Children's Health Insurance Program (CHIP)
CHIP provides health coverage to children (and sometimes pregnant women) in families with incomes too high to qualify for Medicaid but too low to afford private insurance. The program covers approximately 10 million children and is jointly funded by federal and state governments.
Program Structure
States operate CHIP in one of three ways:
| Model | Description | Example States |
|---|---|---|
| Separate CHIP | A standalone program with its own eligibility, benefits, and administration | Florida, New York, Pennsylvania |
| Medicaid Expansion CHIP | CHIP-eligible children are enrolled in the state's Medicaid program | Hawaii, Maryland, South Carolina |
| Combination | Uses both models for different eligibility groups | California, Illinois, Ohio |
Eligibility
- Income: Typically children in families earning up to 200–300% FPL (varies by state; some states cover up to 400% FPL)
- Age: Generally children under 19
- Citizenship: U.S. citizens and qualifying legal immigrants (with potential waiting periods)
- No other coverage: Children must not be eligible for Medicaid or covered by a group health plan
Benefits
CHIP plans must cover at minimum:
- Well-child visits and immunizations
- Physician services
- Hospital care (inpatient and outpatient)
- Lab and X-ray services
- Prescription drugs
- Dental and vision services
- Mental health and substance use treatment
States that operate separate CHIP programs may charge modest premiums and copayments (unlike Medicaid, where cost-sharing is minimal). Federal law caps CHIP cost-sharing at 5% of family income.
Federal Funding
- The federal government provides an enhanced match rate (E-FMAP) for CHIP, typically about 15 percentage points higher than the state's regular Medicaid FMAP
- CHIP is funded through federal block grants to states, meaning each state receives a fixed annual allotment
- Congress must periodically reauthorize CHIP funding (most recently extended through 2029)
CHIP and Medicaid Interaction
Children who apply for CHIP may be found eligible for Medicaid instead (if their family income falls below Medicaid thresholds). States must screen CHIP applicants for Medicaid eligibility first. The coordination between CHIP and Medicaid ensures no gaps in coverage for eligible children.
