Children’s Medicaid: What is CHIP and how does it work?

Congress approved Medicaid for children (CHIP) in 1997 during the Clinton administration. This program provides health coverage to people under the age of 19 whose parents have incomes too high to qualify for Medicaid, but not enough to pay for private coverage.

KEY INFORMATION:

  • The program Medicaid for children (CHIP) is a federal health care program that provides health coverage to people age 19 and younger whose parents cannot afford private insurance but earn too much to qualify for Medicaid.
  • Generally, a family of four earning up to $45,000 a year will qualify for CHIP, but the limits vary by state.
  • Many services covered by CHIP are free, but some require a copay. Meanwhile, some states require a monthly premium that can’t exceed 5 percent of annual income.
  • Much confusion remains about whether low-income families should use Medicare, CHIP, or the Affordable Care Act.

Keep reading: What is the difference between Medicaid and Medicare?

Understanding the Children’s Medicaid Program (CHIP)

Medicaid for children (CHIP) is a US federal health care program administered and named differently by each state. For example, the state of New York calls its program Child Health Plus, while Arkansas calls its program ARKids. Similar to how Medicaid works, the federal government provides matching funds to each state. Responsibility for administering the CHIP programs rests with each state’s Medicaid administration.

Generally, a family of four earning up to $45,000 a year will qualify for CHIP, but the limits vary by state. In many cases, these families are unable to obtain health insurance coverage for their children through an employer. Families must apply for CHIP and many are unaware of the program’s existence. In 2009, Congress appropriated federal funds to help increase visibility and also help more families sign up.

Many medical services covered by CHIP are free, but some require a copay. Some states also require a monthly premium that cannot exceed 5 percent of the annual household income. CHIP generally covers annual checkups, immunizations, doctor visits, hospital care, dental and vision care, prescriptions, lab services, X-rays, and emergency services. Some states also extend coverage to parents and pregnant women.

CHIP coverage can begin at any time of the year and benefits are available immediately. Sometimes parents who qualify for Medicaid can enroll their children in CHIP so they don’t have to buy coverage.

Keep reading: How to change Medicaid health plan

Who is eligible for CHIP?

Federal law gives states the option to cover low-income children and low-income pregnant women under a separate CHIP. In addition, states may provide coverage to certain groups that were historically excluded from CHIP, such as children or pregnant women who are legally residing or have access to public employee coverage. Below we provide descriptions of these options.

They are eligible for CHIP:

  • Under 19 years old.
  • Uninsured (determined to be ineligible for Medicaid and not covered through a group health plan or creditable health insurance).
  • Be a citizen or meet immigration requirements.
  • Be a state resident
  • Eligible within the state CHIP income range, based on family income and any other rules specified in the state CHIP plan.

Not eligible for CHIP:

  • Inmates of a public institution.
  • Patients in an institution for mental illness.
  • Children who are eligible for health benefit coverage under a state plan due to a family member’s employment with a public agency (unless a state qualifies for the maintenance of the agency contribution or the hardship exception that They described below).

Within these guidelines, states have the flexibility to adopt their own eligibility standards. For example, some states have designed programs for specific geographic areas or for children with disabilities. However, states cannot establish certain types of eligibility criteria, such as discriminating on the basis of diagnosis.

The eligibility criteria for a specific low-income child are described in Section 2110(b) of the Social Security Act.

Keep reading: Does Medicaid cover braces?

How long a child who has been enrolled in CHIP will be covered

Once registered, children are guaranteed 12 months of CHIP coverage unless they no longer meet basic eligibility requirements. Families must renew their coverage each year for it to continue. CHIP insurance companies send renewal notices 90 days before benefits end, and families must complete and submit renewal information to their CHIP insurance company to continue receiving benefits.

Keep reading: Medicaid Income Chart

Is there a time limit for how long a child can stay enrolled in CHIP?

Children and teens can stay covered as long as they qualify. You only need to renew coverage once a year.

Who can apply for CHIP for a child?

Parents, a grandparent, guardian, or other authorized representative may apply on behalf of the child. If you are a teenager living alone, your state may allow you to apply for Medicaid on your own behalf or any adult can apply for you.

Children’s Medicaid (Request more information from CHIP)

For more information, visit InsureKidsNow.gov or call 1-877-KIDS-NOW (1-877-543-7669).

How do I apply for the State Children’s Health Insurance Program?

You can enroll in CHIP at any time and you can apply online, by phone, by mail, or in person at your state Medicaid or CHIP agency. For specific information about CHIP in your state, including steps to apply, visit InsureKidsNow.gov.

Keep reading: What is Medicare Advantage? Medigap vs. Medicare Advantage

Children’s Medicaid: Special Considerations for CHIP

When Congress passed the Affordable Care Act (ACA) In March 2010, many politicians and health care officials thought this new mandatory health insurance program would replace the need for CHIP, but that didn’t happen. Instead, we now have Medicaid, CHIP, and ACA, so there is more confusion among low-income families about which options are best for them.

Benefits and copays are not the same in these programs. Therefore, it is important to research all the options very well before choosing one.

Given the uncertainty surrounding the ACA, it remains to be seen what additional changes may come to affordable health care programs for low-income families.

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