Children's Health Insurance Program (CHIP): Who It’s For and How To Enroll
Written by: Aaron Garcia
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.
No child should go without healthcare : 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 Medicaid system. CHIP is for households with income too high to qualify for Medicaid.
With the recent rise in the number of uninsured children, [i] CHIP is a great way to get essential coverage for preventive services such as check-ups and vaccinations.
Find a local Medicare plan that fits your needs
To receive CHIP benefits, [i] 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% [i] 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. [i]
Each state administers CHIP with shared funding from the federal government. States can form their CHIP in one of three ways:
- Offer services through Medicaid.
- Create entirely new programs.
- 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
- Emergency Room Visits
The means the following services are often covered by CHIP: [i]
Inpatient hospital stays
Laboratory and X-rays
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 [i] to learn exactly what’s covered by your state’s CHIP.
Are you eligible for cost-saving Medicare subsidies?
Apply yourself at The Health Insurance Marketplace [i] at Healthcare.gov. If approved, your state’s Medicaid department will contact you to complete the next steps.
Or, 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.
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:
- 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
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.
The federal Medicaid system lists prescription drug services as an optional benefit, but each state currently covers a range of medications. [i] 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 formulary that lists all medications covered by its CHIP system.