What CHIP covers and who it serves

The Children's Health Insurance Program (CHIP) is a joint federal and state program that pays for doctor visits, hospital care, prescriptions, and dental and vision services for children whose family income is too high for Medicaid but too low to afford private insurance. Each state runs its own CHIP program under federal rules, so the exact services covered, income limits, and monthly costs vary by where you live.

CHIP covers children from birth through age 18 in most states, though some states extend coverage to age 19. The program pays for preventive care like checkups and vaccines, treatment for illness and injury, mental health services, and emergency care. Many state programs also cover dental work, eyeglasses, and hearing aids, though the scope differs.

Your state's CHIP program has its own name — it might be called Peach Care, BadgerCare Plus, Hoosier Healthwise, or something else entirely. Finding your state's program name is the first step, because you will need it to learn your state's specific rules and income thresholds.

Key Takeaways

  • CHIP is run by your state, not the federal government, so income limits, covered services, and monthly costs are different in every state.
  • Your state's CHIP program has its own name and website where you can find the exact income threshold for your family size and the services your state covers.
  • Most states charge a small monthly premium and a copay for some visits, though the amounts vary widely and some states charge nothing.
  • You provide proof of your child's age and citizenship, your household income, and where you live when you submit information to your state program.
  • Coverage usually starts the month you submit your information, though some states backdate it to the first day of the month you applied.

Income limits and family size thresholds

CHIP income limits are set as a percentage of the federal poverty line and differ by state. A state might cover children in families earning up to 200 percent of the poverty line, while another covers up to 250 percent. For 2024, the federal poverty line for a family of four is $31,200 per year, but your state's CHIP threshold could be anywhere from roughly $37,000 to $78,000 depending on the percentage your state chose.

Income limits also change based on family size. A single parent with one child has a different threshold than a single parent with three children. Your state's CHIP website will have a tool or chart showing the exact income limit for your household size, or you can call your state program directly and give them your family size to learn whether your income falls within range.

The income counted includes wages, self-employment income, Social Security, unemployment benefits, and child support. Some states exclude certain income like student loans or tax refunds. Your state's program will tell you which types of income to report.

Monthly costs and what you pay at the doctor

Most states charge a monthly premium for CHIP coverage, though the amount varies. Some states charge $0 to $20 per month per child, while others charge $50 or more. A few states have no monthly premium at all. When you contact your state program, ask what the monthly cost is for your family size and income level, because premiums are often based on how much you earn.

In addition to the monthly premium, you typically pay a copay when you visit the doctor, go to the emergency room, or fill a prescription. A copay might be $3 for a doctor visit and $5 for a prescription, or it could be higher. Some preventive services like vaccines and well-child checkups are free with no copay. Your state's CHIP program will send you a list of copays when you enroll.

If you fall behind on monthly premiums, your state may suspend coverage until you pay what you owe. Some states give a grace period of one or two months before suspending; others suspend when ready. Ask your state program what happens if you miss a payment and whether you can set up a payment plan.

Documents you need and how to submit information

To enroll your child in CHIP, you will need to provide proof of your child's age (a birth certificate works), proof of citizenship or legal residency (a Social Security card, passport, or state ID), and proof of your household income. Income proof can be a recent pay stub, tax return, or a letter from your employer stating your annual salary.

You will also need to show where you live — a utility bill, lease, or mortgage statement with your current address. If you are explore for more than one child, you need documents for each child but can use the same income and address proof for all of them.

Most states let you submit information online through their CHIP website, by mail, or in person at a local office. Some states use a joint process for both Medicaid and CHIP, so if your child does not may have access to for Medicaid, the same form automatically moves them into CHIP if your income is within range. Online submission is usually fastest — you upload documents and get a decision within one to two weeks.

When coverage starts and how long it lasts

Coverage typically begins the month you submit your information, though some states backdate it to the first day of the month you applied. A few states have a waiting period of a few days or weeks. When your state approves your child, you will receive a notice in the mail with your child's member ID number, the effective date of coverage, and instructions for finding doctors in your state's network.

CHIP coverage lasts for 12 months from the date it starts. Before your 12 months end, your state will send you a renewal notice asking you to confirm that your income and family situation have not changed. If your income stays below the limit and you submit the renewal information on time, coverage continues for another 12 months with no gap.

If your income rises above your state's CHIP limit, your child will no longer be covered. Some states allow a transition period where you can keep CHIP for a few months even if your income goes slightly over the limit, but this varies. If your income changes during the year, contact your state program to report it, because staying enrolled when you no longer meet the income requirement can result in having to repay the cost of coverage.

Finding your state's CHIP program and next steps

To find your state's specific CHIP program, visit Healthcare.gov and select your state from the map, or search "[your state name] CHIP" in a search engine. Your state's program website will show the income limit for your family size, the monthly premium, the services covered, and a link to submit your information online.

You can also call 1-877-KIDS-NOW (1-877-543-7669), a national hotline that connects you to your state's CHIP program. A representative can answer questions about your state's income limit, tell you what documents to gather, and help you understand the next step.

If you think your child might also be covered by Medicaid instead of CHIP, ask your state program about that when you contact them. Some children may have access to for both, and Medicaid may have lower or no monthly costs. Your state will help you figure out which program is the better fit for your family.

Frequently Asked Questions

What if my child has a pre-existing condition or was denied coverage before?

CHIP does not deny children based on pre-existing conditions like asthma, diabetes, or heart problems. If your child was denied coverage in the past, it was likely because your family income was above the limit at that time. If your income has changed, you can submit a new process and your child will be considered based on current income only.

Can my child stay on CHIP if I get a job and my income goes up?

If your income rises above your state's CHIP limit, your child will no longer be covered once your 12-month enrollment period ends. Some states allow a few months of continued coverage if you go slightly over the limit. When you renew, your state will tell you whether your child still qualifies. If not, you may be able to buy private insurance through your employer or the health insurance marketplace.

Does CHIP cover dental and vision care?

Most states cover dental checkups, cleanings, and basic treatment through CHIP, and many cover vision exams and eyeglasses. However, the scope varies by state — some cover more extensive dental work like braces, while others cover only basic care. Check your state's CHIP website or call the program to learn what dental and vision services your state includes.

What happens if I move to a different state?

CHIP coverage does not transfer between states. If you move, your child's coverage in your old state will end, and you will need to submit a new process to your new state's CHIP program. The income limits and services covered may be different. Contact your new state's program as soon as you move to avoid a gap in coverage.

Can I use any doctor with CHIP, or do I have to use a network doctor?

Most states require you to use doctors and hospitals in your state's CHIP network, though emergency care is covered anywhere. When your child is enrolled, your state will send you a list of in-network providers or a website where you can search for doctors near you. Using an out-of-network doctor usually means you pay more or the visit is not covered at all.