CHIP is a government health insurance program for children whose families earn too much for Medicaid but not enough to afford private coverage

CHIP stands for Children's Health Insurance Program. It covers doctor visits, hospital care, prescriptions, dental work, and vision care for children under 19 in families with moderate incomes. Each state runs its own CHIP program with slightly different rules, income limits, and covered services, but the federal government funds part of it.

CHIP is separate from Medicaid, though the two programs often work together. If your child doesn't may have access to for Medicaid because your income is too high, CHIP may cover them. If your child qualifies for both, CHIP acts as a backup. The program has been around since 1997 and covers millions of children across the country.

Key Takeaways

  • CHIP covers children under 19 whose family income is above the Medicaid limit but below a threshold that varies by state, usually between 200% and 400% of the federal poverty level.
  • Each state administers CHIP under its own name — for example, New York calls it Child Health Plus, Texas calls it CHIP, and California calls it Medi-Cal for children — so you search for your state's program.
  • CHIP covers preventive care, doctor visits, hospital stays, prescriptions, dental, vision, and mental health services, though the exact list varies by state.
  • You contact your state's CHIP program directly or use the federal 1-877-KIDS-NOW hotline to find your state's program and learn the income limits for your household size.

How income limits work and whether your family qualifies

CHIP income limits are set by each state and change yearly. They are usually expressed as a percentage of the federal poverty level. For 2024, the federal poverty level for a family of four is about $31,200 per year. Many states set their CHIP limit at 200% to 250% of that amount, which means a family of four earning up to roughly $62,000 to $78,000 might may have access to. Some states go higher — up to 400% of poverty level.

Income limits also depend on family size. A single parent with one child has a different limit than a family of five. When you contact your state's CHIP program, you provide your household size and gross income, and they tell you whether your family falls within the range. Some states count only earned income; others include child support or other sources. The rules are specific to your state.

If your income is right at the edge, it is worth contacting your state program anyway. Some states have enrollment periods or waiting lists, and some have special rules for families who recently lost coverage or had a change in income.

What CHIP covers and what it does not

CHIP covers the basics: regular doctor visits, emergency room care, hospital stays, lab tests, X-rays, prescriptions, and vaccines. Dental and vision care are included in most states, though the scope varies — some cover cleanings and fillings but not braces, for example. Mental health services and substance abuse treatment are covered in all states.

CHIP does not cover everything. Cosmetic procedures, experimental treatments, and some specialized therapies may not be covered. Long-term care in a nursing home is not covered. If your child needs a service, you can ask your state's CHIP program whether it is covered before you schedule it. Many states have a list of covered services on their website, or you can call and ask.

Copays and deductibles vary by state. Some states charge nothing; others charge a small copay per visit or prescription. If your family's income is very low within the CHIP range, your copays may be waived or reduced.

How to find your state's CHIP program

CHIP operates under different names in different states. The federal government runs a hotline — 1-877-KIDS-NOW (1-877-543-7669) — that connects you to your state's program. You can call and say where you live, and they will give you the phone number and website for your state's CHIP.

You can also search online for your state's name plus "CHIP" or "children's health insurance." For example, searching "New York CHIP" will take you to Child Health Plus, or "Texas CHIP" will take you to the Texas CHIP program. State Medicaid offices often run CHIP as well, so searching your state's Medicaid website is another route.

Once you reach your state's program, you will need to provide proof of your child's age, your household income (usually a recent tax return or pay stub), and proof of residency in that state. Some states let you start the process online; others require a phone call or a mailed form.

The difference between CHIP and Medicaid

Medicaid is for lower-income families; CHIP is for families with higher income. Medicaid income limits are lower — usually around 130% to 150% of the federal poverty level, though this varies by state. If your family earns more than the Medicaid limit but less than the CHIP limit, CHIP is the program for you.

Both programs cover children, but Medicaid also covers adults, pregnant people, and seniors. CHIP is only for children under 19. In some states, if a child qualifies for both Medicaid and CHIP, Medicaid covers the child first, and CHIP acts as a secondary program. In other states, you choose one or the other.

Medicaid and CHIP also differ in how they handle copays. Medicaid typically has lower or no copays. CHIP may charge small copays depending on your income level within the CHIP range.

What happens after you contact your state's CHIP program

When you call or submit information online, your state's CHIP program will review your household income and your child's age to determine whether your child is within the income range. This review usually takes a few days to a few weeks. If your child qualifies, you will receive a notice in the mail or by email with your child's coverage details, including the effective date and any copay amounts.

Once your child is enrolled, you can use CHIP to see any doctor or specialist who accepts CHIP in your state. You will receive a card or a number to give to the doctor's office. Some states mail a physical card; others provide the information online or by phone. Your child's coverage typically lasts for one year, and you will need to renew it annually by providing updated income information.

If your income changes during the year — you lose a job, get a raise, or have another major change — contact your state's CHIP program. Some changes may affect your child's coverage, and some states allow you to update your information without waiting for the annual renewal.

CHIP waiting lists and enrollment periods

Most states accept CHIP applications year-round, but a few have waiting lists when funding runs low. If your state has a waiting list, you can still submit your information, and your child will be added to the list. When funding becomes available, children are enrolled in the order they were added to the list. Some states prioritize children with urgent medical needs.

A few states have open enrollment periods — windows of time when you can apply — rather than year-round enrollment. If your state has this rule, your state's CHIP website will clearly state the enrollment period. If you miss the window, you may have to wait until the next period, though some states make exceptions for major life changes like losing health coverage.

You can call 1-877-KIDS-NOW or your state's CHIP program directly to ask whether there is currently a waiting list or enrollment period in your state.

Frequently Asked Questions

What if my child has a pre-existing condition?

CHIP covers children with pre-existing conditions. Your child cannot be denied coverage or charged more because of a health condition. This protection applies to all children, regardless of their medical history.

Can my child stay on CHIP after turning 19?

No. CHIP covers children under 19. When your child turns 19, coverage ends. Some states have programs for young adults, or your child may may have access to for Medicaid or marketplace insurance. Contact your state's CHIP program before your child's 19th birthday to learn what options are available.

Do I have to pay a monthly premium for CHIP?

Most states do not charge a monthly premium for CHIP, especially for families with lower incomes within the CHIP range. Some states charge a small monthly premium — usually $10 to $50 per child — for families with higher incomes. Your state's CHIP program will tell you the premium amount, if any, when you enroll.

What if my child needs a specialist or a specific treatment?

CHIP covers specialist visits and most treatments. Some states require you to get approval from your child's primary care doctor before seeing a specialist, and some treatments may need prior approval from the state. Your child's doctor's office can check whether a treatment is covered and whether approval is needed before scheduling.

Can I use CHIP if we move to a different state?

No. CHIP is state-based, so coverage ends when you move. You will need to enroll in the new state's CHIP program. Contact your new state's program as soon as you move so your child's coverage does not lapse. Some states allow a brief overlap period, but it is best not to rely on it.