CHIP

Finding information on the Children’s Health Insurance Program (CHIP) is often the first priority of parents of children who need medical assistance benefits. The CHIP program has been in effect since 1997 as a way to keep children who are not eligible for Medicaid in good health by providing them access to affordable health insurance. Even if a family does not have Medicaid eligibility children in that family can still apply for and qualify to receive CHIP benefits. CHIP and Medicaid enrollment may seem like they are part of the same program, but they have different rules and regulations that make them separate from each other. Many who are interested in the CHIP program ask, “What is CHIP Medicaid?” when they first look in to the program. Find the answers to those questions and learn what is covered by CHIP Medicaid by reading the information in the sections below.

Children’s Health Insurance Program Overview

Medicaid or CHIP enrollment procedures vary between states, so not every state manages these programs in the same way. After enrolling in CHIP and being accepted, beneficiaries will have access to any of the medical providers that are in-network with CHIP. In some states, CHIP and Medicaid for children use the same network while other states have different networks for the beneficiaries to use. Services covered by CHIP may not be covered if the beneficiary goes to an out-of-network provider. In most states, enrollees can choose which in-network professionals and providers they see. Discover more information, including how to apply for CHIP and the differences between CHIP and Medicaid, in the following sections.

Is CHIP considered Medicaid?

CHIP and Medicaid are separate programs, but CHIP may operate as an extension of the Medicaid program in some states. The major differences between children’s Medicaid and CHIP pertain to the programs’ eligibility requirements and payment amounts. Medicaid coverage is generally designed to help beneficiaries with very low incomes or those who meet qualifying conditions, such as having a disability. Medicaid eligible children can enroll in Medicaid, while Medicaid ineligible children may qualify to enroll in CHIP if their household income is too high for Medicaid enrollment.

Children on Medicaid will not have to pay for their covered medical services. If an applicant is enrolled in CHIP instead of children’s Medicaid, his or her parent or guardian may have to pay for some of the costs that come with the child’s medical care. In most states, parents or guardians will have to pay small yearly or monthly premiums and predetermined copayments for certain treatments. However, some states offer Children’s Health Insurance Program benefits at no cost or waive the copayments for specific treatments.

Who is eligible for CHIP?

Many children are covered by CHIP in each state across the country. Specific CHIP eligibility requirements vary by state, but the program’s general eligibility requirements include the following:

  • Petitioners must be 19 years of age or younger.
  • Petitioners must be a U.S. citizen or legal resident.
  • Petitions must meet income requirements set by the program.
  • Petitioners not be enrolled in private health insurance or Medicaid.

While applying for CHIP, applicants will have to show proof of eligibility by showing documentation of their identity, Social Security number, household income and citizen or immigration status. Expectant mothers with Medicaid eligibility will often need to apply for the Medicaid program instead. Yet, some states do allow pregnant women to be enrolled in CHIP.

What services are covered by CHIP?

CHIP in the United States covers many medically necessary treatments and preventative services. The following are services covered by CHIP benefits:

  • Doctor’s appointments and check-ups
  • Immunization shots
  • Prescription drugs
  • Hospital stays
  • Emergency services and transportation
  • Dental care
  • Vision and hearing exams
  • Physical therapy

While CHIP and Medicaid are different programs, most of the services listed above are covered by each program. The program covers other medical treatments not listed above, including medical equipment like inhalers and diabetes testing kits. However, Medicaid for children may cover more services like non-emergency medical transport that may not be covered by CHIP. Please be aware that the program mainly covers scientifically-proven medical treatments and will not cover alternative medicine. To learn more about services covered by CHIP, download our comprehensive guide today.

How to Apply for CHIP

Learning how to apply for CHIP benefits can help prospective applicants to submit a successful application. Most states offer a way to apply for CHIP online through online applications or benefits accounts. Certain states also allow the CHIP application to be mailed or faxed to a central location. Applying for CHIP in-person is possible by going to one’s local human or social services office. However, not every state may offer all of these options, so it is important to look at how your state will allow you to apply. Most states will give you information on CHIP enrollment status within a month, with some states taking longer.

Please be aware that knowingly giving false information while applying for CHIP or any other program can result in criminal charges. It is best to always give truthful and accurate information whenever you apply to any government program. For more information about applying for CHIP benefits, you can download our complimentary guide.