Children’s Health Insurance Program (CHIP)

The Children’s Health Insurance Program (CHIP) is a low-cost health insurance plan for children up to 19 years of age. CHIP assists children whose family income is too high to meet Medicaid eligibility requirements.

Children must be under 19 years of age to qualify, be a resident of the state they are seeking benefits and have valid citizenship status. Families may apply for the program at any time, and coverage begins immediately.

Applicants may apply online, by telephone or through their state’s Medicaid agency. Recipients must renew their benefits every year to continue coverage. Potential applicants can continue reading for more information on how to qualify for the CHIP program and the steps required to apply.

What is the CHIP program?

The CHIP program, also known as the Children’s Health Insurance Program provides low-cost health insurance to uninsured children. CHIP health insurance offers coverage specifically to children in families with income too high to qualify for Medicaid benefit coverage.

CHIP is a partnership between the federal and state government. Each state implements a CHIP program and the benefits offered vary between each state. The CHIP program works closely with Medicaid to determine a child’s eligibility for the program.

Families may apply for CHIP insurance anytime throughout the year as there is no specified enrollment period. Once approved, coverage begins immediately. As such, program participants may seek care before their coverage card arrives in the mail. They may present their eligibility letter as proof of insurance when making an appointment.

Related Article: Medicaid Benefits Explained

Recipients must undergo a recertification process every year to confirm they are still eligible for the program. If a program participant no longer qualifies for the program after recertification may appeal the decision. During the appeal, he or she may present the case before a hearing officer. The officer makes a final determination on continuation of benefits after hearing all information presented by the program participant.

How to Qualify for the CHIP Program

To qualify for CHIP insurance, the applicant may be no older than 19 years of age. Also, to be eligible for CHIP Medicaid, the applicant’s family income may not exceed the threshold set by the federal government. For 2018, the average maximum income for a family of four is $4,372, per federal guidelines. Actual values will vary by state.

The program requires all participants to be U.S. citizens or lawfully present immigrants. They must also be a resident of the state which they receive benefits. Families may prove their citizenship status, submitting relevant documentation such as:

  • Income verification with a W-2, 1099, paystub, Social Security benefits letter or unemployment benefits letter.
  • Social Security number verification with a Social Security card, tax return, paystub documentation, U.S. Military I.D. card or a divorce decree.
  • Proof of U.S. citizenship using a U.S. passport, Certificate of Naturalization, state-issued enhanced driver’s license or a tribal enrollment card.
  • Confirmation of immigration status using a Permanent Residence card, foreign passport, arrival/departure record or a notice of action form I-797.

Emergency Medicaid services are available to all non-citizens if they would meet all other program requirements besides legal residency status.

Once an individual reaches their 19th birthday, they are no longer eligible for Medicaid for children. However, they may still qualify for standard Medicaid. Medicaid coverage is not automatic, and these individuals must apply for the program to determine their eligibility. Those who have “aged out” of the foster program lose their CHIP coverage but may be eligible for Medicaid up to their 26th birthday. There is no income limit for these beneficiaries.

Some state CHIP policies may offer limited coverage to pregnant women, while others may only offer Medicaid coverage for pregnant women.

Services Covered Under the Children’s Health Insurance Program

Medicaid for children provides a comprehensive health care package that includes services such as routine check-ups, doctor visits, immunizations as well as inpatient and outpatient hospital care. Some states also offer dental care with CHIP insurance.

Program participants do not pay for routine doctor and dental visits. However, they may be required to pay copayments for certain services. Also, some states charge a monthly fee for the insurance. The premium usually does not exceed 5 percent of the family’s annual income.

How do I apply for CHIP?

Families may apply for CHIP anytime throughout the year even if the open enrollment period has passed. Once approved, for CHIP insurance, coverage begins immediately. Individuals may apply using one of three methods:

Healthcare.gov

Families may use the Healthcare.gov website to see if they qualify for the program. Using this method, applicants must complete an application through the Health Insurance Marketplace. During the application process, applicants must provide information about everyone in their household. They must give the names and ages of all individuals in the household, income for the household and details on existing insurance plans. If a family meets CHIP income guidelines for the program, the marketplace sends their information to the state’s Medicaid agency.

Telephone

Individuals seeking child Medicaid eligibility information may request the information via telephone by calling 1-800-318-2596 (TTY: 1-855-889-4325). The telephone agent can take their information over the phone and submit their application. When calling, applicants should have documentation necessary to complete the application. For example, income information for all household members, Social Security Numbers for each individual requesting coverage and necessary citizenship documents. Having this information on hand can help complete the application without unnecessary delays.

State Medicaid Agency

Each state has a Medicaid agency that administers the program. Individuals may contact their state Medicaid agency for information on registering for the CHIP program. The state agency will be able to provide full details on CHIP eligibility, how to apply and what information is required to do so.

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