Medicaid and CHIP for Children: A Parent's Step-by-Step Guide

If you're wondering whether your child may qualify 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 are designed specifically to make sure children — regardless of their family's financial situation — have access to the medical care they need. Eligibility is based primarily on household income relative to the Federal Poverty Level (FPL), and in most states, families with moderate incomes may still be able to access CHIP coverage even if they don't qualify for full Medicaid.

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Data Snapshot

According to the Centers for Medicare & Medicaid Services (CMS), as of federal fiscal year 2023, Medicaid and CHIP together enrolled approximately 41.4 million children — representing roughly 37% of all children in the United States. Total federal and state Medicaid expenditures for children exceeded $130 billion in that same period. You can review current enrollment and expenditure data directly from CMS at https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html.

These numbers reflect just how central these programs are to children's health in America — and how many families are already navigating them successfully.

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How Medicaid and CHIP Are Different (And Why It Matters)

Parents often use the terms interchangeably, but Medicaid and CHIP are technically separate programs with different funding structures and, in some states, slightly different eligibility rules.

Medicaid for Children Medicaid is a joint federal-state program that provides health coverage to children in lower-income households. In most states, children in families earning up to 138% of the FPL are covered under Medicaid — though many states set their income limits significantly higher for children specifically. Medicaid for children is an entitlement, meaning that if your child meets the eligibility criteria, the state is required to provide coverage.

Children's Health Insurance Program (CHIP) CHIP was created to fill the gap for families who earn too much to qualify for Medicaid but still can't afford private insurance. Most states set CHIP income limits between 200% and 300% of the FPL, and some states go even higher. CHIP may involve small premiums or copayments depending on your state, but costs are kept low by design.

Medicaid Expansion and Children Under the Affordable Care Act, states that expanded Medicaid extended coverage to more adults — but children's Medicaid eligibility was already generous in most states before expansion. If you're unsure which program applies to your child, your state's Medicaid agency can help you determine which category fits.

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What's Covered Under Medicaid and CHIP for Kids

Both programs are required to cover a broad set of services for children under what's called Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) — a federal standard that ensures children receive comprehensive, preventive care. Covered services typically include:

  • Well-child visits and preventive screenings
  • Immunizations and vaccines
  • Dental care, including cleanings, fillings, and orthodontia in some states
  • Vision care, including eye exams and glasses
  • Mental health and behavioral health services
  • Prescription medications
  • Emergency room and hospital care
  • Specialty care referrals
  • Physical, occupational, and speech therapy

Benefit amounts and specific covered services vary by state. Some states offer additional benefits beyond the federal minimum.

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Income Eligibility: What the FPL Thresholds Mean in Practice

Eligibility for both Medicaid and CHIP is calculated as a percentage of the Federal Poverty Level (FPL), which is updated annually by the Department of Health and Human Services (HHS). Rather than quoting specific dollar figures that change each year, here's how to think about where your family may fall:

  • Up to ~138% FPL: Most states cover children under Medicaid at this level or higher.
  • 138%–200% FPL: Many states transition children to CHIP in this range.
  • 200%–300% FPL (and above): CHIP coverage is available in most states; some states extend eligibility even further.

To find the current FPL figures and see how your household income compares, visit HHS's poverty guidelines page. Your state's Medicaid agency will calculate your eligibility based on your household size and gross monthly income.

Important: Immigration status rules vary. Many lawfully present immigrant children may be eligible for Medicaid or CHIP. Undocumented children are generally not eligible for full Medicaid, but emergency Medicaid may be available. Check with your state agency for specifics.

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Documents You'll Need to Apply

Gathering your paperwork before you start the application can save significant time. Here's a practical checklist of what most states will ask for:

Proof of Identity and Citizenship/Immigration Status - Child's birth certificate - Social Security numbers for the child (and often for parents) - Passport or immigration documents if applicable

Proof of Residency - Utility bill, lease agreement, or official mail showing your current address

Proof of Income - Recent pay stubs (typically the last 30 days) - Most recent federal tax return - Documentation of any other income: child support, Social Security, unemployment benefits, self-employment records

Household Information - Names and dates of birth for all household members - Information about any current health insurance coverage

Not every state requires every document upfront — some use electronic data matches to verify income and citizenship. But having these ready will help move your application forward faster.

