The Children's Health Insurance Program (CHIP) may be one of the most underutilized federal health coverage programs available to working families — and a new analysis from Georgetown University's Center for Children and Families suggests that states themselves may be leaving federal matching dollars unused by not fully activating a funding tool called Health Service Initiatives (HSIs). For families with uninsured or underinsured children, understanding how CHIP works — and how HSIs could expand what your state offers — may help you learn about programs that may be available to your household.

What Are CHIP Health Service Initiatives?

CHIP Health Service Initiatives are a federal authority under Title XXI of the Social Security Act that allows states to use a portion of their CHIP allotment for health services that go beyond direct medical coverage. These can include:

  • Outreach and enrollment assistance to reach families who don't know they may be eligible
  • Care coordination services for children with complex health needs
  • School-based health programs and community health worker initiatives
  • Mental health and oral health wraparound services

The Georgetown analysis highlights that states can claim federal CHIP matching funds for these activities — but many simply aren't doing so. That gap matters because HSIs can directly fund the outreach workers and enrollment navigators who help families like yours actually get connected to coverage.

Who Is CHIP For? Income Limits by Household Size

CHIP is a joint federal-state program administered by the Centers for Medicare & Medicaid Services (CMS) and run individually by each state. It provides low-cost or no-cost health coverage to children in families whose income is too high for Medicaid but who cannot afford private insurance.

Income eligibility thresholds vary significantly by state, but here is the general framework:

  • Medicaid for children typically covers households at or below 133%–138% of the Federal Poverty Level (FPL)
  • CHIP typically picks up where Medicaid leaves off, covering children in households earning between approximately 138% and 200%–300% FPL, depending on the state
  • Several states — including New York, California, and others — have expanded CHIP eligibility to 400% FPL or higher
  • CHIP Perinatal programs in some states also cover unborn children and pregnant individuals who do not otherwise qualify for Medicaid

Because FPL percentages translate to different dollar amounts each year, the best way to check your household's eligibility is through your state's CHIP agency or HealthCare.gov's screening tool.

Children Who May Be Eligible

CHIP generally covers children under age 19. In most states, eligible children may receive:

  • Routine well-child visits and immunizations
  • Dental and vision care
  • Emergency services
  • Prescription drug coverage
  • Mental health and substance use services
  • Inpatient and outpatient hospital care

Benefit amounts and covered services vary by household size and income, and by state program design.

Why the HSI Gap Matters for Your Family

The Georgetown University research makes a practical point that goes beyond policy: when states don't use HSI authority, fewer outreach workers are funded, fewer families hear about CHIP, and fewer children get enrolled — even when they are eligible.

According to federal data, millions of children who are eligible for Medicaid or CHIP remain unenrolled. The reasons are well-documented: families don't know the program exists, they assume they earn too much, they face language barriers, or they simply don't know where to apply. HSI-funded outreach programs are specifically designed to close that gap.

If your state is not fully using HSI authority, that may mean fewer local enrollment navigators, fewer school-based outreach events, and less translated materials — all of which can make it harder for eligible families to connect with coverage.

How to Apply for CHIP: Step-by-Step

Unlike ACA Marketplace plans, CHIP has no open enrollment deadline. You can apply at any time during the year.

Step 1: Gather Required Documents

Most state CHIP applications will ask for: - Proof of identity for the child (birth certificate or hospital record) - Proof of U.S. citizenship or qualifying immigration status - Proof of state residency (utility bill, lease agreement) - Proof of household income (recent pay stubs, tax returns, or employer letter) - Social Security numbers for household members (where applicable) - Current health insurance information, if any

Step 2: Choose Your Application Method

You can apply for CHIP through several channels:

  • HealthCare.gov — The federal marketplace screens applicants for both Marketplace plans and Medicaid/CHIP eligibility simultaneously
  • Your state's Medicaid/CHIP agency — Every state has a dedicated agency; many offer online portals, paper applications, and in-person assistance
  • Federally Qualified Health Centers (FQHCs) — Community health centers are required to assist with enrollment regardless of your ability to pay
  • 2-1-1 helpline — Dialing 2-1-1 connects you to local social services navigators who can help identify programs that may be available in your area

Step 3: Complete the Application

Applications typically take 15–45 days to process, though many states have expedited processes for children. If your child needs immediate care, ask about presumptive eligibility, which allows qualified entities like hospitals and health centers to temporarily enroll children while the full application is reviewed.

What If Your Child Doesn't Qualify for CHIP?

If your household income exceeds your state's CHIP threshold, other programs may help:

  • ACA Marketplace plans with Premium Tax Credits are available to families earning above 100% FPL (or above 138% FPL in Medicaid expansion states). Advanced Premium Tax Credits can significantly reduce monthly premiums.
  • Community Health Centers (FQHCs) provide sliding-scale fee care regardless of insurance status, with fees based on ability to pay.
  • NeedyMeds and RxAssist are national databases of prescription assistance programs offered by pharmaceutical manufacturers for families who cannot afford medications.
  • State-specific programs — Some states operate their own children's health programs that supplement or extend beyond federal CHIP rules.

A Note on State Variation

Because CHIP is a state-administered program, eligibility rules, covered benefits, cost-sharing requirements, and the availability of HSI-funded services differ meaningfully from state to state. What is available in Texas may differ substantially from what is available in Massachusetts. Always verify current rules with your state's CHIP agency or a certified enrollment navigator.

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

Last reviewed: April 2026