How CHIP Covers Children and What It Actually Pays For

What CHIP covers and who gets it

CHIP (Children's Health Insurance Program) is a state-run program that pays for doctor visits, hospital care, prescriptions, and dental work for children whose families earn too much to may have access to for Medicaid but not enough to afford private insurance. Each state runs its own CHIP program with its own name, income limits, and what it covers — so what's available in one state may differ from another.

CHIP is designed for children from birth through age 18 or 19, depending on your state. Some states also cover pregnant women. The program pays the provider directly, so you don't have to pay upfront and then wait for reimbursement. You'll usually pay a small monthly premium (often $0 to $50 per child) and a small copay when you use care, though many states waive these costs for families below a certain income.

Key Takeaways

• CHIP covers children up to age 18 or 19 depending on your state, and income limits vary widely — some states cover families earning up to 400% of the federal poverty level.
• Each state runs its own CHIP program under a different name, so you need to search for your state's specific program to learn what it covers and how to contact it.
• The program covers preventive care, doctor visits, hospital stays, prescriptions, dental, vision, and mental health services, though what's included varies by state.
• You'll need proof of your child's age, citizenship or immigration status, and your household income to get your free guide.

Income limits and how they work in your state

CHIP income limits are set by each state and change yearly. Most states cover children in families earning between 200% and 400% of the federal poverty level — meaning a family of four might may have access to with an annual income anywhere from roughly $55,000 to $110,000, depending on where you live. A few states have lower limits; a few have higher ones.

The easiest way to find your state's current limit is to call your state health department or search "[your state name] CHIP income limits" online. You can also call 211 (a free referral line) and ask them to tell you your state's limit and whether your household income falls within it. They can often tell you in one call whether your children would likely be covered.

What CHIP actually pays for

CHIP covers the same kinds of care Medicaid does: routine doctor visits, emergency room care, hospital stays, lab work, X-rays, prescriptions, dental care, vision care (including glasses), and mental health and substance use treatment. Preventive care — well-child visits, vaccines, screenings — is covered at no cost to you in most states.

What you pay out of pocket varies by state. Some states charge no premium and no copay. Others charge a small monthly premium per child (usually $10 to $50) and a copay of $1 to $5 per visit or prescription. A few states charge higher copays for emergency room visits if you use the ER instead of an urgent care clinic. Your state's CHIP program can tell you exactly what you'll pay before you enroll.

Citizenship and immigration status requirements

CHIP requires proof that your child is a U.S. citizen, a lawful permanent resident (green card holder), or a may have access to immigrant. Lawful permanent residents and some other may have access to immigrants can enroll, but undocumented children cannot. You'll need to provide a birth certificate, passport, or Social Security card as proof of citizenship or immigration status.

If your child was born in the U.S., a birth certificate is usually the simplest proof. If your child is a green card holder, bring the green card itself or an immigration document showing their status. If you're unsure whether your child's immigration status qualifies, call your state's CHIP program directly — they can tell you before you spend time on paperwork.

How to find and contact your state's CHIP program

CHIP goes by different names in different states: in California it's Medi-Cal, in New York it's Child Health Plus, in Texas it's CHIP, in Florida it's MediKids. The fastest way to find your state's program is to search "[your state] CHIP" or "[your state] children's health insurance" online, or call 211 and ask for your state's CHIP program by name.

Once you find your state's program, you can usually start the process online, by phone, or by mail. Most states let you apply online in 15 to 20 minutes. You'll need your child's birth certificate or Social Security number, proof of your address (a utility bill or lease), and your most recent tax return or pay stubs to show your household income. Some states ask for proof of citizenship; others don't require it upfront.

What happens after you submit your information

After you submit your information, your state's CHIP program will review it and send you a letter saying whether your child is covered, not covered, or covered but on a waiting list. This usually takes two to four weeks. Some states have waiting lists during certain times of year when funding is tight; others cover children immediately year-round.

If your child is covered, you'll receive a health insurance card in the mail with a member ID number. You can use this card at any doctor, hospital, or pharmacy that accepts CHIP in your state. If you're not covered, the letter will explain why and may tell you about other programs your child might may have access to for, such as Medicaid.

How CHIP differs from Medicaid

CHIP and Medicaid are separate programs, though they work similarly. Medicaid is for lower-income families and covers children, pregnant women, parents, and some adults. CHIP is specifically for children in families that earn too much for Medicaid but still need help paying for health insurance. In some states, CHIP covers slightly more services than Medicaid (like more dental work or vision care), but in others they're nearly identical.

If your child doesn't may have access to for CHIP, ask whether they may have access to for Medicaid instead. Many families may have access to for one or the other. You can apply for both programs at the same time, and your state will tell you which one your child qualifies for.

Frequently Asked Questions

Can I keep CHIP if my income goes up?

CHIP coverage usually continues for 12 months even if your income increases during that time. After 12 months, your state will redetermine your income and may end coverage if you're now above the limit. Some states let you keep coverage for a few months longer if your income just barely exceeds the limit. Contact your state's CHIP program to ask about their income change policy.

What if my child already has private insurance through my job?

Most states will not cover a child through CHIP if they already have private insurance. However, if your private insurance is very expensive or doesn't cover much, some states may still enroll your child in CHIP to help pay for what private insurance doesn't cover. Call your state's CHIP program to ask whether your situation qualifies.

Can I use CHIP at any doctor or hospital?

CHIP works with a network of doctors and hospitals in your state, similar to private insurance. You can use any provider in the network without extra cost. If you use an out-of-network provider, you may have to pay more or the claim may be denied. Your CHIP card or your state's website will show you how to find in-network providers near you.

What if I need to renew my child's CHIP coverage?

CHIP coverage usually lasts 12 months. Before it expires, your state will send you a renewal form asking you to confirm your income and household information. You can usually renew online, by phone, or by mail. If you don't renew on time, coverage will end, but you can reapply at any time during the year.

Does CHIP cover therapy or mental health care?

Yes, CHIP covers mental health and behavioral health services in all states, including therapy, counseling, and psychiatric care. Some states limit how many visits you can have per year or require you to see a provider in their network. Contact your state's CHIP program or your child's CHIP card to find out what mental health services are covered and whether you need a referral.