Learn About the Children’s Health Insurance Program (CHIP)

Learn About the Children’s Health Insurance Program (CHIP)

The Children’s Health Insurance Program (CHIP) is a collaboration between the federal and state governments. The program’s aim is to provide inexpensive health insurance for children in households that make too much money to be eligible for Medicaid but not enough to afford private health insurance.

Although the program is meant for children, some states include pregnant women among those who qualify for CHIP.

 CHIP healthcare is available in all states and is closely related to the Medicaid program. While each state offers different CHIP benefits, the coverage provided by all states is equally comprehensive. It includes immunizations, prescriptions, regular checkups, and doctor visits among others.

 Different rules apply in each state regarding who is eligible for CHIP. To know whether or not you qualify, you can easily submit an application whenever you have some free time. Applying for Medicaid will also reveal if your kids qualify for CHIP. To gain more clarity about your family’s eligibility status, you may want to check with your state’s CHIP office.

 It’s worth noting that CHIP may be called something different in your state. No matter what its name is, however, the program generally behaves the same everywhere. Generally, the benefits children will get when they enroll in CHIP include: 

  • Regular checkups.
  • Doctor visits.
  • Prescriptions.
  • Immunizations.
  • Vision and dental care.
  • Lab and X-ray services.
  • Inpatient and outpatient hospital services.
  • Emergency services.

The Purpose of CHIP Insurance

Created in 1997, the Children’s Health Insurance Program aims to push for states to increase access to low-cost health insurance. The creation took place after a phase where employer-provided coverage for children declined markedly. 

In addition, there were also reports showing a rise in the number of uninsured children. Thus, CHIP was born.

To make sure kids do not have to go without medical care, the federal government pays a larger percentage of expenses, ranging from 65 to 81 percent in comparison with 50 to 73 percent in Medicaid.

However, such programs are actually more flexible when it comes to design. For instance, CHIP funds may be used for Medicaid CHIP (M-CHIP), which is an expanded version of the standard Medicaid for children. States may also use the funds to create other CHIP programs in different ways, or even work up both approaches in a combined manner. 

The fixed part of this is the fact that M-CHIP follows the same rules as Medicaid except for one thing: eligibility only for uninsured children. So, even though CHIP doesn’t collectively provide health insurance to every child, it does make available health coverage to millions of uninsured children.

Who Is CHIP for?

There are guidelines established to determine categories of children who can be covered with CHIP funds. Sometimes, children who cannot be covered with CHIP funds may receive a Medicaid cover instead. This can happen in states that have chosen to expand Medicaid eligibility. But in general, certain requirements need to be met for children to qualify for the program.

To receive coverage through the CHIP program, a child must be under 19. Additionally, they must be a U.S. national, citizen, resident alien or have legal status in the United States. The child cannot be a participant of Medicaid or other types of health insurance programs.

Factors such as income, family size, and state rules play an important role in determining eligibility. In most cases, children in families that live at or below 200 percent of the federal poverty level may be able to receive CHIP coverage. The income eligibility thresholds can still be higher than that, though, especially in states where the rules set higher limits.

How Does CHIP Work?

In general, CHIP works similarly to other health insurance programs.

If your child joins CHIP as a new member, you will need to choose a primary care physician (PCP/doctor) for your child. A CHIP ID card will then be delivered to your child. It will list the PCP of your choice and needs to be shown at every doctor appointment.

For a CHIP Perinatal Member or a pregnant woman, the procedure is almost the same. After you pick a PCP for your pregnancy care, you will receive a CHIP Perinatal ID card which needs to be shown at every doctor appointment before you give birth.

Meanwhile, participating in the CHIP Perinatal Newborn Member category will also require you to choose a PCP for your newborn baby. A CHIP Perinatal ID card will be delivered to your baby. It lists the doctor of your choice and should be shown at every doctor appointment.

In some states, you may have to pay a small premium each month for your child to receive CHIP benefits. In general, though, the program comes with low costs.

The most important part of the process of joining CHIP is picking a PCP who will provide a full range of primary care services. By law, you do not have to pay for “well child” appointments and routine dental visits if your child is enrolled in CHIP.

As with almost any insurance, however, you may be responsible for copayments and other out-of-pocket costs for certain other services. Generally, these end up being around $10 or less, making them extremely affordable compared to many private health insurance plans.

How to Apply for CHIP

Even though CHIP is administered slightly differently in each state, the general rules and application process are the same. 

There are two main ways to apply for CHIP. The first is to call 1-800-318-2596 (TTY: 1-855-889-4325) to apply by phone. The second is to apply online through the Health Insurance Marketplace set up by the Affordable Care Act (ACA). 

If you apply online, you will also find out if anyone in your household is able to receive Medicaid or qualifies for insurance subsidies that help with the cost of private insurance premiums. If your child is eligible for CHIP, the Marketplace will forward your application to the appropriate agency in your state. Someone from the state agency will then contact you.

Unlike other health insurance plans, CHIP is not subject to open enrollment periods. This means that you can apply for CHIP at any time of the year.