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Learn All About the CHIP Program

The Children’s Health Insurance Program (CHIP) is a nation-wide healthcare program created to support low-income families with children. Through CHIP insurance, families can receive health coverage at low- to no-cost for their kids. Previously known as the State Children’s Health Insurance Program, CHIP is administered at the state level based on federal guidelines. As such, each state provides its own version of the program, often under a different name.

Families may be eligible for this health insurance for kids if their children are within a certain age range. To determine who qualifies, parents and guardians must submit an application and provide information on their current income. The application process is fairly simple and enables applicants to learn about their eligibility for other health programs at the same time. Once approved, children can receive benefits as long as they continue to qualify.

What is the CHIP program?

CHIP is a program that provides health insurance for kids from families that cannot afford other coverage options. Each CHIP program is managed and partly funded at the state level. However, the states are required to follow specific federal guidelines in regards to services covered and benefit distribution. In exchange, the federal government agrees to match state funds up to a certain level in order to cover as many children as possible.

Though CHIP healthcare is often considered a part of Medicaid, it is technically a separate program. In fact, CHIP was created in order to help families whose income is too high for Medicaid coverage. Due to federal guidelines, Medicaid has more restrictive financial requirements than CHIP. Families who are not eligible for Medicaid but are still unable to afford private health insurance may qualify for CHIP instead. In addition, these programs also cover slightly different groups. Medicaid programs extend coverage to caretakers and individuals who are 65 and older or disabled. In contrast, eligibility for CHIP is generally limited to children.

Learn About CHIP Requirements

The most basic requirement for CHIP insurance coverage is age. Any child may qualify to receive benefits as long as he or she is within the program age limits. Any parent, guardian or otherwise authorized individual can apply on behalf of a child. Each state may have its own additional requirements for CHIP, but basic requirements include the following:

  • Applicants must be residents of the state in which they apply.
  • Beneficiaries must be a U.S. citizen or legal non-citizen.
  • The household of the applicant must meet a certain income limit.

In some states, CHIP eligibility is also extended to pregnant women. Income limits are determined based on the federal poverty level (FPL) and household size. However, there is no mandatory federal income level for receiving coverage. Instead, each state is responsible for establishing its own standards for coverage.

Depending on your income level, you may be eligible for free coverage under CHIP. If you do not meet income limits for free coverage, you may be charged premiums and copayments. However, these fees are restricted to a certain amount by federal guidelines.

To learn more about CHIP, you can download our comprehensive guide today.

How to Apply for CHIP Insurance

The CHIP application process simple, as there are two main ways you can apply for coverage. The first is by submitting an application to the Healthcare Marketplace. The Marketplace accepts applications online or over the phone, for your convenience. Once you apply, your eligibility is evaluated for CHIP as well as other healthcare programs. If you are eligible, the Marketplace forwards this information to your state CHIP provider.

Alternatively, you can choose to apply for CHIP directly through your state provider. With this option, submission guidelines may vary. Some states offer online submission portals, while others may accept applications by mail, over the phone or in person.

Once you are enrolled, your child can receive benefits until they age out of the program. As long as your household continues to meet income requirements, CHIP benefits do not run out. However, you are required to renew your application on an annual basis to continue receiving coverage for your child. Some states may offer a continuous eligibility option to ensure that there is no lapse in coverage.

What services does CHIP insurance cover?

According to federal guidelines, CHIP benefits are required to provide comprehensive coverage. This means that certain medical services must be covered in every state program. Mandatory services include, but are not limited to:

  • Annual check-ups
  • Doctor visits
  • Prescriptions
  • Lab work and X-rays
  • Hospital care for both in-patient and out-patient services

CHIP coverage is also available for various vision and dental services. Beneficiaries are generally required to select a dentist from an approved list to use their benefits. In addition, states may choose to expand coverage to other services at their discretion. Applicants should review their state guidelines for information on coverage options for CHIP services.

To access your benefits, you should present an enrollment card at the office where you are requesting care. If you are having trouble with your coverage, you can contact your local CHIP agency for assistance. These agencies can help you find a doctor that accepts your benefits, explain what services are covered and solve any issues with your enrollment card.

What happens if you are denied CHIP healthcare coverage?

If you are denied CHIP coverage, you are allowed to appeal this decision. Appeals are also available in the event that your eligibility status changes. Depending on how you applied, you may appeal your denial through your state provider or the Health Insurance Marketplace. Each state has its own appeal process. In general, you can find information on the appeal process in the eligibility notice you receive in the mail. The steps to appeal usually include:

  • Submission of an official appeal form.
  • Acceptance of your appeal request.
  • Submission of any supporting documents to contest your denial.

During the processing of your appeal, your eligibility for CHIP will be re-evaluated. If you are still unsatisfied with the results of your appeal, you can usually request a formal hearing. You may also be considered for other programs, including Medicaid and similar low-cost healthcare options. To learn more about CHIP applications and denials, download our informative guide.