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Learn About CHIP in California

“What is CHIP Medicaid in California?” is a question often asked by those seeking low-cost health care for their children. The Children’s Health Insurance Program (CHIP) was created in 1997 as a way to help more low-income children have access to affordable health care. CA CHIP is for children 18 years of age or younger whose families do not meet Medicaid enrollment criteria for income. If a family does not have Medicaid eligibility children in that family can still apply for CHIP benefits. Medicaid for children, Medicaid for adults and CHIP are all part of the Medi-Cal program in California. Many prospective applicants ask “Is CHIP considered Medicaid?” when looking into CHIP, because of these close relationships among the programs. Find answers to these questions and learn what is covered by CHIP Medicaid in California by reading the rest of this page.

What is the California Children’s Health Insurance Program?

California CHIP is designed for Medicaid ineligible children who still need help obtaining affordable health insurance. CHIP is not a private insurance or entitlement program, but rather a form of government assistance. The CA Children’s Medicaid program is for children from low-income families that exceed the maximum income requirements for Medicaid. CHIP eligible children will come from families with higher incomes than those on Medicaid. Both programs require recipients to use in-network medical providers and professionals. Enrollees who do receive out-of-network services may not receive coverage by the CHIP or Medicaid program for those services. CHIP and Medicaid enrollment is handled differently in each state.

Is CHIP considered Medicaid in California?

The Children’s Health Insurance Program in California is not the same as the Medicaid program, but is instead considered a Medicaid extension program. All government-subsidized health coverage in California is provided by the Medi-Cal program, which covers adults, children, families and those with disabilities. CA Children’s Medicaid and CHIP are both part of the Medi-Cal program, but that does not mean that CHIP is the same as Medicaid.

Children on Medicaid in California will not have to pay for their Medicaid covered services. Those on CHIP will have to pay a small copay for their medical services and a premium for maintaining enrollment in the program. Premiums and copays are decided by the size of the enrollee’s family’s income. If an enrollee fails to pay the premium, he or she may face disenrollment and will have to reapply.

Who qualifies for CHIP in California?

Before learning how to apply for CHIP in California, you should look at how the eligibility criteria is managed in California. Those eligible for CHIP enrollment must:

  • Be a United States citizen or legal resident.
  • Be younger than 19 years of age.
  • Not have health insurance.
  • Meet income guidelines for the program.

When you apply for CA CHIP benefits, you will have to prove your eligibility by showing documents that verify your identity, citizen or immigration status and income. Income criteria also factors in household size. For example, a family of four will have a lower income requirement than a household of seven. The best way to truly know if one is eligible for California CHIP or any other Medi-Cal programs is to apply. Pregnant women may also be covered by a Medi-Cal program. Please be aware that enrollment in CHIP or Medicaid is not permanent, and one will need to reapply. You are required to inform the Medi-Cal program of any important changes to your eligibility such as your income as soon as possible. Any information regarding your enrollment in the program or when to reapply will be sent through the mail. You can download our free guide to learn more about requirements for CHIP and Medicaid.

What services are covered by CHIP in California?

CHIP enrollment in California allows children from low-income households to obtain coverage for many medically necessary or preventative medical services. Numerous services are covered by CHIP, including:

  • Doctor’s appointments and check-ups.
  • Immunization shots.
  • Emergency care and transportation.
  • Hospitalization.
  • Surgeries.
  • Dental care.
  • Vision and hearing exams.
  • Laboratory work and x-rays.

CA CHIP and Medicaid programs will only cover scientifically tested and proven forms of medical treatment. Alternative medicine will not be covered by CHIP or other Medi-Cal programs. Some treatments like teeth cleaning and eye exams are only covered once a year. If these services are needed more than once per year, the recipients will need to cover the cost of those services. Medicaid eligible children may be entitled to additional services, such as medical transport in non-emergency situations. To learn more about services provided through CHIP and Medicaid, download our comprehensive guide today.

How to Apply for CHIP in California

One can apply for CHIP or Medi-Cal coverage through California health marketplace called Covered California. Applicants can follow instructions online to submit the electronic application. Applicants can also print out the paper CA CHIP application and fax it to Covered California. Lastly, those applying for CHIP or another Medi-Cal program can send their application to this address:

Covered California
P.O. Box 989725
West Sacramento, CA 95798

Please be aware the purposefully giving false information while applying to the CHIP program in CA is a serious offense that may come with jail time.