CHIP Benefits and Eligibility

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CHIP Benefits and Eligibility

The Children’s Health Insurance Program, also known as CHIP healthcare, is a health insurance program that is jointly funded by the federal and state governments. Today, over 9.4 million children are enrolled in the program in order to ensure the health and wellness of children who would otherwise not have access to health insurance. While this program follows federal requirements, it is administered at the state level. As such, “What is CHIP?” is a common question among interested applicants, since each state may have its own version of the program.

CHIP health insurance is designed to provide coverage to children whose families cannot afford private healthcare, but do not qualify for Medicaid. For a child to obtain these benefits, the family must meet eligibility requirements, including those based upon the child’s age and the household’s income. If interested in obtaining CHIP benefits for your child, learn more about covered services, eligibility requirements and how to enroll a child into the program below.

What is CHIP?

CHIP provides insurance for children whose families surpass income requirements for Medicaid, but that do not make enough to afford private health insurance. With CHIP coverage, children who might not otherwise have access to a comprehensive health insurance plan are ensured health and wellness services, preventative care, visits with their doctor and more.

CHIP healthcare was first signed into law in 1997 and, since then, every state has expanded the program in order to best accommodate local residents. In 2014, the Affordable Care Act allowed states to expand eligibility further, in order to offer insurance coverage to even more children. Over 9.4 million children are able to receive healthcare through this insurance program today.

This Health Insurance Marketplace insurance option can be applied for in numerous ways, depending on your state. However, you are strongly encouraged to learn more about covered services, eligibility requirements, costs and any potential waiting periods before submitting an application.

Reviewing CHIP Eligibility Requirements

Children must meet CHIP qualifications regarding age in order to enroll into this health insurance program. In general, coverage is available to children who are otherwise uninsured and under the age of 19. Other program qualifications state that the child’s family must have an income too high to meet Medicaid eligibility requirements, but still low enough of an income to qualify for CHIP.

Additionally, children and qualifying pregnant women must also have proof of citizenship or lawful presence within the United States. However, CHIP income limits are the most important requirement to meet. Applicants must include sufficient supporting documentation, which includes proof of household income.

CHIP income guidelines can vary between states, but most states are up to or above 200 percent of the Federal Poverty Level (FPL). In 24 states, income limits have been raised to 250 percent of the FPL or higher.

CHIP eligibility regarding age is not considered when the applicant is a pregnant woman. Instead, eligibility guidelines will focus on income limits and lawful presence. Additionally, pregnant women may not be charged cost sharing for preventative or pregnancy-related services and cannot have a waiting period prior to enrollment.

How to Enroll in CHIP Health Insurance

Not only will the Health Marketplace allow you to submit an application for CHIP, but the marketplace will automatically submit your information to your state agency if it looks like you may qualify. Your state agency will then contact you regarding your application, including whether or not any additional information or documentation is necessary in order to process your application.

Alternatively, a CHIP Medicaid application can be submitted directly to your state Medicaid agency. Acceptable application methods will vary by state. Depending on your state, you may be eligible to apply online, by mail or in person.

When submitting a CHIP application, you will most likely be required to provide documentation to verify your eligibility as well. It is crucial that you provide this documentation in a timely manner in order to avoid any delay of benefits, or the denial of your application.

Waiting Periods for CHIP Enrollment

If you are approved for CHIP benefits, you may experience a waiting period before your benefits begin. This waiting period varies depending on the state that you live in. As of November 2016, there are 15 states that have a waiting period after an application is accepted. These waiting periods typically range from one to three months. However, several of these states have exemptions in place which allow coverage to begin immediately after an applicant receives approval for benefits.

Reviewing CHIP Coverage

If approved for CHIP healthcare, it is important to understand the medical services that will be covered under this health insurance program. However, covered services can also vary by state as there are a number of medical services that the federal government allows states to decide upon. Mandatory benefits include, but are not limited to:

  • Well-baby and well-child visits.
  • Dental benefits (exact plan and coverage can vary)
  • Behavioral health benefits.
  • Vaccinations.

In addition to mandatory CHIP benefits, states also have the ability to choose between a Medicaid expansion program, separate CHIP or a combination of these two programs in order to offer additional coverage to qualifying applicants.

If a state opts for Medicaid coverage expansion, then CHIP participants will receive the same benefits as they would if under the Medicaid program. Otherwise, states can choose to offer benchmark coverage or equivalent coverage. Coverage must be equal to the health benefit plans offered to state or federal employees.

Costs Associated With the CHIP Program

CHIP offers insurance for children at an affordable cost. If approved for CHIP, you may receive benefits for free or at the cost of a small premium. Additionally, you may be imposed enrollment fees, deductibles, coinsurance and copayments depending on your income.

These cost sharing fees generally cannot exceed five percent of a family’s annual income. In addition, cost sharing for CHIP benefits cannot exceed the amount permitted in the state’s Medicaid program for families with incomes at or below 150 percent of the FPL. Moreover, cost sharing cannot be imposed for certain medical services, such as well-baby and well-child visits.