Moving From Medicaid to CHIP: What Changes and What Stays the Same

What happens when your child moves from Medicaid to CHIP

When your child ages out of Medicaid or your household income rises above the Medicaid limit, you may find that CHIP becomes the coverage option instead. The transition itself is usually straightforward — your child's coverage simply switches from one program to the other on a specific date. What matters most is understanding what stays the same and what changes: CHIP covers similar services, but the cost structure, copayments, and how you pay are different.

The timing of the switch depends on why it's happening. If your child is aging out of Medicaid (usually at age 19 or 21, depending on your state), your state's Medicaid office will send you a notice with the exact date coverage ends. If your income has risen above Medicaid limits, you'll typically have a grace period — usually 12 months — to stay on Medicaid before CHIP takes over. During that grace period, you can plan for the change without losing coverage.

Key Takeaways

• CHIP coverage usually begins on the first day Medicaid ends, so there should be no gap, but confirm the exact date with your state Medicaid office before the transition.
• CHIP requires a monthly or annual premium in most states, while Medicaid is free; the amount depends on your household income and your state's CHIP program.
• Copayments for doctor visits and prescriptions are typically higher under CHIP than under Medicaid, though many preventive services remain free.
• Your child's doctors and hospitals may change because not all providers accept CHIP; check your child's current providers before the switch to see if they participate.
• You will need to re-enroll in CHIP rather than having coverage continue automatically, so watch for enrollment deadlines after Medicaid ends.

How premiums and copayments differ between the two programs

Medicaid is free — there is no monthly premium and no copayment for most services. CHIP, by contrast, charges a monthly or annual premium in nearly every state. The amount varies widely: some states charge as little as $20 per month per child, while others charge $100 or more, depending on your household income. A few states have no premium at all, so check your state's CHIP program directly to learn what you'll owe.

Copayments under CHIP are also higher than under Medicaid. On Medicaid, your child typically pays nothing for doctor visits, emergency care, or prescriptions. Under CHIP, you might pay $3 to $10 per doctor visit, $5 to $15 per prescription, and $50 to $100 for an emergency room visit (though this is often waived if your child is admitted to the hospital). Preventive care — well-child visits, vaccinations, screenings — usually remains free under CHIP, just as it does under Medicaid.

The total cost difference can be significant. If your child sees a doctor four times a year and takes one prescription monthly, Medicaid costs you nothing. Under CHIP, that same pattern might cost you $100 to $200 per year in copayments, plus the monthly premium. Budget for this change before the transition happens so you're not caught off guard.

Confirming your child's doctors and hospitals accept CHIP

Not all providers who accept Medicaid also accept CHIP. Some doctors, dentists, and hospitals have decided not to participate in CHIP because the reimbursement rates are lower than they prefer. Before your child's coverage switches, call each of your child's regular providers — pediatrician, specialist, dentist, therapist — and ask directly: "Do you accept CHIP coverage in [your state]?" Write down the answer and the date you called.

If a provider says no, you have two options. You can find a new provider who accepts CHIP by calling your state's CHIP program and asking for a provider directory, or you can ask your current provider whether they will make an exception for your child. Some practices will continue seeing a patient even if they don't officially accept the insurance. It's worth asking, especially if your child has been seeing that provider for years.

Hospitals are usually less of a concern because most emergency departments must treat you regardless of insurance. However, if your child receives care at a specialty hospital or a children's hospital, confirm in advance that they accept CHIP. The same goes for any ongoing therapies, imaging centers, or surgical facilities your child uses regularly.

The re-enrollment process and timing

Medicaid does not automatically roll over to CHIP. You must submit a new CHIP enrollment form after Medicaid ends. Your state Medicaid office should send you information about how to do this — either by mail, online, or by phone — but do not wait for them to contact you. Reach out to your state's CHIP program 30 days before your Medicaid coverage ends and ask for the enrollment form and deadline.

The enrollment process itself is similar to applying for Medicaid: you'll provide proof of your child's age and citizenship, your household income, and your address. Most states let you enroll online or by mail. Processing time is usually two to four weeks, though some states are faster. If you submit your CHIP form before Medicaid ends, your CHIP coverage should begin on the day Medicaid ends, with no gap in protection.

If you miss the deadline or if your state has a waiting list for CHIP, your child could lose coverage temporarily. This is rare but possible. To avoid it, submit your CHIP enrollment at least two weeks before your Medicaid end date, and keep a copy of your submission confirmation. If coverage does lapse, you can still enroll retroactively in most states, though you'll be responsible for any medical bills during the gap.

What to do if your income changes after the transition

CHIP programs have income limits, just as Medicaid does. If your household income drops after your child moves to CHIP, your child may become may be able to access for Medicaid again. You can report the income change to your state's CHIP program and ask to be switched back. This usually happens within 30 days.

If your income rises while your child is on CHIP, your child will eventually age out of CHIP as well — usually at age 18 or 19, depending on your state. At that point, your child will no longer be covered by either program unless they meet other criteria (such as pregnancy or disability). Plan ahead for this transition by researching marketplace insurance options or your state's young adult coverage programs.

Keeping your child's medical records during the switch

When coverage changes, medical records don't automatically follow. Before your child's Medicaid coverage ends, request a copy of all recent medical records from your child's doctors, including vaccination records, growth charts, and any test results. Ask for these in writing and keep them in a folder at home. You'll need them if your new CHIP provider hasn't worked with your child before, and they're essential if your child ever needs to see a specialist.

Also ask your Medicaid provider office for a summary of any ongoing prescriptions, therapy sessions, or treatment plans. Write down the names and dosages of all current medications. This information helps your new CHIP provider understand your child's medical history without having to repeat tests or evaluations.

Frequently Asked Questions

Will my child have a gap in coverage between Medicaid and CHIP?

Not if you enroll in CHIP before Medicaid ends. Most states coordinate the transition so coverage begins on the day Medicaid ends. However, if you miss the enrollment deadline, there can be a gap. Submit your CHIP form at least two weeks before your Medicaid coverage ends to be safe.

Can I keep my child's current doctor if they don't accept CHIP?

You can ask the doctor to make an exception, though they're not required to. If they refuse, you'll need to find a new provider who accepts CHIP. Your state's CHIP program can provide a list of participating doctors in your area.

What if I can't afford the CHIP premium?

Some states reduce or waive premiums for families with very low incomes. Contact your state's CHIP program and explain your situation. You may also be able to pay the premium in installments rather than all at once. Do not skip paying the premium — your child's coverage can be terminated if premiums go unpaid for more than 30 days.

Does CHIP cover the same services as Medicaid?

CHIP covers most of the same services — doctor visits, hospital care, prescriptions, dental, and vision — but copayments are higher and some states have slightly different coverage rules. Ask your state's CHIP program for a detailed benefits summary before the transition so you know what's covered.

What happens when my child turns 19 or 21?

CHIP coverage ends at the age limit set by your state, usually 18 or 19. At that point, your child is no longer covered unless they meet other criteria. Research marketplace insurance or your state's young adult programs at least three months before your child's CHIP coverage ends.