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Learn About CHIP Health Insurance for Adults

Although the Children’s Health Insurance Program is primarily for children, some parents may receive CHIP insurance for adults in select states. This is typically available only for pregnant women or new mothers. How much and what kind of insurance coverage eligible parents receive can vary from state to state. For example, some states provide coverage only for pregnancy-related medical issues. Other states provide comprehensive medical coverage throughout the pregnancy and for a period of time afterward.

Figuring out whether your state provides CHIP for adults can be complicated. Because CHIP is not designed for adults, few states emphasize the option to seek coverage as a pregnant or recent mother. Additionally, a majority of states do not offer any kind of parental coverage through CHIP, instead directing eligible parents to Medicaid. Finally, states have a lot of flexibility with CHIP program funding. In some cases, the funding is consolidated into Medicaid, only to be made available to child recipients. In such states, mothers would only have the option to apply directly to Medicaid for coverage, not CHIP. The sections below describe what kind of coverage may be available in your state and how that coverage may be distributed.

Learn About CHIP Coverage for Adults

Some states offer certain kinds of CHIP insurance for adults, depending on program requirements. This can include anything from prescription coverage to disease management to dental treatment. However, this coverage is typically exclusively reserved for women who are currently pregnant when they submit their applications, or for new mothers. This is because states offering coverage for pregnant women as an extension of the CHIP program do so to protect the unborn child. Lack of medical treatment throughout pregnancy can severely affect the early health and success of a child. Therefore, states provide coverage to pregnant women in order to ensure that their children have a better chance at health.

CHIP for adults typically includes thorough pregnancy coverage, because the purpose of the coverage is to protect the newborn. This can include treatment like ultrasounds and check-ups throughout the pregnancy, prenatal vitamins and even the hospitalization typically required to give birth. These are all very expensive procedures for pregnant women without insurance. With CHIP coverage options, women can receive better and more consistent treatment than if they were uninsured. Unlike in regular CHIP program, there is typically no 30 to 60 day waiting time in place for coverage to begin. Instead, women who qualify for coverage under the CHIP program should receive coverage as soon as they are approved.

In some states, pregnant women can receive additional medical treatment through the CHIP program outside of immediate pregnancy care. For instance, in the majority of states that offer CHIP for adults, pregnant women can receive coverage for prescription medication. A majority of states additionally offer oral health, mental health and emergency services for pregnant women. Many states also offer disease management for pre-existing conditions, which means mothers can get medical treatment for illnesses unrelated to pregnancy. Numerous states also offer postpartum care to provide treatment to mothers after they have given birth.

Additionally, in a majority of states where the CHIP program coverage is extended to pregnant women, qualifying women have no cost-sharing expenses for treatment. This means that women do not have to seek only treatment they can afford, instead getting the services they need for a healthy pregnancy. This is because CHIP is intended for low-income families who may not be able to afford insurance and treatment otherwise.

Learn About Postpartum CHIP Coverage

In numerous states where the CHIP program is extended to cover pregnant women, postpartum coverage is included. States may offer postpartum coverage for up to 60 days after the birth of the child, during which mothers can seek treatment. States may offer limited treatment during this time. For example, Texas limits postpartum treatment to two visits for the mother, while the newborn begins traditional CHIP insurance. Other states may allow women to seek as much treatment within the time period as needed. In New Jersey, Medicaid and CHIP funding is directed to the NJ FamilyCare program. Through this program, pregnant women who meet the income requirements can receive health insurance, including postpartum coverage up to 60 days. Therefore, pregnant women seeking CHIP insurance should keep in mind that equivalent programs differ in different states. They may even have different names in different states. To learn more about CHIP coverage in different states, potential beneficiaries can download our comprehensive guide.

After the postpartum coverage period, new mothers must leave the CHIP program. However, they may instead be able to enroll in Medicaid. Oftentimes, Medicaid and CHIP work side by side. In many states, Medicaid and CHIP are combined into a single program. Therefore, women who qualify for CHIP while pregnant may still be able to receive insurance from the state after they give birth.

How CHIP for Adults Is Offered

Under the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) passed under President Barack Obama, states could add amendments to their coverage plans. That reauthorization act included language that allowed states to extend CHIP program funding coverage to low-income pregnant women. The act allowed states who choose to expand their program this way to receive additional funding through Federal Medical Assistance Payments.

Some states have taken advantage of this feature to offer health insurance for pregnant women who meet the qualifications. This extension typically includes more thorough health insurance coverage, including coverage for conditions unrelated to the pregnancy. Just a handful of states have taken this route, and just over 5,000 women on average are covered by such amendments annually. To find out if CHIP insurance for adults is available, applicants should contact the state agency in charge of Medicaid and CHIP. Other states direct pregnant low-income women to the state Medicaid program.

Other states may have used the Section 1115 waiver to extend the CHIP program coverage to qualifying pregnant women. These states use Title 21 funds to provide their coverage, and adapt their plans to include health insurance for pregnant women. Finally, some states may modify their CHIP plan so that low-income pregnant women may qualify by extending coverage to unborn children. In such states, coverage extends from conception to birth, which means qualifying women can receive check-ups, prenatal treatment and hospitalization coverage. However, in such cases, the treatment may be limited to pregnancy-related treatment. That means pregnant women may not seek treatment for medical issues unrelated to the pregnancy, such as pre-existing conditions, unless it impacts the pregnancy. To learn more about CHIP coverage for pregnant women, applicants download our informative guide.