CHIP (the Children’s Health Insurance Program) is a government health insurance program that covers children in families who earn too much to qualify for Medicaid but too little to afford private insurance. It covers kids under age 19 and is jointly funded by the federal government and individual states. Each state runs its own version of CHIP, so the specifics of what’s covered, what it costs, and who qualifies vary depending on where you live.
Who Qualifies for CHIP
To be eligible, a child must be under 19 years old and part of a family whose income falls within the program’s range. The federal baseline sets eligibility at 200% of the federal poverty level (FPL), but states can expand well beyond that. In practice, state income thresholds range from about 170% to 400% of the FPL. A family of four at 200% FPL in 2024 earns roughly $62,400 a year, so in many states, solidly middle-class families can qualify.
The child also can’t already be covered by another insurance plan. Because CHIP is designed as a safety net rather than a replacement for employer-sponsored coverage, federal law requires states to guard against families dropping private insurance to enroll in CHIP. Some states do this through a waiting period: after voluntarily leaving a group health plan, a child may need to be uninsured for up to 90 days before CHIP enrollment kicks in. As of early 2024, only 9 states still enforce a waiting period, and 7 of those set it at the full 90 days. The other 41 states with separate CHIP programs monitor for coverage substitution through other methods, like checking private insurance databases.
What CHIP Covers
Regardless of which state you live in, every CHIP program must cover a core set of benefits:
- Well-baby and well-child visits. Routine checkups throughout childhood, though states decide how frequently they’re offered.
- Dental care. Coverage must include preventive dental services, restorative treatments, and emergency dental care.
- Behavioral health. This includes services to prevent, diagnose, and treat mental health conditions and substance use disorders. CHIP programs must also cover tobacco cessation services and medication-assisted treatment for substance use.
- Vaccines. All age-appropriate immunizations are covered.
Beyond these mandatory benefits, most states cover a much broader package that resembles typical health insurance: doctor visits, hospital stays, prescriptions, lab work, vision care, and more. The exact list depends on how your state designed its program.
Mental Health Parity
Federal law requires CHIP programs to follow mental health parity rules. That means any limits placed on mental health or substance use disorder benefits, like visit caps or prior authorization requirements, can’t be more restrictive than the limits applied to medical and surgical benefits. If the plan covers 30 physical therapy visits a year, for example, it can’t cap therapy sessions for anxiety at 10.
How States Structure Their Programs
States have three options for how they build CHIP. Some run it as a Medicaid expansion, meaning kids enrolled in CHIP follow the same rules, use the same providers, and get the same benefits as children on Medicaid. Others create a completely separate CHIP program that operates more like commercial insurance, with its own benefit package, provider network, and branding. A third group does both: they use a Medicaid expansion for younger or lower-income children and a separate program for older kids or those in higher-income families.
This is why CHIP looks so different from state to state. In a Medicaid-expansion model, federal Medicaid rules generally apply. In a separate CHIP program, states have more flexibility to design benefits, charge premiums, and market the program under its own name. You may know your state’s CHIP program by a completely different name, like PeachCare in Georgia, Hoosier Healthwise in Indiana, or Child Health Plus in New York.
What It Costs Families
CHIP is not always free, but it’s designed to be affordable. States can charge premiums and copays, but there’s a hard cap: for families earning above 150% of the federal poverty level, total out-of-pocket costs for the year, including premiums and copays combined, cannot exceed 5% of the family’s income.
Certain groups and services are shielded from cost sharing entirely. States cannot charge copays or premiums for American Indian and Alaska Native children. They also cannot charge anything for well-baby and well-child care, the routine checkups that catch developmental issues and keep immunizations on track. And cost-sharing rules can’t be structured in a way that favors higher-income families over lower-income ones.
How CHIP Differs From Medicaid
CHIP and Medicaid are closely related but serve different income brackets. Medicaid covers children in the lowest-income families, while CHIP picks up where Medicaid leaves off, extending coverage to families that earn more but still can’t swing private premiums. Both programs are funded by a mix of federal and state dollars, but CHIP historically receives a higher federal matching rate, meaning the federal government covers a larger share of each dollar spent.
For families, the practical difference depends on whether their state runs CHIP as a Medicaid expansion or a separate program. In expansion states, the experience is essentially identical to Medicaid. In states with separate programs, CHIP may feel more like a traditional insurance plan, potentially with a different provider network, small copays, and monthly premiums.
How to Apply
You can apply for CHIP through your state’s Medicaid agency, through Healthcare.gov, or by calling 1-800-318-2596. In most states, a single application covers both Medicaid and CHIP, so the state determines which program your child qualifies for based on your household income. Processing times vary, but coverage can begin quickly once eligibility is confirmed. If your child has been uninsured and your state has a waiting period, you’ll need to account for that gap before coverage starts.