What Is the Children's Health Insurance Program (CHIP)?
Key takeaways:
The Children’s Health Insurance Program (CHIP) provides health insurance for young people under age 19 who live in households with incomes too high to qualify for Medicaid and too low to afford a private health plan.
CHIP is available in every state, Washington, D.C., and five U.S. territories: American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands.
States set their own coverage rules but must abide by federal standards.
Table of contents
The Children’s Health Insurance Program (CHIP) provides insurance coverage to millions of people in the U.S. who are under age 19. Here’s an introduction to this family-friendly insurance administered by state and territory Medicaid programs.
What is the Children’s Health Insurance Program (CHIP)?
CHIP provides free or low-cost health insurance for kids in households with slightly too much income for Medicaid eligibility. Like Medicaid, CHIP is a federal-state partnership. Generally, the federal government was expected to cover about 70% of the funding for states in fiscal year 2024 and an even higher percentage in the territories. Also like Medicaid, CHIP may be administered by a state or territory government and/or by a Medicaid-contracted managed care organization.
How does CHIP work?
A 1997 federal law mandates that each state or territory have a CHIP (though it may be called another name).
The programs can be designed in one of three ways:
Separate CHIP: Medicaid programs receive federal funds to provide health coverage to uninsured children from low-income households.
Medicaid expansion CHIP: This pertains to the 40 states and Washington, D.C., which have expanded Medicaid to people and households with slightly higher incomes and receive a higher level of federal matching funds to cover individuals.
Combination CHIP: These programs receive federal funding to cover both traditional CHIP and expansion CHIP populations.
Search and compare options
Medicaid expansion and combination CHIP options have more autonomy to design and operate their plans. Because CHIP plans vary by state and territory and can change from year to year, it’s important to read your health plan documents carefully to make sure the coverage fits your child’s needs.
What standard benefits does CHIP cover?
CHIPs must offer standard benefits that include coverage of:
Behavioral healthcare
Dental and vision care
Doctor visits
Emergency services
Inpatient and outpatient hospital care
Laboratory and X-ray services
Prescriptions
Routine checkups (well-baby and well-child visits)
Vaccines
Medicaid expansion states also must cover the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit for children under 21 enrolled in Medicaid. This includes developmental health services. Some states with separate CHIPs have EPSDT or similar coverage.
How much does CHIP cost?
CHIP is not free, but the costs are very low. States can impose modest out-of-pocket cost-sharing for covered benefits, such as:
Copayments
Coinsurance
Deductibles
Enrollment fees
Premiums
What should you do if your child loses Children’s Health Insurance Program (CHIP) coverage? You can appeal the decision or reapply with your state or territory Medicaid program.
Here are other health insurance options for children. A child could join a parent’s health plan or may qualify for Medicare because of a condition or disability.
Young adults have more options. An adult can be covered by a parent’s health plan up to age 26 or older, and also may have access to college campus health coverage.
States have more cost-sharing flexibility for CHIP enrollees from higher-income households.
What are CHIP eligibility requirements?
Depending on where you live, the people who qualify for CHIP may include:
Targeted low-income children who meet age, family income, and citizenship requirements
Targeted low-income pregnant women and, sometimes, postpartum women
Lawful residents who are targeted low-income children and pregnant women
Targeted low-income children in the families of state employees and who have access to public employee coverage
Read more like this
Explore these related articles, suggested for readers like you.
Income also determines eligibility. Depending on your state or territory, household income eligibility for CHIP ranges from 170% of the federal poverty level (FPL) to 400% of the FPL.
You can easily check whether your child qualifies for Medicaid and CHIP with this eligibility tool on HealthCare.gov.
How do parents prove eligibility for CHIP?
You will be asked for information to determine your child’s eligibility. Records you may need include:
Proof of age, identity, and citizenship (such as a birth certificate, driver’s license, or photo ID) for you and the minor applicant(s)
Proof of residency (such as a lease, utility bill, or property tax record)
Proof of all sources of income
Medical records for proof of disability or pregnancy
How and when can families apply for CHIP?
