Healthcare Assistance

CHIP and Medicaid for Kids: What Parents Need to Know About Children's Health Coverage

A plain-English breakdown of how Medicaid and the Children's Health Insurance Program (CHIP) work together to cover millions of American children — and how to find out if your family may be eligible.

July 22, 2026·MSBy Michael Spitaleri, Editor-in-Chief·✓ Reviewed July 2025

Close-up of hands holding a home insurance document indoors, showing personal details section.

Key Takeaways

✓Medicaid and CHIP together covered approximately 37.4 million children in federal fiscal year 2023 — roughly 41% of all children in the United States — making them the largest source of health insurance for kids in the country.
✓CHIP was created in 1997 specifically to fill the gap for families who earn too much for Medicaid but cannot afford private insurance. Income limits typically range up to 200%–300% of the Federal Poverty Level (FPL), depending on your state — and some states go higher.
✓Coverage under these programs may include doctor visits, immunizations, dental care, vision, mental health services, and emergency care. Exact benefits vary by state and program design.
✓Applying is free. Most states allow families to apply online, by phone, by mail, or in person. You do not need to be a U.S. citizen to apply on behalf of a child in many states.
✓If your child recently lost job-based coverage, was uninsured, or your household income dropped, this may be a good time to explore whether Medicaid or CHIP may be available to your family.

Informational guide only. Not affiliated with any government agency. Program details vary by state and change frequently. Verify eligibility directly with your local agency or at Benefits.gov.

If you're trying to figure out whether your child may be eligible for free or low-cost health insurance through a government program, Medicaid and the Children's Health Insurance Program (CHIP) are the two most important places to start. Together, these programs covered an estimated 37.4 million children in federal fiscal year 2023 — and many families who may be eligible have never applied because they assumed they earned too much, or simply didn't know these programs existed.

---

Data Snapshot

According to the Centers for Medicare & Medicaid Services (CMS), approximately 37.4 million children were enrolled in Medicaid and CHIP combined as of federal fiscal year 2023, representing roughly 41% of all children in the United States. Federal CHIP allotments to states totaled over $19 billion in that same fiscal year. These figures are drawn directly from CMS program data available at Medicaid.gov. The scale of enrollment reflects how central these programs are to children's health coverage across every region of the country — not just for the lowest-income households, but for working families at a wide range of income levels.

---

Why These Two Programs Exist

Medicaid has covered low-income children since 1965, when it was established alongside Medicare as part of the Social Security Amendments under President Lyndon B. Johnson. For decades, it served as the primary safety net for children in the lowest-income households.

By the mid-1990s, however, a persistent gap had emerged: millions of children in working- and middle-class families earned too much to qualify for Medicaid but still couldn't afford private health insurance. In 1997, Congress created CHIP — originally called the State Children's Health Insurance Program (SCHIP) — as part of the Balanced Budget Act. CHIP was designed specifically to reach those children in the middle.

CHIP has been reauthorized multiple times since then and is currently funded through 2027. Its bipartisan legislative history reflects a durable consensus that children's access to preventive and acute care produces long-term public health and economic benefits.

---

How Medicaid and CHIP Are Different — and How They Work Together

These two programs are closely related but serve different income ranges within the same overall goal: making sure children have access to healthcare regardless of their family's financial situation.

Medicaid for Children

Medicaid is a joint federal-state program that provides health coverage to children in families with lower incomes. Under the Affordable Care Act, states are required to cover children up to at least 133% of the Federal Poverty Level (FPL) through Medicaid, though many states set their eligibility thresholds higher.

For children under age 6, coverage is generally available up to 133% FPL. For children ages 6 through 18, the federal minimum is 100% FPL — but again, most states exceed this floor. Because each state administers its own Medicaid program within federal guidelines, the exact income cutoff where you live may be meaningfully different from a neighboring state.

