Child's Health Insurance Program (CHIP)

What is the Children’s Health Insurance Program (CHIP) ?


Congress passed the Children's Health Insurance Program (CHIP) in 1997 during the Clinton administration. CHIP provides medical coverage for children 18 years of age and younger. CHIP is a federal-state partnership much like Medicaid. CHIP covers children whose parents earn too much income to qualify for Medicaid, but not enough to pay for private coverage. CHIP offers low-cost or free health insurance for children in families with slightly higher incomes.

Generally, the federal government covers about 70% of the funding. Like Medicaid, CHIP can be administered by a state's government or a managed care organization. A 1997 federal law mandates that every territory or state must have a CHIP. This can be a separate CHIP or a combination CHIP that expands Medicaid. But most states have combination chips.

CHIPs for Medicaid expansion follow federal Medicaid regulations so it matters, but a state with a combination or separate CHIP can design and operate its own program independently. Combination or separate CHIP programs may have longer coverage waiting periods and higher premiums than state Medicaid. In short, these can be different plans, so it is important to read the policy documents carefully to ensure that you have the coverage that suits your child's needs.

The Children's Health Insurance Program (CHIP) is an important source of health coverage for pregnant women and children. On January 22, 2018, Congress extended funding for the CHIP program for six years, a program that serves 9 million children nationwide. But we welcome the news that the funding expansion of Child's Health Insurance Program has taken a long time.

Strengthening the Children's Health Insurance Program (CHIP) and Medicaid is a key priority for the administration. Medicaid and CHIP provide health care coverage for more than 80 million families, including more than 40 percent of children with disabilities in the United States and older adults and low-income adults.

The Children's Health Insurance Program (CHIP) was created in 1997 with strong bipartisan support. CHIP provides financial assistance to states to expand publicly funded coverage to uninsured children who are not eligible for Medicaid. CHIP provides a fixed amount to the states in the form of block grants.

In April 2009, the Children's Health Insurance Program Reauthorization Act (CHIPRA) reauthorized CHIP and provisions to strengthen the program were included in the Affordable Care Act (ACA) of 2010. The ACA extended CHIP funding until September 30, 2015, and requires states to maintain eligibility standards by September 30, 2019. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended CHIP funding without any programmatic changes until September 30, 2017.
 

How Does the Children's Health Insurance Program (CHIP) Work ?


The Children's Health Insurance Program (CHIP) is a U.S. There is a federal health program that is designated and administered differently by each state. For example, in Arkansas the program is called ARKids and New York calls its program Child Health Plus. In each state, the federal government provides matching funds.

Responsibility for managing CHIP programs falls under the state's Medicaid Administration. Many are unaware of the existence of the CHIP program, families are required to apply for Children's health insurance Program. In many cases, family employers are unable to obtain health insurance coverage for their children. The medical services covered by CHIP are free, but some services require a co-payment.

CHIP usually covers vaccinations, annual checkups, doctor visits, dentistry, hospital care, vision care, X-rays, laboratory services and emergency services, and some states also provide coverage to parents and pregnant women .

The benefits of CHIP health insurance coverage are available immediately and can start at any time throughout the year. Parents who qualify for Medicaid can enroll their child in CHIP so they don't need to purchase coverage.

Child's Health Insurance Program (CHIP)

Medicaid and the Child's Health Insurance Program (CHIP)


  • CHIP and Medicaid provide health insurance. This program provides access to medical care to low-income families. In September 2020, Medicaid helped pay more than 81 million children and adults.
  • Note: The Children's Health Insurance Program (CHIP) is a special form of Medicaid for children who have it. This includes medical supplies, hospital care, tests, dental care, eye exams and routine checkups.
  • Medicaid pays for a significant portion of American births. In the states reporting the data, Medicaid-funded birth rates typically fall between 30% and 50%.
  • The Affordable Care Act increased Medicaid coverage by 32.3%. It allowed qualifying single adults and raised the maximum income level.

