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Learn About CHIP in Texas

Texas CHIP is a federally funded program designed to assist families who cannot qualify for Medicaid but do not earn enough income to afford private or employer-based insurance. In many instances, these children live in families with working parents, but the income earned is not enough to pay for the premium costs of private health care. TX CHIP insurance also extends coverage to pregnant women in the state who meet the program’s guidelines. Free prenatal care services can help these residents to obtain the treatment they need without incurring medical debt.

The Children’s Health Insurance Program is federally funded, so there are strict eligibility guidelines that must be met by program beneficiaries. This ensures that the program is only providing this free health insurance coverage to children and pregnant women who are truly in need. CHIP Medicaid and other health insurance assistance programs do not charge monthly premiums to program beneficiaries, but they may need to provide small copayments before treatments or services are provided. They may also be responsible for enrollment fees. To find out more about this program, including the benefits provided and the application process, read through the information below.

What is CHIP in Texas?

As Texas health insurance for kids, this program is also often referred to as TexCare, or Children’s Medicaid. However, program benefits are only provided to children living in families that make too much to qualify for true Medicaid insurance options, but not enough money to afford private insurance. In some cases, families may be responsible for enrollment fees after approval, but these are usually minimal.

Some families who are accepted to receive coverage through the child health insurance plan do not pay any enrollment fees, but may still be responsible for copayments when seeking treatment. The amount of income and size of the household will determine whether or not an approved family must pay these enrollment fees.

Residents may wonder “What is CHIP and what is its purpose?” The program is designed to provide important medical, dental and vision insurance to these low-income families so they can take their children to the doctor, dentist or eye care specialist for scheduled treatments. Families who qualify for the program do not have to worry about incurring medical expenses that lead to debt and financial instability. By being able to provide kids with the preventative care and necessary medical attention they need, families can ensure their children grow up healthy and thriving.

Who does Texas CHIP cover?

Before completing the Texas CHIP application, families should review the eligibility guidelines set by the program. Since the program is designed to only assist children and pregnant women with low incomes, many of the qualifications include household characteristics and age restrictions. Generally, to qualify for CHIP benefits, an applicant must be:

  • Younger than 19 years of age.
  • A Texas resident.
  • Not currently insured through Medicaid or a private insurer.
  • A U.S. citizen, legal alien, U.S. national or permanent resident.

Additionally, to meet TX CHIP eligibility guidelines, the applicant must fall within the low-income guidelines of the program. These guidelines are based on the Federal Poverty Level (FPL) so they can change annually. Pregnant women may also receive benefits through the program, including prenatal vitamins and care. To qualify, pregnant women cannot have other medical coverage, including Medicaid, and they must meet all other eligibility guidelines.

Residents wondering “Who qualifies for CHIP?” should attempt to apply for coverage. By completing this application, department representatives can assist these applicants in finding coverage. Even if children or pregnant women do not qualify for this program, there may be other medical insurance programs, such as Medicaid, that they do qualify for. To learn more about CHIP, applicants can download our informative online guide.

How to Apply for CHIP in Texas

You can apply for CHIP online in Texas through the department’s website. You must first create an online account and complete all screens to submit your application to the department. Before you apply for benefits, you can use the department’s pre-screening tool to learn if you meet all eligibility guidelines for the program. However, if you feel you meet these qualifications but the pre-screening tool states that you may be denied for benefits, complete the online application process anyway. A department representative may be able to provide you more information on other government assistance programs you qualify for. The answers you provided within the pre-screening tool can be submitted as your application, if you choose to apply.

If you are wondering how to apply for CHIP in TX without using the online system, you can print an application and mail it in to a local office or visit an agency to apply. Before you visit, be prepared to provide the information needed by gathering documents to bring with you, such as your paycheck stubs and identification.

What is included with Texas CHIP coverage?

Program beneficiaries can call the Texas CHIP number to review their coverage benefits and request a list of participating medical providers. The program offers comprehensive medical, dental and vision insurance that covers most preventative and necessary treatments recommended by medical professionals. To utilize program benefits, beneficiaries can only visit medical providers that accept this type of insurance. In addition to CHIP dental coverage, eye exams are also covered by program benefits. Some of the most common medical treatments that beneficiaries can seek using this insurance include:

  • Wellness exams.
  • Prescription drugs.
  • Mental health care.
  • Hospital care.
  • X-rays.
  • Medical supplies.

CHIP insurance program beneficiaries can also seek treatment for pre-existing conditions and other special health needs through the program. To find out more about the services covered through the program, download our detailed guide.

How much is CHIP health insurance in Texas?

Texas CHIP benefits are provided to eligible applicants without monthly premium charges. Most preventative care, such as wellness exams, are covered by the program for free. However, other services may incur mandatory copayments before treatment is provided. These copayments can vary, depending on the services requested. Program enrollees can learn more about the copayments they may owe when seeking treatment after being accepted into the program. The department provides extensive information on participating medical providers and services offered to children and pregnant women.

How long do CHIP benefits last in Texas?

If a child applies for the Texas CHIP program after cancelling a private health insurance plan, he or she may need to wait for coverage to begin. After approval for the program and the waiting period, a child can obtain coverage. This coverage lasts for one year until the department re-evaluates the beneficiary’s eligibility. Sometimes, children can become too old for coverage or families can begin to earn too much income to qualify. If this is the case, coverage cannot be renewed but the child can attempt to find private health insurance or insurance through Medicaid, if eligible.