CHIP and Medicaid have open enrollment all year. When you apply for Medicaid, you will also find out whether any of your family members are eligible for CHIP.
Each state has its own application and enrollment process for CHIP, but you can apply:
Online via HealthCare.gov
Through your state ACA marketplace, if your state doesn’t use the national marketplace
By calling the Affordable Care Act (ACA, also known as Obamacare) health insurance marketplace at 800-318-2596
You can also use our GoodRx Medicaid state-by-state guide to find information to directly contact the Medicaid program in your state or territory.
Where can families get help with CHIP applications?
Many government agencies and organizations can guide you through applying for CHIP.
The federal Medicaid website provides contacts in each state and territory that can help with your application at no charge.
Healthcare.gov also has a Find Local Help locator that can help you find someone to assist with your application for free.
Frequently asked questions
In some cases, yes. Depending on your income, your child may qualify for free or low-cost coverage through Medicaid or a CHIP in your state or territory.
Yes. One disadvantage of CHIP may be that you are enrolled in a managed care program that limits you to healthcare professionals and facilities in the plan’s network. During the COVID-19 pandemic, Medicaid provided continuous coverage, which meant children in CHIP were automatically renewed without program administrators reviewing their eligibility for several years.
The post-pandemic Medicaid “unwinding” process reset the program nationwide, resulting in millions of children losing coverage — most due to procedural issues and not because they didn’t qualify. This lapse in coverage can happen even outside of the unwinding. If you think your child is eligible, file an appeal or reapply. But, the disadvantage is that — in the meantime — a child who should have coverage lacks insurance and, sometimes, needed healthcare.
In most cases, an adult child can be considered a dependent covered by a parent’s health insurance plan in the U.S. until the last day of the year in which they turn age 26. In a few states, you can remain on a parent’s plan until you turn 30 or 31, under certain circumstances.
The bottom line
CHIP is health insurance for people under age 19 from households with incomes too high to qualify for traditional Medicaid and too low to afford a private health insurance plan. CHIP is available in all states, Washington, D.C., and five U.S. territories. The plans provide comprehensive coverage, including dental care and behavioral healthcare. In some cases, CHIP coverage includes pregnant and postpartum women. Each state has its own CHIP eligibility guidelines. You can learn more from your state or territory Medicaid program. You also can check your eligibility and apply for CHIP through the Affordable Care Act health insurance marketplace.
Why trust our experts?
References
Centers for Medicare & Medicaid Services. (n.d.). Medicaid and CHIP overview.
Duong, T. M. (2022). Strengths and weaknesses of the Children’s Health Insurance Program. The Alliance for Citizen Engagement.
Healthcare.gov. (n.d.). Saving money on health insurance.
KFF. (2024). Status of state Medicaid expansion decisions: Interactive map.
Kanter, J., et al. (2024). ASTHO and NAMD letter urging Congress to fully fund Medicaid and CHIP in U.S. territories. Association of State and Territorial Health Officials.
Medicaid.gov. (n.d.). Benefits.
Medicaid.gov. (n.d.). CHIP cost sharing.
Medicaid.gov. (n.d.). CHIP eligibility.
Medicaid.gov. (n.d.). CHIP managed care.
Medicaid.gov. (n.d.). CHIP state program information.
Medicaid.gov. (n.d.). Early and periodic screening, diagnostic, and treatment.
Medicaid.gov. (n.d.). Program history.
Medicaid.gov. (n.d.). Where can people get help with Medicaid & CHIP?
Medicaid and CHIP Payment and Access Commission. (2023). Exhibit 6. Federal medical assistance percentages and enhanced FMAPs by state, FYs 2021–2024.
National Academy for State Health Policy. (2024). State efforts to extend Medicaid postpartum coverage.
Office of the Assistant Secretary for Planning and Evaluation. (2024). Poverty guidelines.
