest in the country. For a family of four, 200% of the 2026 federal poverty level works out to about $66,000 a year, and 405% works out to roughly $133,650 a year. The honest answer to “do we qualify” depends entirely on which state you live in. Your state Medicaid or CHIP agency’s website will list the exact percentage and dollar cutoff for your household size.

Applying and renewing both go through the same state Medicaid or CHIP agency, usually online, by phone, or by mail. Most states accept a single combined application that checks eligibility for both programs at once, so you never have to guess which one to apply for. If a renewal is denied, most states have to tell you the specific reason in writing and give you a window to appeal or submit missing documents before coverage actually lapses. Call the number on the denial notice the same week it arrives. A missed document is fixable; a missed appeal deadline is not.

What can end coverage during the year, and what cannot

The rule is not absolute. A specific, short list of events can end a child’s coverage before the 12 months are up, and income is deliberately left off that list.

Circumstance	Ends coverage during the 12 months?
Family income goes up or down	No
Child turns 19 (or the state’s cutoff age)	Yes
Parent asks the state to end the child’s coverage	Yes
Child moves out of state	Yes
State finds the original approval was granted in error	Yes
Family misses a CHIP premium payment (premium states only)	Yes, premium states only
Family’s address changes within the same state	No

Most of the list has nothing to do with money. The only income-adjacent exception nationwide is a missed CHIP premium payment. That only applies in the 18 states that currently charge CHIP premiums or enrollment fees at all, according to KFF’s state-by-state tracker, usually to families in the program’s higher income tiers.

The renewal notice most families miss

The 12-month clock resets with a renewal, not automatically. Near the end of your child’s coverage year, the state mails a renewal packet asking you to confirm your household information so coverage can continue. In Marisol’s case, that packet is due back the same June her extra shift started. It is easy to mistake this for junk mail or a bill, especially if nothing about your circumstances has changed. Missing the response deadline, not the income change itself, is what actually puts coverage at risk. Set a reminder for the month before your approval anniversary and open every envelope from your state Medicaid or CHIP agency the same week it arrives.

If your state charges a CHIP premium

If your state is one of the 18 that charge a CHIP premium or enrollment fee, that payment is the one place where money genuinely intersects with the 12-month protection. The amount ranges from $15 a month in Idaho to $198 a month in Missouri for one child, depending on income tier.

A missed payment can lead to disenrollment even mid-period, though most states include a grace period before that happens. If a job change means a premium payment is suddenly tight, call your state’s CHIP office before you miss a payment. Ask specifically about a grace period or a payment plan. That one call is the difference between staying covered and starting the entire application process over.

Frequently asked questions

Does my child lose CHIP coverage the month my income goes above the limit? No. Once your child is approved, federal law guarantees 12 months of coverage no matter what your income does in between. The state cannot re-check your income or cancel coverage mid-year because you started earning more.

What if I forget to respond to the renewal notice? Missing the renewal deadline is the main way families lose coverage, not the income change itself. If you miss it, call your state Medicaid or CHIP agency right away. Many states allow a short window to submit late paperwork before coverage actually ends.

Does this 12-month rule apply to Medicaid too, or just CHIP? Both. The Consolidated Appropriations Act, 2023, made 12-month continuous eligibility mandatory for children under 19 in both Medicaid and CHIP, starting January 1, 2024. The same protection applies whichever program covers your child.

My state charges a CHIP premium. What happens if I’m late on a payment? A missed premium payment is the one situation where money can end coverage mid-period, but most states build in a grace period first. Call your state’s CHIP office as soon as a payment looks tight and ask about a grace period or payment plan before you miss the due date.

Can I still add a new baby or a second child mid-year? Yes. The 12-month rule protects a child once enrolled; it does not stop you from applying for a newly eligible child at any point in the year. Apply as soon as the child is born or otherwise becomes eligible rather than waiting for your other child’s renewal date.