Learn About the Children’s Health Insurance Program

Administered by the Centers for Medicare and Medicaid Services (CMS), the Children’s Health Insurance Program (CHIP) is the part of Medicaid that provides low-cost or free medical and dental care coverage to American children and teens.

Signed into law in 1997, CHIP lowered the level of uninsured children to a record low of 7 percent in 2012. Jointly funded by state and federal governments, CHIP is run under state guidelines set within federally mandated parameters. As of 2016, there were 8.9 million kids and teens enrolled in CHIP.

A state’s CHIP program may be offered separately from Medicaid, as part of the Medicaid expansion or through participation in a government program providing both a separate CHIP program and the Medicaid expansion. Coverage options under CHIP include provisions for lawfully residing pregnant women and children. Via CHIPRA (Children’s Health Insurance Program Reauthorization Act), CHIP eligibility has been expanded and coverage options include prenatal care. A state may also choose to extend eligibility for CHIP to the children of state employees. Learn more about the program by reviewing the following sections.

Who qualifies for CHIP?

Any child up to 19 years of age whose parents qualify for Medicaid will most likely qualify either for CHIP or Medicaid. Further, a child may qualify for CHIP if his or her family earns too high an income to qualify them for Medicaid. A child living in a family of four with a household income of $49,200 annually or less, as of 2018, may qualify for CHIP. Certain states have slightly differing requirements, including potentially higher income limits. Some states also allow pregnant women to qualify for CHIP.

There are currently 46 states, along with the District of Columbia, covering kids and teens living at or above the Federal Poverty Level (FPL) by 200 percent through CHIP. Further, two dozen of these states’ CHIP programs cover families at 250 percent of the national poverty level. A CHIP-enhanced coverage match may also be available in states for children and teens in households up to 300 percent over the country’s poverty level. Some states have even expanded coverage to those living at higher than 300 percent of the federal poverty level, at that level offered the matching Medicaid rate. If a child remains consistently eligible for CHIP, a state can choose to offer continuous aid to the child.

How to Apply for CHIP

There is no open enrollment period for CHIP, which means you can apply for it at any time of year if you need to save money on health care for your child. You can apply for CHIP in one of two ways, either through your state’s Medicaid agency or through the Health Insurance Marketplace. Whichever of these methods you choose, you can apply in person, online, by mail or by phone. A child’s parent, guardian or authorized representative can apply for CHIP on behalf of the child. Coverage must be renewed every year. For your convenience, you will be contacted by a representative from the CHIP to inform you when the time comes to renew coverage for your child.

What services does CHIP cover?

The services CHIP covers vary somewhat between states, as states are generally allowed to tailor their coverage options to their populations as long as they follow certain federal guidelines. Regardless, in all states, CHIP must cover the following:

  • Regular physician checkups.
  • Dentist and doctor appointments.
  • Vaccinations.
  • Prescriptions.
  • Mental health services.
  • Hospital care, both outpatient and inpatient.
  • X-ray and laboratory services.
  • Emergency services.

Beyond those minimums, benchmark coverage is based on either the regular preferred provider Blue Cross/Blue Shield plan given to federal workers, the plan offered to state employees or an HMO plan with the greatest non-Medicaid commercial enrollment in the state. Benchmark-equivalent coverage is actuarially equivalent to benchmark coverage and must include well-child and well-baby services. Secretary-approved coverage is any other form of health care coverage the U.S. Secretary of the Department of Health and Human Services deems acceptable and appropriate. For some children enrolled in CHIP, medical services will be free. Otherwise, some families will pay a small enrollment premium or other fee for coverage and make small copayments toward services.

There are also dental benefits that may be covered under CHIP. States offering CHIP through the Medicaid expansion must also offer the EPSDT (Early and Periodic Screening, Diagnostic and Treatment) benefit. Provided separately from CHIP, this dental coverage must include services required to treat emergencies, restore oral function and health, promote oral wellness and prevent disease. Your state may either provide these dental benefits through a benchmark dental insurance plan or an original grouping of dental benefits that meet the requirements of CHIP. All CHIP providers and benefits plans can be conveniently reviewed on your state’s official CHIP website.

Be aware that if your household is eligible for CHIP, there is a chance you may also be eligible for other government benefits and government medical programs.

How to Use CHIP for Medical Services

If your child already has a primary doctor, find out if the doctor accepts CHIP. If the doctor does not accept CHIP, you can ask your state’s CHIP office if your child can continue seeing that doctor until you find another who does accept CHIP. Either way, you can find a doctor who accepts CHIP through your state’s CHIP agency website or by calling the agency on the phone. The number to call will be listed on the rear of your child’s CHIP enrollment card. Make sure your provider knows your child is enrolled in CHIP. If you have difficulty finding or getting an appointment with a doctor who accepts CHIP, call the CHIP agency in your state for assistance.

There may be a waiting period between qualifying for CHIP enrollment and becoming eligible for CHIP coverage. In 15 states, waiting periods are between a month and 90 days. At least 21 other states utilize a variety of procedures to ensure CHIP is not being used to substitute for eligible health coverage. In many of these states, exemptions to these waiting periods or other procedures also exist. These exceptions may include expiration or voluntary termination of COBRA or other eligible coverage, income or life status changes or reaching the coverage limits under currently enrolled programs.

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