CHIP is a separate program from Medicaid that covers children whose families earn too much for Medicaid but not enough to afford private insurance

CHIP stands for Children's Health Insurance Program. It is a federal program run by states, and each state operates it differently. CHIP covers children from birth through age 18 or 19 (depending on the state) when their household income is above the Medicaid limit but below a threshold set by that state — usually between 200% and 400% of the federal poverty line.

CHIP is not Medicaid, though the two programs often work together. If your child does not may have access to for Medicaid because your income is too high, CHIP may cover them. If your state has combined its CHIP and Medicaid programs into one system, you may see it called "Medicaid CHIP" or a state-specific name like "Peach Care" (Georgia) or "Badger Care Plus" (Wisconsin). The coverage and rules vary by state.

Key Takeaways

  • CHIP covers children whose family income is above the Medicaid limit but below your state's CHIP income threshold, which ranges from roughly 200% to 400% of the federal poverty line.
  • Each state runs CHIP with different income limits, covered services, and cost-sharing rules, so you must check your state's program directly.
  • CHIP covers doctor visits, hospital care, dental, vision, and prescription drugs, though the exact services and copays depend on your state.
  • You apply through your state's Medicaid or CHIP office, usually online or by mail, and the process typically takes 30 to 45 days.
  • If your income drops, you may become Medicaid-may be able to access instead, and your child can switch programs without a gap in coverage.

Income limits and how they work by state

CHIP income limits are set by each state and change year to year. Most states cover children in families earning between 200% and 300% of the federal poverty line, but some go as high as 400%. For 2024, 200% of the federal poverty line for a family of four is roughly $55,000 per year, though this figure changes annually.

Your state's CHIP program publishes its exact income limit on its website. To find it, search "[your state] CHIP income limits" or "[your state] children's health insurance." Income is usually counted as gross household income before taxes. Some states count child support or alimony; others do not. If your income is close to the limit, contact your state's CHIP office directly — they can tell you whether you are within range before you submit paperwork.

If your income drops below your state's Medicaid limit, your child will be moved to Medicaid instead of CHIP. This is automatic in most states and does not interrupt coverage.

What CHIP covers

CHIP covers the same basic services as Medicaid: doctor visits, hospital stays, emergency care, prescription drugs, dental care, and vision care. Many states also cover mental health services, therapy, and preventive care like vaccines and screenings at no cost to you.

The exact services and what you pay out of pocket vary by state. Some states charge a small monthly premium (usually $0 to $50 per child per month), and some charge copays for doctor visits or prescriptions (often $0 to $5 per visit). A few states charge nothing. Check your state's CHIP website or call the program to learn what your child's coverage will cost.

Preventive services — vaccines, well-child checkups, screenings — are covered at no cost in all states. If your child needs a service that is not listed as covered, the program will tell you before you receive it, so you are not surprised by a bill.

How to apply for CHIP in your state

You apply for CHIP through your state's Medicaid or CHIP office, not through a federal office. Most states let you apply online through their website. Some accept mail or phone applications. A few require you to apply in person at a local office.

To apply, you will need your child's Social Security number, proof of income (recent pay stubs or tax return), proof of citizenship or immigration status, and proof of your state residency. Some states ask for proof of identity as well. The exact documents vary by state.

After you submit your application, the state usually makes a decision within 30 to 45 days. Some states are faster. You will receive a letter in the mail telling you whether your child is covered, what the monthly cost is (if any), and when coverage begins. Coverage usually starts on the first day of the month after approval.

CHIP versus Medicaid: which program covers your child

If your child's household income is below your state's Medicaid limit, they will be placed in Medicaid, not CHIP. Medicaid is usually free or very low-cost. If your income is above the Medicaid limit but below the CHIP limit, your child will be placed in CHIP.

Some states have combined their Medicaid and CHIP programs into a single system with one application and one enrollment process. In those states, you apply once, and the state automatically places your child in whichever program they may have access to for based on income. You do not choose between them.

The main difference from a parent's perspective is usually the cost. Medicaid is free or nearly free in most states. CHIP may have a small monthly premium or copays, though many states keep CHIP free or very low-cost as well. Coverage is similar in both programs.

Renewing CHIP coverage each year

CHIP coverage must be renewed once a year. Your state will send you a renewal notice in the mail, usually 30 to 60 days before your child's coverage ends. The notice will tell you what information you need to send back and by what date.

You can renew online, by mail, or by phone, depending on your state. You will need to provide updated income information (pay stubs or tax return) and confirm that your address and family situation have not changed. If you do not renew by the deadline, your child's coverage will end, and you will have to reapply.

If your income has changed, tell the state during renewal. If your income has dropped below the Medicaid limit, your child will be switched to Medicaid. If your income has risen above the CHIP limit, your child will lose coverage, but you may be able to buy private insurance through the health insurance marketplace.

What happens if your income changes during the year

If your household income drops during the year, you can report the change to your state's CHIP office and request a mid-year review. Your child may become Medicaid-may be able to access, and the state will move them to Medicaid without a gap in coverage.

If your income rises above the CHIP limit, your child's coverage will end on the last day of the month in which the income change occurred. You will receive a notice in the mail. At that point, you can look for private insurance through the health insurance marketplace or through your employer if you have a job that offers it.

Frequently Asked Questions

Does CHIP cover dental and vision care?

Yes, CHIP covers dental and vision care in all states, though the exact services and copays vary. Most states cover two dental checkups per year, cleanings, and basic fillings. Vision coverage usually includes one eye exam per year and glasses or contacts. Call your state's CHIP office to learn what your child's plan covers.

Can I apply for CHIP if my child is already on Medicaid?

No. If your child is on Medicaid, they are already covered. CHIP is for children who do not may have access to for Medicaid. If your income rises and your child loses Medicaid, you can then apply for CHIP if your income is within the CHIP range.

What if I am not a citizen but my child is?

Your child can be covered by CHIP even if you are not a citizen, as long as your child is a U.S. citizen or may have access to immigrant. You will need to provide proof of your child's citizenship or immigration status when you apply. Contact your state's CHIP office for details on what documents are accepted.

Can I get CHIP coverage to start right away, or is there a waiting period?

Coverage usually starts on the first day of the month after your application is approved. There is no waiting period once you are approved. The approval process itself takes 30 to 45 days in most states, so plan ahead if your child needs care soon.

What if my state does not have a separate CHIP program?

A few states have folded CHIP into their Medicaid program under a different name. Search "[your state] children's health insurance" to find your state's program. You will apply through your state's Medicaid office, and the state will place your child in the right program based on your income.