CHIP in Massachusetts

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Since the Massachusetts Children’s Health Insurance Program (CHIP) was signed into law about 20 years ago, many children have been able to access affordable health coverage. The mission of the MA CHIP program is to provide children age 19 or younger with inexpensive health insurance. Both Medicaid and CHIP enrollment are managed by the MassHealth program. However, CHIP is meant for children who do not meet Medicaid eligibility requirements, due to higher income. Even if a family has been denied Medicaid eligibility children in that family may still be eligible for CHIP benefits. Many families may be wondering, “What is CHIP Medicaid?” and, “Who is eligible for enrollment?” Get the answers to those questions and learn how to apply for CHIP by reading the information provided below.

Massachusetts’s Children’s Health Insurance Program Overview

Many potential beneficiaries ask, “Is CHIP considered Medicaid in MA?” Medicaid for children and CHIP are a part of MassHealth, but they are not the same program. Children’s Medicaid and Medicaid for adults cover individuals who have very low incomes, are elderly or have disabilities. CHIP is for Medicaid ineligible children whose families cannot afford health coverage. The two programs are financed by the state government of Massachusetts, as well as the federal government. Those on Medicaid will not have to pay for a portion of their medical services, while children enrolled in CHIP will have a large portion of their medical treatments covered, with beneficiaries responsible for paying remaining medical costs.

What are the differences between CHIP and Medicaid in Massachusetts?

CHIP is not Medicaid in Massachusetts, even though it is part of the MassCare program. The program is only for those who do not meet Medicaid qualifications, but still need medical assistance. Children lacking Medicaid eligibility can still apply for the program. Each state has different rules regarding these two medical benefits programs. Since CHIP is not considered Medicaid, those already enrolled in Medicaid will not need to apply for this program. Even if one is not eligible for either program, there are other forms for medical assistance provided by the state of Massachusetts.

To learn more about CHIP and Medicaid benefits, download our free guide.

Who is eligible for CHIP in Massachusetts?

All those interested in CHIP enrollment must be aware of the qualifying guidelines for the program. Since children of low-income households may not qualify for Medicaid coverage, it is important to review the CHIP requirements as well to make an educated application decision regarding government-sponsored healthcare. To qualify for CHIP in MA, patients must be:

  • Children younger than 19 years old.
  • United States citizens or legal immigrants.
  • Living at an address in the state of Massachusetts.
  • Uninsured and not enrolled in Medicaid.
  • Able to meet income guidelines for the program.

MA CHIP does not offer coverage for pregnant women. Expectant women who have Medicaid eligibility can apply for that program, instead. Once the child is born, the family can enroll him or her in CHIP. About 96 percent of CHIP-eligible children are enrolled in the program, making that a total of about 110,000 children statewide.

To learn more about CHIP eligibility, download our complimentary guide.

What services are covered by CHIP in Massachusetts?

When it comes to what is covered by CHIP Medicaid in Massachusetts, beneficiaries can rest easy knowing the program handles sufficient medical treatments, procedures, testing and visits. Preventive and lifesaving medical care is covered by CHIP in the state of Massachusetts. The types of services covered by CHIP include, but are not limited to:

  • Hospital visits.
  • Check-ups.
  • Eye exams and hearing tests.
  • Emergency care.
  • Diagnostic laboratory tests and X-rays.
  • Dental care.

Download our guide to review the comprehensive list of medical services covered by CHIP.

Many services covered by Children’s Health Insurance Program require small copayments. Keep in mind, Medicaid-qualified children will not have to pay for any services, and may have access to other types of treatments than those in the CHIP program. MA CHIP has limitations on the frequency of how certain services are rendered. For example, CHIP enrollees can only have one eye exam a year. Some services could be capped by how much CHIP benefits are spent, such as there being a $200 limit on certain types of dental work. Both CHIP and Medicaid for children may not cover unproven medical treatments, such as experimental or homeopathic treatments. Also, the copay for brand-name pharmaceuticals may cost slightly more than generic prescription medication.

How to Apply for CHIP in Massachusetts

Applying for CHIP involves applicants first providing proof of their eligibility. Petitioners will have to show documentation of their identities, Social Security Numbers, citizenship status and income earnings of the household. Lying or misleading the MassHealth program while applying for CHIP benefits could result in criminal charges and a prison sentence.

Those who need help understanding how to apply for CHIP or need an application sent to them can call: the state helpline. The CHIP application can be requested at most hospitals, community health centers or agencies. The application can also be printed and mailed to the following address:

Health Insurance Processing Center
P.O. Box 4405
Taunton, MA 02780

CHIP and Medicaid enrollment follow similar procedures, but use different means of submitting the application. For example, there is no way to apply for CHIP online, yet those interested in Massachusetts Medicaid can apply online. Download our guide to review more information about CHIP and children’s healthcare benefits.