CHIP Health Insurance

Erin De Santiago
doctor checking boys throat

The Children's Health Insurance Program (CHIP) is a government program that "provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid." CHIP is available in each U.S. state, though qualification requirements vary from one state to another.

CHIP Versus Medicaid

CHIP is coverage that is for families that don't qualify for full Medicaid assistance, though the two programs are administered in coordination with each other. The program "is funded jointly by the federal government and states through a formula based on the Medicaid Federal Medical Assistance Percentage (FMAP)." States may operate CHIP as a separate program from Medicaid, as an expansion of Medicaid, or a combination of both.

Eligibility for CHIP

States have discretion on setting income eligibility standards and income requirements for CHIP. According to Medicaid, 46 states and the District of Columbia cover children up to or above 200% of the Federal Poverty Level (FPL). For example, children in Nevada qualify with an annual family income of up to 200% of the federal poverty level, which is $48,600 for a family of four. Many of these states offer coverage to kids with family incomes at 250% of the FPL or higher. States that opt to expand coverage to above 300% of the FPL get Medicaid match rates from the federal government.

It is important to note that CHIP should not replace dependent coverage through group health plans for eligible families. The Social Security Act that requires states to include in their plans a description of how the state ensures CHIP doesn't substitute for coverage under group plans.

Waiting Periods

Effective as of January 2014, regulations provide that the waiting period imposed under the plan, which is a period of time the child must be without health coverage before he or she can be covered, must not exceed 90 days. States also have to adopt certain exemptions to the waiting period.

Some states do not have any waiting period, while others require 30, 60 or 90 days. See the CHIP Waiting Periods Chart to find out the requirements are for your state.

How to Apply for CHIP

CHIP applications can be submitted any time of year, as there is no specific open enrollment period. A child's parent, guardian, grandparent, or other authorized representative can apply on his or her behalf. Teenagers who live on their own may be allowed to apply for CHIP and/or Medicaid themselves, or have an adult apply for them. You can apply directly to your state's program or through the Health Insurance Marketplace.

Direct Application

You can go to Insure Kids Now to find out how to apply directly to CHIP in your state. Simply select your state from the drop down above the U.S. map graphic to get the applicable information for where you live. From there, you can complete an application or find contact information for the agency that administers CHIP in your state.

Each state page offers information such as:

  • State specific CHIP information and requirements
  • How each state administers both Medicaid and CHIP
  • Links to apply for CHIP
  • Links to apply for Medicaid (in some cases you may apply for both simultaneously)

For example, when you click on Texas, you receive the link for applying for both CHIP and Medicaid as the programs are administered together. If you click on Illinois, you'll see a link to apply for All Kids, which is that state's CHIP program.

Health Insurance Marketplace

Alternately, you can apply through the Health Insurance Marketplace by filling out an application on Healthcare.gov or calling 800-318-2596. The benefit of applying through the Marketplace is they collect all your information in case you qualify for another program and give you quotes for alternate insurance plans in case you don't qualify for CHIP or Medicaid based on your income level.

Depending on what state you live in, you may be directed to another website to apply, rather than applying directly on the Marketplace. For example, California will direct you to Covered California to start your application, while New York residents will apply through the New York State of Health.

General CHIP Benefits

Every state is required to provide comprehensive coverage under CHIP. Minimum coverage requirements include:

  • doctor checking seniors blood pressure
    Immunizations
  • Routine check-ups
  • Doctor visits
  • Prescriptions
  • Dental care
  • Vision care
  • Inpatient hospital care
  • Outpatient hospital care
  • Laboratory services
  • X-ray services
  • Emergency services

In some states, more services are covered. Additionally, Medicaid and CHIP enhancements include a special eligibility category for pregnant women to receive coverage through CHIP in some cases. As a result, some states have chosen to "provide necessary prenatal, delivery, and postpartum care to low-income uninsured pregnant women" through CHIP.

Cost Sharing

The cost of what you're expected to pay varies on individual situations and is directly tied to your income. Some families get free coverage for children and teenagers, while others may be required to pay a small enrollment fee, modest premiums, and co-pays for some services. The remainder of the coverage is paid for by the federal government or the state where you reside and applied for CHIP coverage.

Under CHIP, the annual premiums and cost-sharing amounts a family is required to pay is generally limited to five percent of a family's annual income. For some services, including well-child and well-baby doctor visits, cost sharing is not allowed. Some states charge a monthly premium, but it won't exceed five percent of your family's income for the year. For families with incomes at or below 150% of the Federal poverty level (FPL), premiums can't exceed the amount permitted in Medicaid.

Finding Health Care Providers

In order to use this insurance, you need to see providers who accept CHIP. If you need help, finding a doctor (or other healthcare provider), contact the state CHIP agency listed on your coverage card and request a list of approved providers in your area. When you are making an appointment, be sure to let the provider know you're on the CHIP program to verify that they do accept your coverage.

Is CHIP a Good Program?

A Houston Chronicle article indicates that some physicians may not be satisfied with how reimbursed is handled through the program, but that CHIP seems to be good for consumers. From the consumer standpoint, people seem to be satisfied with the program. For example, a HuffPost article cites an Iowa survey that indicates a dissatisfaction rate of less than one percent.

Kaiser Family Foundation published a brief on the program's impact, which is overwhelmingly positive. Key findings include:

  • Coverage for kids from low-income families has been greatly expanded under CHIP.
  • CHIP has led to better access to primary and preventative for some kids.
  • CHIP is invaluable for children with special health care needs.
  • CHIP seems to be having a positive impact on health outcomes.

Future of CHIP

The future of CHIP is undecided due to political debates that may reduce or eliminate funding for CHIP. For now, CHIP is still an active federal program. If you think you are eligible, visit the Healthcare Marketplace and follow the directions to apply through your respective state for coverage.

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CHIP Health Insurance