CHIP

CHIP picks up where Medicaid leaves off. Most states set CHIP eligibility between 200% and 300% of the FPL, though several states — including California, New York, and others — have expanded coverage further. A handful of states extend CHIP eligibility to children in families earning up to 400% FPL or higher.

Because income thresholds are updated annually with FPL adjustments and vary significantly by state, the most reliable way to check your child's potential eligibility is through your state's Medicaid agency or through Benefits.gov.

What Coverage May Include

Both programs may cover a broad range of services for children, including:

Well-child visits and preventive care
Immunizations and vaccines
Prescription medications
Dental and vision care
Mental health and behavioral health services
Emergency room visits and hospitalizations
Specialist referrals

The exact benefits available depend on your state's program design. CHIP states have some flexibility in how they structure benefits, so coverage details may differ from state to state. Benefit amounts vary by household size, income, and state.

---

Who May Be Eligible

Eligibility for Medicaid and CHIP depends on several factors:

Household income relative to the Federal Poverty Level
State of residence — each state runs its own program within federal guidelines
Age of the child — generally under 19, though some states cover up to age 21
Immigration status — U.S. citizens and many lawfully present immigrants may be eligible; some states also cover undocumented children using state-only funds
State residency — you must reside in the state where you're applying

You do not need to be employed, own a home, or have a bank account to apply. Families already receiving other forms of assistance — such as the Supplemental Nutrition Assistance Program (SNAP) or housing vouchers — may also be eligible for children's Medicaid or CHIP.

---

Documents You'll Likely Need

Gathering the right paperwork before you apply can significantly reduce processing time. Most states will ask for:

Proof of identity for the parent or guardian (driver's license, state ID, or passport)
Proof of the child's age (birth certificate or hospital record)
Proof of residency (utility bill, lease agreement, or recent mail with your address)
Proof of income (recent pay stubs, most recent tax return, or a letter from an employer)
Social Security numbers for the child and, in most cases, the applying parent
Immigration documents, if applicable (green card, visa, or other status documentation)

If you're missing any of these documents, don't let that stop you from starting the process. Many state agencies can work with you to gather what's needed, and some documents may be submitted after the initial application is filed.

---

How to Apply: Step by Step

Step 1: Check Your State's Income Limits

Visit Benefits.gov or your state's Medicaid agency website to find the current income thresholds for your state. Income limits are expressed as a percentage of the Federal Poverty Level and are updated each year.

Step 2: Choose Your Application Method

Most states offer multiple ways to apply:

Online: Through your state's Medicaid portal or HealthCare.gov
By phone: Call your state Medicaid office directly
In person: At your local Department of Social Services or health department
By mail: Download a paper application from your state's website

If you submit a form through any online portal, note that by doing so you may be consenting to be contacted by the agency regarding your application. Review any consent language on the form before submitting.

Step 3: Submit Your Application

Complete the application as accurately as possible. If applying online, you'll typically receive a confirmation number — keep this for your records and use it for any follow-up inquiries.

Step 4: Respond to Any Follow-Up Requests

After submitting, the agency may contact you to verify information or request additional documents. Responding promptly helps avoid delays in processing.

Step 5: Receive Your Eligibility Determination

Federal rules require states to process most CHIP and Medicaid applications within 45 days (or 90 days if disability determination is involved). Many states process children's applications considerably faster — sometimes within a few business days — particularly when documentation is complete at submission.

Step 6: Enroll in a Health Plan, If Required

In some states, CHIP operates through managed care plans, meaning you'll select a health plan for your child after an eligibility determination is made. Your state agency will provide instructions on this step.

---

What If Your Child's Application Is Denied?

A denial is not necessarily the end of the road. If your child's application is denied, you have the right to appeal. The denial notice will include instructions on how to request a fair hearing. You can also contact your state's Medicaid office to ask for clarification on the reason for denial and whether any information can be corrected or resubmitted.