Key Features of Child's Health Insurance Program (CHIP)


  • The Children's Health Insurance Program (CHIP) is a federal health program that provides medical coverage to children.
  • CHIP is designed to help families who earn too much to qualify for Medicaid but who can't afford private insurance.
  • Each state has a Children's Health Insurance Program (CHIP) that provides health insurance up to the age of 19.
  • Children can still qualify for CHIP even if household income is high enough for Medicaid eligibility.
  • Typically a family of four will qualify/benefits up to $106,000 (before taxes) annually for CHIP, but limits vary from state to state.
  • Those pregnant women who meet the eligibility requirements can enroll in the CHIP program.
  • Some of the services covered by CHIP require a co-payment and many are free. Meanwhile, some states require monthly premiums that cannot exceed 5% of annual income.
The CHIP program operates in all US states and territories. According to the CHIP and Medicaid Modern Medicaid Alliance, the U.S. I insure 1 in 3 children. More than 40% of the country's 13.9 million children with special needs are insured through CHIP or Medicaid. Medicaid or CHIP insures 25% or more of children in these 12 states : 
  1. Alaska
  2. Arkansas
  3. California
  4. District of Columbia
  5. Kentucky
  6. Louisiana
  7. Montana
  8. New Mexico
  9. New York
  10. Rhode Island
  11. Vermont
  12. West Virginia

What Standard Benefits does CHIP Cover ?


The benefits covered under CHIP are relatively standard, but some benefits may vary on a state-by-state basis. According to its website, the following benefits are offered under CHIP :

CHIP Benefits


  • Routine check-ups
  • Immunizations
  • Doctor visits
  • Prescriptions
  • Dental and vision care
  • Inpatient and outpatient hospital care
  • Laboratory and X-ray services
  • Emergency services
  • Mental health services
States cover essential physical and occupational therapy for Medicaid eligible people. Medicaid expansion states for children also include early and periodic screening, diagnosis and treatment (EPSDT) benefits. This includes health and development services. All state Medicaid programs cover essential outpatient and inpatient mental health services. Children can receive treatment with CHIP for mental health conditions.

Some states also provide additional services beyond federal coverage. For example :
  • Through Medicaid, Maine has free tobacco-prevention and cessation programs.
  • Wisconsin provides specialized services for children with moderate to severe asthma at CHIP.
  • Hawaii Chip establishes school-based vision-checking program.

How Much Does CHIP Cost ?


The chip isn't completely free, but the cost is modest. States that have CHIP programs follow Medicaid rules on premiums and cost-sharing. Some CHIP benefits, such as doctor visits and dental visits, are free. However, depending on your income, your state may charge a reimbursement fee for some services. Medicaid/CHIP nominees with income 151% of the federal poverty level, as of January 2020, can expect to share costs for :
  • Non-preventive physician visits (in 16 states)
  • Generic prescription medications (in 12 states)
  • Inpatient hospital admissions (in 11 states)
CHIP families paid an average monthly premium of $18 to $25 per child in 2018 in cost-sharing states, and this amount varies by income. Federal rules limit how much your state CHIP program can charge. Your insurance provider may charge no more than 5% of your income, in aggregate, for cost-sharing. Therefore, your insurance provider can charge no more than $1,500 (5% of $1,500) if a five-person family earns $30,000 in a year. That $1,500 cap includes:
  • Fees
  • Deductibles
  • Co-payments
  • Coinsurance
  • Premiums

Premium and Cost-Sharing


States may enforce cost-sharing (i.e. co-insurance, deductible and co-pays) for certain children enrolled in CHIP under federal guidelines. In general, states cannot adopt premium policies or cost-sharing that favor high-income households over low-income households, or that impose costs in excess of 5% of the family's income. They are also forbidden from imposing cost-sharing for child care, including vaccinations.
States cannot count money raised through cost-sharing or premiums in dollar terms for the purposes of meeting block grant matching requirements. Premiums in CHIP and Medicaid reduce enrollment because they place a financial burden on families, potentially increasing the number of uninsured children.

Who is Eligible for CHIP ?


States set income and age eligibility for different chip programs. The income threshold is expressed as a percentage of the federal poverty level. Eligibility for programs such as CHIP may change if your family income increases or decreases. With age, many children also fall out of CHIP eligibility. The CMS has established maximum income as a percentage of the federal poverty level for the combined Medicaid and CHIP programs:

Child's Age

Medicaid

CHIP

Birth to age 1

195%

217%

Ages 1 to 5

217%

217%

Ages 6 to 18

138%

155%

States with separate CHIP programs have an income maximum of 255% of the federal poverty limit for children of all ages. Federal law limits eligibility in certain situations. Some states cover postpartum or pregnant women under CHIP. Other eligibility criteria such as immigration status, citizenship and state residence also apply.

