CHIP (Children's Health Insurance Program)

The Children's Health Insurance Program (CHIP) provides health coverage to uninsured children in families that earn too much to qualify for Medicaid but cannot afford private insurance. CHIP covers over 7 million children nationwide and is one of the most successful public health insurance programs in the United States.

Established in 1997 as part of the Balanced Budget Act, CHIP is jointly funded by federal and state governments with an enhanced federal matching rate higher than standard Medicaid. Each state designs and administers its own CHIP program within federal guidelines, which is why the program has different names in different states (e.g., SCHIP, PeachCare, Hoosier Healthwise).

States can implement CHIP as an expansion of their Medicaid program, as a separate standalone program, or as a combination of both approaches. Some states also use CHIP funds to cover pregnant women and, in limited cases, parents of eligible children.

What CHIP Covers

CHIP provides comprehensive health coverage for children. At minimum, all CHIP programs must cover:

• Routine check-ups and well-child visits
• Immunizations and vaccinations
• Doctor and specialist visits
• Hospital care (inpatient and outpatient)
• Emergency room services
• Prescription medications
• Dental care (cleanings, fillings, extractions, and more)
• Vision care and eyeglasses
• Hearing screenings and hearing aids
• Mental health and substance use disorder services
• Laboratory and X-ray services

Additional Benefits (Vary by State)

• Physical, occupational, and speech therapy
• Home health care
• Durable medical equipment
• Orthodontic services
• Transportation to medical appointments

Who Qualifies for CHIP

• Age: Children under 19 years old
• Income: Family income above Medicaid limits but below the state's CHIP threshold — typically up to 200-300% of the Federal Poverty Level (some states go up to 400% FPL)
• Insurance Status: Child must be uninsured (not currently covered by a group health plan)
• Residency: Must be a resident of the state where applying
• Citizenship: Must be a U.S. citizen or qualified immigrant

For reference, in 2025, 200% FPL is approximately $62,400 for a family of 4, and 300% FPL is approximately $93,600. Many states set CHIP income limits between these ranges.

Some states also cover pregnant women through CHIP, providing prenatal care, labor and delivery, and 12 months of postpartum coverage.

CHIP Costs

• Premiums: Free to low cost depending on state and income. Medicaid-expansion CHIP programs are typically free. Separate CHIP programs may charge $10-$50/month per child or per family.
• Copays: Minimal. Typically $5-$10 for doctor visits, $3-$10 for prescriptions. No copays for preventive care and immunizations.
• Deductibles: Generally none or very low
• Out-of-Pocket Maximum: Total family cost-sharing cannot exceed 5% of household income per year

Children in families at or below 150% FPL typically have no cost-sharing at all. Cost-sharing increases modestly at higher income levels but remains far below private insurance costs.

How to Enroll

Like Medicaid, CHIP has open enrollment year-round with no limited enrollment periods.

• Online: Apply through your state's CHIP/Medicaid website or HealthCare.gov (the application screens for both Medicaid and CHIP)
• By Phone: Call 1-877-KIDS-NOW (1-877-543-7669) to be connected to your state's program
• In Person: Visit your local Department of Social Services or community health center
• At School: Many school districts partner with CHIP programs for enrollment drives

Processing times are typically 2-4 weeks. Coverage begins on the date of application or the first day of the month of application, depending on the state. Many states offer presumptive eligibility, allowing children to receive temporary coverage while the full application is processed.

Pros

• Free or very low-cost comprehensive health coverage for children
• Includes dental and vision care, which many private plans exclude for children
• Year-round enrollment with no open enrollment restrictions
• Covers preventive care and immunizations at no cost
• Higher income limits than Medicaid, covering the working middle class
• Strong emphasis on child-specific care and developmental screenings

Cons

• Only covers children under 19 (and in some states, pregnant women) — parents are not covered
• Benefits and income limits vary significantly by state
• Some states have waiting periods if a child recently had private insurance
• Provider networks may be more limited than private insurance
• Annual renewal/redetermination required, which can lead to coverage lapses
• CHIP funding depends on congressional reauthorization (though historically renewed)