Children’s insurance for health and medical coverage is a vital part of a healthy formative life. This is especially true in modern times, where uncertainty is the rule and not the exception.
The Children’s Health Insurance Program (CHIP) helps provide health insurance coverage to qualified U.S. children in need. Find out all about CHIP qualification requirements, coverage benefits and how to apply by reading ahead now.
Apply for CHIP (and Get the Most Out of CHIP Coverage for Your Children)
The Children’s Health Insurance Program (CHIP) functions both as part of the Medicaid program and via separate CHIP programs alike. Its primary focus is providing healthcare for children of qualified households.
Coverage benefits and qualification requirements are important to understand prior to submitting applications for CHIP. Continue reading to learn about the following CHIP topics:
- Children’s Health Insurance Program 101 (What Is CHIP?)
- Difference between Medicaid and CHIP.
- CHIP eligibility and qualification requirements.
- Apply for CHIP by following these steps.
- Using Medicaid (getting the most from your benefits).
CHIP functions as part of the Medicaid program and as an individual children’s insurance program. Its primary focus is providing healthcare for children in qualified households. Medicaid, along with its peer-program Medicare, is one of the two primary U.S. government-sponsored health insurance programs available today.
Medicare and Medicaid focus on senior citizens, the qualified disabled and financially needy. CHIP, however, provides services to children. CHIP also provides coverage for pregnant women in certain states.
All CHIP programs are operated jointly by state government agencies even though requirements and oversight are mandated by federal agencies. Both states and the federal government agencies also provide funding for CHIP programs nationwide, although federal monies (92.5 percent) dominate state funding (7.5 percent).
The CHIP program was founded in 1997. The 2018–2023 HEALTHY KIDS Act extended CHIP’s federal funding from prior numbers. The Bipartisan Budget Act of 2018 subsequently extended funding through 2027, or an additional four years. Despite national political and socio-economical conflict about Medicaid expansion overall, CHIP is still thriving.
These CHIP program funding extensions and revised eligibility requirements are indicative of how important healthcare for children is considered by Congress and other numerous government officials and agencies.
Medicaid and CHIP work in-tandem to ensure financially needy households receive the healthcare coverage they need. Medicaid and CHIP benefits are also both administered by individual U.S. states but managed and overseen by federally mandated guidelines and regulatory agencies. Childrens Medicaid was enacted in 1965 via the Social Security Act to provide healthcare insurance to households where dependent children lived with families whose cumulative income was at or below the U.S. federal poverty line (FPL).
Original Medicaid provided coverage for qualified children up to five years of age who lived in homes where the household income was up to 133% of the FPL. School-aged children who lived in homes where the household income was up to 100% of the FPL were also eligible for Medicaid benefits as per the program’s original guidelines. The Affordable Care Act revised the FPL guidelines to include more families and households in 2010, however.
CHIP was created as both an extension of Medicaid and a standalone program in 1997. Medicaid itself is a significantly larger program, covering over seventy-five million enrollees.
CHIP still provides coverage for more children than does Medicaid, although CHIP benefits are also more limited overall. For example, CHIP does not provide Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits, whereas Medicaid does. Together, however, CHIP and Medicaid cover qualified healthcare expenses and treatments for children in households where income is up to 300% of the FPL threshold.
As per the Medicaid.gov website, CHIP Medicaid eligibility standards are categorized by both income and population-based data. Income eligibility is determined by calculating the Modified Adjusted Gross Income (MAGI) of a household. Population-based eligibility targets:
- Children of low-income households.
- Financially needy pregnant women.
- Lawfully residing (non-U.S.-citizen) children and pregnant women.
- Children of state employees who meet either the Maintenance of Agency Contribution Condition or Hardship Condition requirements (Please note: This type of CHIP program coverage is provided solely at the discretion of each state and is not a federally mandated program requirement).
Children’s Medicaid coverage for children was expanded to 138% of the FPL via the ACA. Different states present different eligibility requirements but income eligibility levels in different state-run programs range between 170% and 400% of the FPL.
Asset and resource tests are not permitted. Variable income or eligibility group disregards are also not permitted per state. The number of people residing in your household and the cumulative household income impact eligibility, however, as well as whether full or partial Medicaid coverage is made available.
Applying for CHIP requires some research because each state facilitates its own programs, which each have their own application process. Overall Medicaid pre-qualification status is verifiable online by visiting HealthCare.gov, however. InsureKidsNow.gov also provides specific information about CHIP coverage and application submissions.
Regardless of state, however, you must prepare verifiable financial documentation for all household members. Proof of employment status for all household members is also required. Medical records and other supporting documentation are required for applicants with qualifying disabilities.
Explore the Medicaid.gov “learn how to apply for coverage” and FAQ pages for more specific information on applying for CHIP benefits in your state. You may also call 1-800-318-2596 (TTY: 1-855-889-4325) to begin your application over the phone.
No specified enrollment periods are required when applying for CHIP or Medicaid benefits. This means you are permitted to enroll in CHIP at any point during the year. Take advantage of this unlimited enrollment feature by applying for CHIP as soon as you know you need the service. Once qualified, your coverage takes effect immediately.
CHIP covers different benefits in different states. Comprehensive CHIP coverage is provided in every state, however. Comprehensive CHIP coverage includes routine checkups, prescription medications and doctor visits. Immunizations and dental and vision care are also covered. CHIP also covers emergency services, hospital care (inpatient and outpatient), laboratory work and x-ray services as well.
CHIP also provides optional health benefits coverage. These benefits are equivalent to those provided by the Federal Employees Health Benefit plans (Blue Cross/Blue Shield preferred provider option), State employee plans and Health Maintenance Organization (HMO) plans. These equivalency plans are required to include the following coverage benefits:
- X-ray services and laboratory work.
- Doctor/physician medical and surgical services.
- Hospital stays (inpatient and outpatient).