CHIP Eligibility


Children up to the age of 18 are eligible for CHIP benefits. The income cut-off depends on the size of the family and the state they live in. The following are the criteria for CHIP eligibility :
  • Uninsured (determined ineligible for Medicaid and not covered through group or trusted health insurance)
  • state resident
  • Meets a citizen or immigration requirements
  • Eligible within the state's CHIP income limit based on family income, and any other state specified rules in the CHIP state plan
Important: A family of four earning up to $106,000 before taxes (as of 2021) will qualify for CHIP, but limits vary on a state-by-state basis.

How Do Parents Prove Eligibility For CHIP ?


Each state has its own application and enrollment process for CHIP, so it's wise to call your local Medicaid office to ask what documents will come in handy to prove eligibility. They may include the following :
  • Proof of household income from all sources before taxes
  • Social Security numbers and birth dates for all applicants
  • Day care expenses (if any)
  • Work transportation expenses (if any)
  • Private health insurance details, if you have or had private health insurance in the last 90 days
Some states offer a simple process called Express Lane Eligibility (ELE). These states are the following :
  • Alabama
  • Colorado
  • Iowa
  • Louisiana
  • Massachusetts
  • South Carolina
  • South Dakota 
Colorado and Massachusetts also have ELE for CHIP. 

With ELE, when you sign up for any of these programs, the state may enroll you in Medicaid based on your information :
  • Supplemental Nutrition Assistance Program
  • Temporary Assistance for Needy Families
  • Head Start
  • National School Lunch Program
  • Special Supplemental Nutrition Program for Women, Infants, and Children

When Can Families Apply For CHIP ?


CHIP and Medicaid have open enrollment throughout the year. You'll know if your family is eligible for CHIP when you apply for Medicaid. It will be retroactive to the date of your application that when you qualify, healthcare can begin immediately. Some states have a waiting period to prevent CHIP from replacing group health insurance. In those states, you can apply for a waiver to receive immediate coverage for the child if :
  • Your child becomes ineligible for Medicaid or other types of income-based coverage.
  • You cannot get affordable healthcare for your child through your employer.
  • Your employer's plan no longer covers dependents.
  • Your employment status changed, which ended your child's health insurance coverage.
  • Your child's health care coverage ended because of divorce or the death of a parent.
  • Your child has special medical needs.

How to apply for CHIP ?


You can use the following methods to apply for Child's Health Insurance Program (CHIP) :
  • Call : 1-800-318-2596 (TTY : 1-855-889-4325).
  • Fill out an online application to be referred to a state agency through the Health Insurance Marketplace.
  • Contact your state CHIP or Medicaid agency to apply directly.

Where Can Families Get Help With CHIP Applications ?


Many organizations and government agencies can guide you in applying for a chip.
  • Provides a complete list of Medicaid phone numbers, state-by-state contacts, and other information.
  • On Healthcare.gov's CHIP & Medicaid coverage page, you can see if you qualify by income and review steps to apply.
  • InsureKidsNow.gov features online resources for each state, as well as phone numbers and a clickable map for guidance.
  • Healthcare.gov also has a Find Local Help page. When you enter your ZIP code, you can find a local source for free personal assistance with your CHIP application.
  • You can fill out a questionnaire with Benefit Finder to learn how to apply and find out the benefits programs available to you.

CHIP Program FAQs


What services does the chip cover?
CHIP covers basic health care, including prescriptions, X-rays, vision and dental care, sick visits, emergency services, annual checkups, vaccinations, and mental health services for eligible children up to the age of 18.

What are the income limits for CHIP?
The income limit for CHIP varies from state to state, but for the most part, a family of four is covered if their annual income before taxes is $106,000.

Who is eligible for chip insurance?
Children who meet immigration requirements by age 18 or older, whose family meets CHIP income requirements and who are US citizens are eligible for CHIP benefits.