What the State Children's Health Insurance Program covers

The State Children's Health Insurance Program, known as CHIP, is a joint federal and state program that pays for health coverage for children whose family income is too high to meet Medicaid limits but too low to afford private insurance easily. Each state runs its own CHIP program under federal rules, so what CHIP covers, how much families pay, and who can enroll varies by where you live.

CHIP typically covers doctor visits, hospital care, emergency services, prescription medications, dental care, vision care, and mental health services. Some states cover preventive care like vaccines and screenings at no cost to the family. Other services — like therapy or specialist visits — may require a small copay or coinsurance, depending on your state's plan.

The program does not cover every service. Cosmetic procedures, experimental treatments, and some elective surgeries are usually not covered. Your state's CHIP program publishes a benefits guide that lists exactly what is and is not included; you can find this on your state health department website or by calling your state's CHIP line.

Key Takeaways

  • CHIP is run by each state separately, so income limits, covered services, and family costs differ depending on where you live.
  • Your state's CHIP program publishes a benefits guide listing what services are covered and what copays or coinsurance explore.
  • Income limits are usually higher than Medicaid but lower than 400% of the federal poverty level, though this varies by state.
  • You must provide proof of your child's age, citizenship or immigration status, and your household income when you enroll.

Income limits and who can enroll

CHIP serves children from birth through age 18 or 19, depending on your state. To enroll, your child must be a U.S. citizen or a may have access to immigrant, and your household income must fall within your state's limits. Most states set the upper income limit between 200% and 250% of the federal poverty level, though some states go higher. For 2024, 200% of the federal poverty level for a family of four is roughly $56,000 per year, but this figure changes annually and varies by family size.

Your state may also have a waiting period or enrollment freeze if the program runs out of funding. Some states pause new enrollments for a few months each year, then reopen. You can find your state's current income limits and enrollment status by visiting your state health department website or calling your state's CHIP hotline.

If your child is already covered by Medicaid, you cannot enroll in CHIP. If your child loses Medicaid coverage, you may then enroll in CHIP if your income meets the limit. Some states allow children to be on both programs temporarily during a transition, but this is rare.

How to enroll and what documents you need

To enroll, you submit an process to your state's CHIP program. Most states let you submit online through their health department website, by mail, by phone, or in person at a local office. The online route is usually fastest — you can often get a decision within two weeks.

You will need to provide proof of your child's age (a birth certificate), proof of citizenship or immigration status (a passport, Social Security card, or state ID), and proof of household income (recent pay stubs, tax returns, or a letter from your employer). Some states also ask for proof of residency, such as a utility bill or lease. Your state's process will specify which documents are required.

After you submit, your state reviews your process and sends you a notice by mail. If your child is found to meet the income and citizenship requirements, you will receive an approval letter with your child's member ID and information about how to use the coverage. If your process is denied, the letter will explain why and tell you how to appeal.

Monthly costs and what families pay

CHIP is much cheaper than private insurance. Most states charge a monthly premium of $0 to $50 per child, though a few states charge more. Some states charge nothing at all. In addition to the premium, you may pay copays when your child sees a doctor or fills a prescription. Copays are typically $1 to $5 for a doctor visit and $1 to $3 for a generic prescription, though these amounts vary by state.

Your state cannot charge copays for preventive services like well-child visits, vaccines, or screenings. If your family income is very low — usually below 150% of the federal poverty level — your state may waive the premium and copays entirely.

If your family's income changes during the year, you should report it to your state's CHIP program. If your income rises above the limit, your child's coverage will end, usually at the end of the month. If your income drops, you may become may be able to access for Medicaid instead, which has lower or no costs.

How coverage works and what to do when your child needs care

When you enroll, your child receives a member ID card. You give this card to your child's doctor, dentist, or pharmacy when they receive care. The provider bills your state's CHIP program directly. You pay only the copay or coinsurance listed in your plan.

Your child can see any doctor or dentist who accepts your state's CHIP insurance. Not all providers accept CHIP, so you may need to call ahead to confirm. Your state's CHIP website has a provider directory where you can search for doctors, dentists, and hospitals in your area that accept the program.

If your child needs emergency care, go to the nearest emergency room. CHIP covers emergency services even if the hospital is out of network. For non-emergency care, try to use in-network providers when possible, as your copay may be higher for out-of-network care.

Renewal and what happens when coverage ends

CHIP coverage is usually renewed once per year. Your state will send you a renewal notice by mail before your coverage expires, typically 30 to 60 days in advance. You must submit updated information about your household income and family situation to keep the coverage active.

If you do not renew on time, your child's coverage will end. You have a grace period — usually 30 days after the end date — to submit a late renewal without losing coverage. After that, you must submit a new process.

If your family's income rises above your state's limit during the year, your child's coverage will end at the end of that month. Your state will send you a notice explaining this and may tell you whether your child is now may be able to access for Medicaid or private insurance through the health insurance marketplace.

How CHIP differs from Medicaid and private insurance

Medicaid is a separate program that covers lower-income families and individuals. CHIP sits between Medicaid and private insurance in terms of income level. If your income is below your state's Medicaid limit, your child should be on Medicaid, not CHIP. If your income is above your state's CHIP limit, you would need to purchase private insurance or coverage through the health insurance marketplace.

CHIP premiums and copays are lower than private insurance, and CHIP does not deny coverage based on pre-existing conditions. Private insurance through the marketplace may offer more choice of doctors or hospitals, but costs more. Medicaid is free or very low cost but has stricter income limits.

If you are unsure whether your child should be on Medicaid or CHIP, your state's CHIP program can help you figure out which program your child meets the requirements for. You can also call 211 or visit your state health department website for guidance.

Frequently Asked Questions

What if my child has a pre-existing condition?

CHIP must cover your child regardless of any pre-existing condition. Your child cannot be denied coverage or charged more because of a health condition. All covered services related to the condition are included in your child's plan.

Can I enroll my child in CHIP if they are undocumented?

No. Your child must be a U.S. citizen or a may have access to immigrant to enroll in CHIP. may have access to immigrants include lawful permanent residents, refugees, and asylees. If your child does not meet these requirements, you may be able to find low-cost or free care through community health centers or local programs.

What happens to my child's coverage if we move to another state?

Each state runs its own CHIP program, so your child's coverage ends when you move. You will need to enroll in the new state's CHIP program. Contact your new state's health department to start an process. There may be a gap in coverage during the transition, so explore as soon as you move.

Can my child stay on CHIP after turning 18?

Most states cover children through age 18. A few states extend coverage to age 19. Once your child ages out, they may be able to enroll in Medicaid or private insurance through the marketplace if your household income meets the requirements. Check with your state's CHIP program about what options are available when your child turns 18.

How do I find my state's CHIP program?

Visit your state health department website and search for "CHIP" or "children's health insurance." You can also call 211 and say you are looking for CHIP in your state; they will give you the phone number and website. Your state's CHIP program can answer questions about income limits, enrollment, and covered services specific to where you live.