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Children's Health Insurance Program (CHIP): Who It’s For and How To Enroll

Free or low-cost health coverage for children

Written by: Aaron Garcia.

Key Takeaways

  • The Children’s Health Insurance Program (CHIP) is a low-cost health insurance for children from low-income households.

  • When a family’s income is too high to qualify for Medicaid but not enough to cover private insurance, CHIP is an option to include the children.

  • CHIP is free or low-cost health care for children 18 and under.

  • Contact your state Medicaid office to find out if you qualify to apply. Parents and legal guardians with low-income or limited resources can apply for CHIP with their state Medicaid office.

What is the CHIP Insurance?

No child should go without healthcareHealthcare is the industry dedicated to maintaining or improving health and well-being.: that’s the idea behind Children’s Health Insurance Programs (CHIP). CHIP is free or low-cost health insurance for qualifying low-income families as part of each state’s MedicaidMedicaid is a state-based health insurance program based on an individual's financial needs. system. CHIP is for households with income too high to qualify for Medicaid.

With the recent rise in the number of uninsured children, [1] CHIP is a great way to get essential coverage for preventive servicesPreventive care is medical care that aims to prevent serious diseases and injuries. These include immunizations, physicals, screenings and more. such as check-ups and vaccinations.

Who is Eligible for CHIP?

To receive CHIP benefits, [2] a child must be:

  • 18 years old or younger
  • Uninsured (and ineligible for Medicaid)
  • A U.S. citizen (or meet current immigration requirements)
  • A resident of the state they’re applying in
  • Within the state’s CHIP income range

Each state’s qualification for CHIP is different. Most states use the U.S. Department of Health and Human Services’ (HHS) guidelines for individual and family financial assistance.

State requirements can be different, but the federal regulation dictates that enrollees can’t be less than 133% [3] of the poverty line. Incomes that qualify are usually above the limit for Medicaid, but not nearly enough to afford individual or family health insurance.

What does that mean?

Federal law requires CHIP to be available to families that earn up to 133% of the poverty level. For example:

$10,000 X 133% = $13,300

As a guide, check the federally recognized poverty levels [4] for 2020.

What Does CHIP Cover?

Each state administers CHIP with shared funding from the federal government. States can form their CHIP in one of three ways:

  1. Offer services through Medicaid
  2. Create entirely new programs
  3. Combine the options above

Even with the differences, states must meet specific standards to receive funding from the federal government. They include a Minimum Set of Benefits:

  • Preventive Care
  • Hospitalizations
  • Emergency Room Visits

The means the following services are often covered by CHIP: [5]

Preventive check-ups

Prescriptions

Inpatient hospital stays

Immunizations

Dental Care

Vision

Laboratory and X-rays

Emergency Services

What Does Your State’s CHIP Cover?

Some states extend coverage to pregnant mothers. Others charge monthly premiums and copayments. Even with all the differences, most states will 100% cover preventive services such as wellness visits to doctors and dentists. Contact your state’s Medicaid office [6] to learn exactly what’s covered by your state’s CHIP.

How Do I Apply for CHIP?

  • Apply yourself at The Health Insurance Marketplace [7] at Healthcare.gov. If approved, your state’s Medicaid department will contact you to complete the next steps.
  • Apply directly through your state’s Medicaid office. Give your state’s office a call to see your options for applying over the phone, online, and in-person.

 

Is There an Enrollment Period?

There is no enrollment deadline to receive coverage. You’re encouraged to apply any time, and most state agencies will help you determine what kinds of coverage you and your family are eligible for.

FAQs

What Personal Information Should I Have In Order to Apply?

To enroll, you’ll first need to apply for Medicaid. Your state’s Medicaid office will then determine if you’re eligible for CHIP. To apply, you’ll need to provide some basic information:

  • Name
  • Current address
  • Phone number
  • Social Security number
  • Identification documents (birth certificate, driver’s license, or passport)

It’s also a good idea to write down your family’s current medical information before you start. This will provide a starting point for finding the care your family needs.

  • The names and addresses of your doctors
  • Which prescription drugs you’re currently taking
  • Any medical issues you’d like to have covered

Do I need to enroll again each year?

Yes. Each year, you’ll need to verify you’re still eligible with your state or county office each year. When accepted, your coverage will be good for the next 12 months.

Does CHIP cover prescription drugs?

The federal Medicaid system lists prescription drug services as an optional benefit, but each state currently covers a range of medications. [8] There are some vast differences between the states, though, as each system classifies drugs differently. If you need specific medications, make sure to tell your Medicaid enrollment specialist. Your state may also have a prescription drug formularyA Prescription Drug Formulary is a list of all the prescription drugs covered by your health insurance. These drugs can be name brand or generic and are broken up into four categories for pricing. that lists all medications covered by its CHIP system.

What's Next?