CHIP in New York

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Since 1997, the Children’s Health Insurance Program (CHIP) has been available in all 50 states including New York. New York CHIP, called Child Health Plus locally, is designed to help children who can’t qualify for Medicaid but still need help affording health insurance. Even if a family lacks Medicaid eligibility children in that family can still apply for the CHIP program. New York offers Medicaid for children and the CHIP program. These two programs are similar, but they are not the same. This often cause potential applicants to ask, “What is CHIP Medicaid?” when they are initially looking into the CHIP program. Get answers to the question “What is covered by CHIP Medicaid in NY?” and learn about CHIP coverage, eligibility and application guidelines by reading the sections below.

New York Children’s Health Insurance Program Overview

“What is CHIP Medicaid in New York?” some petitioners may ask. CHIP and Medicaid are actually separate programs. Each state manages CHIP and Medicaid enrollment differently, so it is important to understand the rules and regulations for the programs in your state. After being accepted into CHIP or the Children’s Medicaid program, enrollees will have access to many health plans based on the county in which they reside. Once a health plan is chosen, the recipient is free to see which ever health care provider he or she would like as long as the provider is in network. Generally, those who enroll in CHIP and Medicaid in NY will have access to the same covered services with a few exceptions. If an enrollee sees an out of network provider, any services rendered may not be covered.

Is CHIP considered Medicaid in New York?

New York CHIP and Medicaid are not the same thing. CHIP is an extension of the Medicaid program for Medicaid ineligible children, so that they can still have adequate health coverage. The Medicaid for children program is reserved for children from families with a very low income or for children with long-term illnesses and disabilities. CHIP eligible children come from families that earn too much to receive Medicaid coverage but still cannot afford health coverage for their children. New York also provides Medicaid for senior citizens and adults.

Because CHIP and Medicaid in NY are not the same, there are key differences between the programs. CHIP enrollees will have to pay for a small portion of their medical care and a small monthly premium. Medicaid recipients will not have to pay a premium nor will they have to pay for any of their covered medical expenses.

Who is eligible for CHIP in New York?

Before you can learn how to apply for CHIP in New York, you should be aware of the eligibility requirements. NY CHIP petitioners must:

  • Be 18 years of age or younger.
  • Be a United States citizen or legal resident.
  • Meet income criteria for their household size.
  • Not be on any health insurance plan.
  • Not be eligible for state employee health benefits coverage.

Pregnant women who meet New York Medicaid eligibility guidelines must apply for the Medicaid program instead of the CHIP program. To be granted CHIP enrollment, all applicants will have to prove their eligibility by providing documentation of their identity, their citizen or immigration status, their income and their address. Giving false information during the CHIP application process to fake eligibility is considered benefits fraud and is a serious crime that often comes with prison sentences. When applying for CHIP in NY, applicants must give true and accurate information.

What services are covered by CHIP in New York?

Several types of medical services are covered by New York CHIP to help treat and prevent diseases and conditions. Services covered by CHIP include:

  • Hospital visits.
  • Immunization shots.
  • Doctor’s appointments and check-ups.
  • Vision and hearing care.
  • Dental care.
  • Outpatient surgery.

New York CHIP can cover other services that are not listed above. Children’s Medicaid will cover these services and more. For example, children on Medicaid can receive non-emergency medical transport and other services that pertain to their disability or illness. Pregnant women on Medicaid will receive prenatal and postnatal care covered by the program. Both CHIP and Medicaid enrollment will not cover experimental or alternative medicine as the programs will only cover treatments that are deemed to be proven effective by scientific means. Therefore, practices like acupuncture will not be covered. Treatments covered by CHIP in NY may also have a limit. For example, CHIP will only cover one eye exam per year.

How to Apply for CHIP in New York

Petitioners can apply for CHIP in New York over the phone, and CHIP and Medicaid support will be offered in both English and Spanish. If an applicant wishes to apply to NY CHIP in person, he or she can visit a local county office that works with the New York Department of Health. Anyone interested in applying for CHIP online can use the Health Marketplace created by the Affordable Care Act. One can enroll during the open enrollment period each fall or apply for special enrollment. To learn more about applying for CHIP and Medicaid, download our comprehensive guide today.