Low-income families across the country benefit from federal and state-funded health insurance programs like Medicaid and the Children’s Health Insurance Program (CHIP). Medicaid aims to provide health insurance to low-income families and children, pregnant women, the elderly and people with disabilities. On the other hand, CHIP focuses primarily on providing health care for children whose families cannot afford it but who not qualify for Medicaid. Depending on the state, CHIP may be a separate program, an expansion of Medicaid or a combination of the two. States can decide on how the CHIP program will be run, but they must adhere to established federal guidelines.
Eligible candidates can visit a local Medicaid office or CHIP agency for all matters involving government-subsidized health care programs. These offices provide a variety of services to low-income families with children who qualify for CHIP coverage. They offer assistance to households interested in applying for CHIP and also to those who are already enrolled in the program. For more information on how the CHIP program operates in each state, download our helpful guide.
Learn About Services Provided by CHIP and Medicaid Agencies
The programs for CHIP and Medicaid for children are overseen by state agencies. These CHIP agencies manage and process all applications, and they accept new applicants year-round. If a household submits an application for Medicaid, the Medicaid agency will also check if any children in the household are eligible for insurance through CHIP. Applications for CHIP can be submitted online or in-person at a local CHIP office. Families who require assistance with filling out their applications can ask for help from a CHIP agent. Agents can help gather missing information, find in-network providers and handle any concerns or complaints.
When an online application is submitted, all pertinent information will be forwarded to a local state agency. State agencies will contact eligible applicants about enrollment and will be able to answer any questions about the healthcare plan. CHIP agents will provide program members with information about benefits, program requirements, medical services covered by the program and more. Program members will be provided with the state guidelines for CHIP. Furthermore, participants will need to visit a CHIP office if they wish to make any changes to their insurance plan. Members are permitted to change their plans:
- For any reason within the first 90 days of enrollment.
- For valid reasons at any period of enrollment.
- If they move to a different state or service area.
- Each year during the annual CHIP re-enrollment period.
Note: CHIP beneficiaries are always recommended to consult with a CHIP agent before making any changes to their plan.
Additional Resources Provided by CHIP Insurance Agencies
Healthcare programs like Medicaid and the Children’s Health Insurance Program were implemented to promote good health with low-income families, especially those with children. Children’s brains have the most development during the early years of their lives, so it is important to promote healthy physical, social and emotional development. In addition to health insurance, the federal government provides various mental health resources free of charge. Parents are encouraged to utilize these resources in order to provide children with the best mental health care.
CHIP and Medicaid for children are the largest providers of mental health resources for kids with special health care needs in America. These services are designed to provide support for children who are at risk for developing chronic physical, developmental, behavioral, or emotional conditions. Low-income children are especially vulnerable to emotional and behavioral disorders early on in life. This program is vital for providing mental health services to low-income children who could not afford it otherwise. Download our handy guide for more information on the additional resources provided by CHIP insurance.
Note: Mental health care is beneficial for everybody, not just children. Everyone is encouraged to seek mental health care in order to maintain a healthy lifestyle.
When Should You Contact Your State Medicaid or CHIP Agency?
A state’s CHIP and Medicaid office is responsible for providing high-quality service with its low-cost health insurance programs. The federal government entrusts these agencies to maintain a high standard of customer service. As such, participants are encouraged to contact their state agencies if they have any questions or concerns. CHIP help services are typically open 24 hours a day. Some common issues that warrant contacting a CHIP office include:
- If a beneficiary did not receive their enrollment card and they are not sure if they are covered.
- If a beneficiary cannot find a doctor who accepts CHIP insurance or they cannot schedule an appointment.
- If a program member has any questions about whether or not a service or product is covered.
- If a household has a change in composition or income that would affect their CHIP eligibility such as:
- An increase or decrease in income.
- Dependents no longer qualify due to age.
- A marriage or divorce.
Note: All changes made to a CHIP healthcare plan must be reported. Any unreported changes in income or family composition can result in a change in the amounts of benefits received.
Beneficiaries who do not have their enrollment card but need to fill a prescription should contact their local CHIP office and request assistance. Most pharmacies will fill three days’ worth of medicine. The CHIP or Medicaid agency will then assist with filling out the rest of the prescription. If a pharmacy does not accept CHIP, a CHIP agent can help to locate one that does. Participants can call a local CHIP office and they will provide a list of pharmacies that accept CHIP in the area.
Learn About the Center for Medicaid and CHIP Services (CMCS)
While states are in charge of the operation and management of the Children’s Health Insurance Program in their area, the Center for Medicaid and CHIP Services (CMCS) is in charge at a federal level. Program members who have complaints or are facing issues with their state agencies can contact a federal official at the CMCS. The CMCS is run within the headquarters of the Centers for Medicare and Medicaid Services (CMS).