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How to Apply: Step-by-Step

Step 1: Go to Your State's Medicaid/CHIP Website Every state runs its own Medicaid and CHIP program. The fastest way to find your state's application portal is through Benefits.gov or HealthCare.gov, which will redirect you to your state's system.

Step 2: Complete the Application You can apply: - Online through your state's Medicaid portal (fastest option in most states) - By phone by calling your state Medicaid agency directly - In person at your local Department of Social Services or Medicaid office - By mail using a paper application from your state agency

If you apply through HealthCare.gov and your child appears eligible for Medicaid or CHIP, you'll be automatically referred to your state program.

Step 3: Submit Your Documents Upload, fax, or mail your supporting documents as directed. Some states allow you to submit documents through a mobile app or online portal.

Step 4: Wait for a Determination Most states are required to process children's Medicaid applications within 45 days (or 90 days if disability is a factor). CHIP timelines vary by state. You should receive a written notice of approval or denial.

Step 5: If Approved, Receive Your Coverage Information You'll receive information about your child's coverage, including which managed care plan they're enrolled in (if your state uses managed care) and how to find in-network providers.

Step 6: If Denied, You Have the Right to Appeal If your application is denied, the notice will explain why and outline your right to a fair hearing. Don't assume a denial is final — income calculations, household size, or documentation issues can sometimes be corrected.

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Retroactive Coverage: A Detail Many Parents Miss

One of the most valuable — and least understood — features of Medicaid is retroactive coverage. In many states, if your child received medical care in the three months before you applied and would have been eligible at that time, Medicaid may cover those bills retroactively. This can be especially important if your child had an emergency or needed care before you knew about the program. Ask your state Medicaid agency specifically about retroactive coverage when you apply.

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Keeping Coverage: What to Do at Renewal

Medicaid and CHIP coverage must be renewed periodically — typically every 12 months. During the COVID-19 public health emergency, continuous enrollment protections kept many children enrolled automatically. As those protections have wound down, states have resumed regular eligibility redeterminations. To avoid a gap in your child's coverage:

  • Update your contact information with your state Medicaid agency whenever you move.
  • Respond promptly to any renewal notices — missing a deadline can result in termination of coverage even if your child is still eligible.
  • Report changes in income or household size as they happen, since these can affect eligibility.

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People Also Ask

Can my child get Medicaid or CHIP if I have a job with health insurance? Possibly. Having access to employer-sponsored insurance doesn't automatically disqualify your child from CHIP in many states, especially if the employer plan is considered unaffordable or doesn't meet minimum coverage standards. Eligibility rules vary by state, so it's worth checking with your state's Medicaid agency even if you have workplace coverage.

How long does it take to get approved for CHIP? Timelines vary by state, but most states process children's applications within 30 to 45 days. Some states offer presumptive eligibility, which can provide temporary coverage within days while the full application is reviewed. Contact your state agency to ask whether this option is available.

What if my child was recently dropped from Medicaid during redetermination? If your child lost coverage during a redetermination review, you may be able to reapply immediately. Many children are dropped due to administrative reasons — like outdated contact information — rather than actual ineligibility. Reapplying and providing current documentation may restore coverage.

Does Medicaid cover dental and vision for children? Yes, in most cases. Federal law requires states to cover dental and vision services for children enrolled in Medicaid under the EPSDT benefit. CHIP dental and vision coverage varies more by state. Check your state's specific benefit package for details.

Can undocumented children get Medicaid? Full Medicaid coverage is generally not available to undocumented children, but emergency Medicaid — which covers emergency medical conditions — may be available in most states. Some states have also created state-funded programs that extend coverage to children regardless of immigration status. Check with your state Medicaid agency for the most current rules in your area.

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

Last reviewed: July 2026