What Medicaid and CHIP Are, and How They Differ

Medicaid and CHIP are two separate government health insurance programs, but they work together

Medicaid is a joint federal and state health insurance program for people with low income. Each state runs its own Medicaid program within federal rules, which means may be able to access, covered services, and how you enroll differ by state. CHIP (the Children's Health Insurance Program) is a federal program that states administer to cover children in families that earn too much for Medicaid but not enough to afford private insurance.

The two programs overlap in purpose but serve different groups. Medicaid covers adults, children, pregnant people, seniors, and people with disabilities. CHIP covers only children and pregnant people, and only in families above the Medicaid income limit. In some states, CHIP also covers postpartum people for a limited time after pregnancy ends.

Both programs are free or very low-cost. Neither requires you to have worked or paid taxes. Both cover doctor visits, hospital care, prescription drugs, and preventive services. The main difference is who can enroll and what the income cutoff is.

Key Takeaways

• Medicaid is run by each state with federal money, so the income limit and covered services vary where you live.
• CHIP covers children and pregnant people in families above the Medicaid income limit, and each state sets its own income ceiling.
• Both programs are free or nearly free, with little to no monthly cost.
• You enroll through your state's Medicaid or CHIP office, not through a federal website or call center.
• If you lose other insurance, you may be able to enroll in Medicaid or CHIP outside the normal enrollment period.

How Medicaid income limits work by state

Medicaid has a federal minimum income limit, but states can set their own higher limit. This means a family earning the same amount might may have access to in one state and not in another. Some states expanded Medicaid in 2014 to cover adults earning up to 138% of the federal poverty line; others did not expand and have lower limits.

Your state's Medicaid office publishes its current income limit. You can find it by searching "[your state] Medicaid income limits" or by calling your state's Medicaid hotline. Income limits also change each year in January when the federal poverty line updates.

Medicaid counts your household income, not just your own. If you are married, both spouses' income counts. If you have children, their income usually does not count toward the household total. Some states count child support or alimony; others do not.

CHIP income limits and how they differ from Medicaid

CHIP income limits are always higher than Medicaid's in the same state. If your child does not may have access to for Medicaid, they may still may have access to for CHIP. The exact limit varies: some states cover children in families earning up to 200% of the federal poverty line, others go as high as 400%.

Like Medicaid, CHIP counts household income. It also counts only the income of the child and the parents or guardians responsible for the child. Siblings' income does not count.

CHIP is designed as a bridge program. If your income drops and you fall below your state's Medicaid limit, you should enroll in Medicaid instead, because Medicaid typically has lower or no cost-sharing. If your income rises above CHIP's limit, you will lose coverage and may need to find private insurance or employer coverage.

What services Medicaid and CHIP cover

Both programs cover the same core services: doctor visits, hospital stays, emergency care, lab tests, X-rays, and preventive care like vaccines and screenings. Both cover prescription drugs, though the list of covered drugs and any cost-sharing vary by state.

Medicaid covers more services than CHIP in most states. Medicaid typically includes dental care, vision care, hearing aids, mental health treatment, and substance use treatment. CHIP covers these services in some states but not all. Check your state's CHIP handbook to see what is covered where you live.

Neither program covers cosmetic surgery, fertility treatment, or experimental drugs. Both cover maternity care and delivery. Medicaid covers family planning services; CHIP coverage of family planning varies by state.

How to enroll in Medicaid or CHIP

You enroll through your state's Medicaid or CHIP office, not through a federal office. Most states let you enroll online, by mail, or by phone. Some states use a single application for both programs; others have separate applications.

To enroll, you will need to provide proof of income (recent pay stubs, tax return, or a letter from your employer), proof of citizenship or immigration status, and proof of where you live. You will also need to list everyone in your household and their dates of birth.

Processing usually takes 30 to 45 days. Some states process faster if you enroll online. Once you are approved, your coverage usually starts on the first day of the month you applied or the month after, depending on your state's rules.

What happens if you lose other insurance

If you lose health insurance through a job, a family member, or another source, you may be able to enroll in Medicaid or CHIP outside the normal enrollment period. This is called a may have access to life event. Loss of insurance is a may have access to event in every state.

You usually have 30 to 60 days from the date you lost coverage to enroll. You will need to provide proof that you lost the insurance—usually a letter from your employer or the insurance company saying when coverage ended. Contact your state's Medicaid office to find out the exact deadline and what proof they need.

If you are pregnant and lose insurance, you can enroll in Medicaid or CHIP at any time during your pregnancy, regardless of the normal enrollment period. Pregnancy is always a may have access to event.

Medicaid and CHIP coverage for pregnant people and new parents

Both Medicaid and CHIP cover pregnancy, delivery, and postpartum care. Medicaid covers postpartum care for 60 days after delivery in every state. Some states have extended this to 12 months; check your state's rules.

CHIP covers pregnancy in all states. Coverage of postpartum care through CHIP varies: some states cover it for 60 days, others for longer, and some do not cover it at all. If you are on CHIP during pregnancy, ask your state program whether you will stay on CHIP after delivery or move to Medicaid.

If you are pregnant and your income is above your state's Medicaid limit but below CHIP's limit, you can enroll in CHIP for pregnancy coverage. You do not have to wait for an open enrollment period.

Frequently Asked Questions

Can I have both Medicaid and CHIP at the same time?

No. You enroll in one program or the other, not both. If you may have access to for Medicaid, you must enroll in Medicaid. CHIP is only for people who do not may have access to for Medicaid in their state.

What if I am not a U.S. citizen?

Medicaid and CHIP rules for non-citizens vary by state and immigration status. Lawful permanent residents (green card holders) usually may have access to. Undocumented immigrants may may have access to for emergency Medicaid in some states. Contact your state's Medicaid office with your immigration status to learn what you may be able to access.

Do I have to pay anything for Medicaid or CHIP?

Medicaid is free in most states. Some states charge a small monthly premium or copay for certain services, but the cost is very low. CHIP usually costs nothing or very little—most states charge no premium, though some charge a small copay when you see a doctor. Check your state's program details.

What if my income changes after I enroll?

You must report income changes to your state's Medicaid or CHIP office. If your income rises above the program limit, your coverage will end. If your income drops, you may become may be able to access for Medicaid if you were on CHIP. Report changes within 30 days to avoid overpayment or coverage gaps.

Can I keep Medicaid or CHIP if I start working?

Yes, but your coverage depends on your new income. If your income stays below your state's limit, you keep coverage. If it rises above the limit, your coverage ends. Some states have work incentive programs that let you keep Medicaid for a few months after you start work, even if your income is above the limit. Ask your state office about work incentives.