Local legal aid organizations and federally qualified community health centers can often help families navigate the appeals process at no cost.

---

Special Situations Worth Knowing

Lost job-based coverage? If your child recently lost employer-sponsored insurance, this may trigger a Special Enrollment Period for Medicaid or CHIP. You generally do not have to wait for an open enrollment window.

Pregnant teens: Many states offer Medicaid coverage specifically for pregnant adolescents, sometimes at higher income thresholds than standard children's Medicaid.

Foster and adopted children: Children in foster care are generally eligible for Medicaid regardless of household income. Some states extend this coverage through age 26.

Children with disabilities: Children who receive Supplemental Security Income (SSI) are typically automatically enrolled in Medicaid in most states.

Aging out of CHIP: When a child reaches the age limit for CHIP — typically 19, though some states extend to 21 — they may be eligible for adult Medicaid if their income falls within their state's limits, or they can explore coverage through the Health Insurance Marketplace at HealthCare.gov. Aging out of CHIP qualifies as a life event that triggers a Special Enrollment Period for Marketplace plans.

---

Program eligibility and availability vary by state. Not affiliated with any government agency.

Sources & Further Reading

Frequently Asked Questions

What is the income limit for CHIP?

CHIP income limits vary by state and are expressed as a percentage of the Federal Poverty Level (FPL). Most states cover children in families earning between 200% and 300% FPL, but some states extend coverage to 400% FPL or higher. Because FPL thresholds are updated annually, check your state's Medicaid agency or Benefits.gov for the most current figures applicable to your household size and state.

Can undocumented children apply for CHIP or Medicaid?

Federal CHIP and Medicaid funds generally require lawful immigration status, but several states use state-only funding to extend coverage to children regardless of immigration status. California, Illinois, New York, and others have expanded coverage to undocumented children. Contact your state Medicaid office or a local community health center to understand what options may be available where you live.

How long does it take to get approved for CHIP or Medicaid?

Federal rules require states to process most CHIP and Medicaid applications within 45 days. Many states process children's applications much faster — sometimes within a few business days — especially when documentation is complete at submission. If you haven't received a response within two weeks, follow up with your state agency using your application confirmation number.

Does CHIP cover dental and vision care for children?

Most CHIP programs include dental and vision coverage for children, which is a notable advantage over many private insurance plans. Covered services may include routine cleanings, fillings, eye exams, and eyeglasses. The specific services covered depend on your state's CHIP plan design, so review your state's benefit summary after an eligibility determination is made.

What happens when a child ages out of CHIP?

When a child reaches the CHIP age limit — typically 19, though some states extend to 21 — they may be eligible for adult Medicaid if their income falls within their state's limits. Alternatively, aging out of CHIP qualifies as a life event that triggers a Special Enrollment Period for Health Insurance Marketplace plans at HealthCare.gov. State Medicaid offices can help families understand transition options.

About the Author

Michael Spitaleri, Editor-in-Chief — Founder & Editor-in-Chief. Michael Spitaleri is the founder and editor-in-chief of Hardship Authority. He oversees all editorial content on the site, ensuring every article meets rigorous standards for accuracy, clarity, and practical usefulness before publication.

Disclaimer: This article is for informational purposes only. It does not constitute legal, financial, or benefits advice. Program eligibility and availability vary by state. Not affiliated with any government agency. Verify information with official sources including Benefits.gov, USDA, HUD, and your state program office.

CHIPMedicaidchildren's health insurancehealthcare assistancelow-income familiesfederal poverty levelhealth coverage for kidsgovernment health programsCHIP eligibilityMedicaid for children

Stay Informed on Benefits Updates

Get free weekly updates on SNAP, housing, energy, and healthcare assistance programs. No spam — unsubscribe any time.

By subscribing, you consent to receive email communications from Hardship Authority. Message frequency may vary. Reply STOP or click unsubscribe to opt out at any time. Not affiliated with any government agency.