What is CHIP?
The Children’s Health Insurance Program (CHIP) is a public health insurance program for children in families whose income is too high to qualify for Medicaid, but who may not be able to afford private health insurance.
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CHIP is jointly funded by the federal government and state governments. Each state administers and operates its own program, so the program name, eligibility rules, and benefits may vary from state to state.
Who is eligible for CHIP?
In general, CHIP is available to children who:
- Do not qualify for Medicaid;
- Do not have access to affordable employer-sponsored health insurance;
- Belong to a family that meets the state’s income requirements; and
- Meet age, residency, and other requirements set by the state.
Because each state sets its own eligibility rules, a family may qualify for CHIP in one state but not in another.
How is CHIP different from Medicaid?
Although both CHIP and Medicaid are public health insurance programs for people with low or modest incomes, they are designed to serve different groups.
Put simply, Medicaid generally serves families with lower incomes. CHIP serves children in families whose income is above the Medicaid limit but still not high enough to make private health insurance affordable.
In other words, CHIP helps close the coverage gap for children whose families earn too much to qualify for Medicaid but cannot comfortably afford private health insurance.
What does CHIP cover?
Although CHIP and Medicaid serve different groups of children, CHIP benefits are generally comprehensive and, in many states, are similar to Medicaid benefits.
Specific benefits vary by state, but CHIP commonly covers many important health care services for children, including:
- Doctor visits;
- Routine well-child visits;
- Immunizations;
- Care for illnesses and injuries;
- Emergency care;
- Hospital care;
- Prescription medications;
- Laboratory tests;
- Mental health care;
- Vision care; and
- Dental care (coverage details vary by state).
Overall, CHIP provides broad health coverage and can significantly reduce the cost of health care for many families.
Premiums and Copays
This is one of the key differences between CHIP and Medicaid. Medicaid is often free or nearly free. Depending on the state, CHIP may require an enrollment fee, a low monthly premium, or small copayments for certain services.
However, these costs are typically much lower than the cost of private health insurance.
Can immigrant families qualify for CHIP?
Whether children in immigrant families qualify for CHIP depends on several factors, including the child’s immigration status, the rules in the state where the family lives, and current legal requirements.
Eligibility rules for immigrant families vary by state and immigration status. Families should check with their state CHIP agency or Health Insurance Marketplace to determine whether their child is eligible.
CHIP by State
Although CHIP is funded by both the federal government and the states, each state administers and operates its own CHIP program under its own rules.
For example, in New York, CHIP is called Child Health Plus, while in Florida, CHIP is known as Florida KidCare.
In some states, CHIP is part of Medicaid. In others, CHIP is administered as a separate program, and some states use a combination of both approaches.
State-specific rules may vary in areas such as:
- Income limits;
- Eligible age ranges;
- Premiums;
- Copayments;
- Covered benefits; and
- The application process.
For this reason, families should review official information from the CHIP program in the state where they live.
How to apply for CHIP
You can visit the official website of your state’s health department, or the equivalent state agency, to learn more about CHIP eligibility, benefits, and the application process in your area.
In many states, when you apply for health coverage through the Marketplace or your state Medicaid agency, the system will automatically determine whether your child may qualify for Medicaid or CHIP.
If your child qualifies for CHIP, your application is typically transferred to the appropriate program without requiring you to submit a new application.
You can also learn more about health coverage programs through HealthCare.gov, the official health insurance website of the U.S. government.
Key Takeaways
- CHIP provides health insurance for children in families whose income is too high for Medicaid but who may still be unable to afford private health insurance.
- CHIP is jointly funded by the federal government and the states.
- Eligibility rules and benefits vary by state.
- CHIP provides comprehensive health coverage for children, including doctor visits, immunizations, hospital care, prescription drugs, vision care, and dental care.
- When families apply through the Marketplace or Medicaid, the system often determines whether a child qualifies for CHIP and refers the application if needed.