Healthcare Assistance

What Is CHIP? How the Children's Health Insurance Program Works and Who It May Cover

A plain-English breakdown of CHIP eligibility, income limits, covered services, and how to apply — for families who may not qualify for Medicaid but still can't afford private insurance.

June 8, 2026·MSBy Michael Spitaleri, Editor-in-Chief·✓ Reviewed June 2026

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Key Takeaways

✓CHIP (Children's Health Insurance Program) provides low-cost or no-cost health coverage to children in families that earn too much for Medicaid but can't afford private insurance — income limits typically fall between 200% and 300% of the Federal Poverty Level, though this varies significantly by state.
✓Coverage generally includes doctor visits, immunizations, dental care, vision, emergency services, and mental health treatment — benefit details vary by state.
✓Most states allow families to apply for CHIP online, by phone, or in person at a local Medicaid office, and many applications can be completed in under 30 minutes.
✓There is no open enrollment period for CHIP — eligible children can apply year-round, and coverage can often begin within days of approval.
✓Program eligibility and availability vary by state. Not affiliated with any government agency.

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.

What Is CHIP and Who May Be Eligible?

The Children's Health Insurance Program (CHIP) is a federally funded, state-administered program that may provide low-cost health insurance to children in households that earn too much to qualify for Medicaid but still struggle to afford private coverage. If your family's income falls roughly between 200% and 300% of the Federal Poverty Level (FPL) — though the exact threshold depends on your state — CHIP may be an option worth exploring for your children.

CHIP was created in 1997 under Title XXI of the Social Security Act and is jointly funded by the federal government and individual states. Each state runs its own version of the program, which means income limits, covered services, premiums, and application processes can differ considerably depending on where you live.

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Data Snapshot

According to the Centers for Medicare & Medicaid Services (CMS), CHIP covered approximately 7.2 million children in an average month during federal fiscal year 2023. The federal government matches state CHIP spending at an enhanced rate — the federal medical assistance percentage (FMAP) for CHIP is at least 65%, and in many states it exceeds 80%, meaning the federal government covers the majority of program costs. As of 2024, the national average CHIP income eligibility threshold for children is approximately 255% of the Federal Poverty Level, though individual state thresholds range from around 175% FPL to over 400% FPL in some states. Source: CMS CHIP Enrollment Data — cms.gov

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How CHIP Differs From Medicaid

Medicaid and CHIP are related programs, but they serve different income bands and operate under different rules.

Medicaid generally covers children in households at or below 138% FPL (and in many states, up to 200% FPL for children specifically).
CHIP is designed for children in households that fall above the Medicaid threshold but still can't reasonably afford marketplace insurance.
Some states run separate CHIP programs; others have expanded Medicaid to cover the same population CHIP would otherwise serve (called "Medicaid expansion CHIP" or "M-CHIP").

In practical terms: if your child was denied Medicaid because your income was slightly too high, CHIP may still be available to them.

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What CHIP Typically Covers

While exact benefits vary by state, most CHIP programs cover a broad range of services for enrolled children, including:

Routine and Preventive Care - Well-child visits and annual physicals - Immunizations and vaccines - Developmental screenings

Medical and Specialty Services - Primary care and specialist visits - Prescription medications - Emergency room and urgent care - Hospitalization - Laboratory tests and X-rays

Dental and Vision - Routine dental exams and cleanings - Orthodontia (in some states) - Eye exams and corrective lenses

Mental Health and Behavioral Health - Outpatient mental health counseling - Substance use treatment - Behavioral therapy (including services for children with autism spectrum disorder in many states)

Cost-sharing — such as copays or premiums — may apply depending on your household income and your state's program structure. Families at the lower end of the income range often pay little to nothing out of pocket.

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CHIP Income Limits: What to Expect

Because CHIP is state-administered, income limits are not uniform nationwide. Here's a general framework:

Lower-income households (at or below ~138%–200% FPL): Likely eligible for Medicaid for children; may also be screened for CHIP.
Middle-income households (~200%–300% FPL): Most commonly served by CHIP in the majority of states.
Higher-income households (300%–400%+ FPL): Some states — including California, New York, and Illinois — have expanded CHIP eligibility to cover children in households at or above 300% FPL.

The FPL is updated annually by the Department of Health and Human Services (HHS). Because exact dollar amounts change each year, the most reliable way to check your household's eligibility is to use your state's official Medicaid/CHIP screening tool or contact your state agency directly.

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Documents You May Need to Apply

Gathering the right paperwork before you apply can speed up the process considerably. Most states will ask for some combination of the following:

Proof of identity for the child (birth certificate, hospital record, or passport)
Proof of U.S. citizenship or immigration status for the child
Proof of state residency (utility bill, lease agreement, or official mail)
Proof of household income (recent pay stubs, tax returns, or employer letter)
Social Security numbers for the child and, in some cases, the applying parent or guardian
Current health insurance information, if any exists

If you don't have all of these documents, don't let that stop you from starting an application. Many state agencies can work with you to gather documentation after an initial submission.

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How to Apply for CHIP: Step-by-Step

Step 1: Find Your State's CHIP Program Visit InsureKidsNow.gov — the official federal resource for CHIP — or go to your state's Medicaid agency website. Every state has a combined Medicaid/CHIP application process.

Step 2: Complete a Screening Many state websites offer a free, no-commitment eligibility screener. This is not an application — it's a tool to help you understand which programs your child may be eligible for before you submit formal paperwork.

Step 3: Submit Your Application You can typically apply: - Online through your state's Medicaid/CHIP portal - By phone through your state's Medicaid helpline - In person at a local Department of Social Services, Medicaid office, or community health center - By mail using a paper application (available on most state agency websites)

Step 4: Respond to Any Requests for Information After submitting, your state agency may contact you to verify income, residency, or other details. Responding quickly helps avoid delays.

Step 5: Receive a Determination Most states are required to process CHIP applications within 45 days (or faster for children under age 1 in some states). If approved, your child's coverage may begin retroactively to the date of application in some states.

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A Note on Year-Round Enrollment

Unlike marketplace health insurance, CHIP has no open enrollment window. Families can apply at any time of year. If your child loses other coverage — for example, if a parent loses a job or employer-sponsored insurance — CHIP may be available immediately as a safety net.

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What If Your Child Is Denied?

If your child's CHIP application is denied, you have the right to appeal. The denial notice must include the reason for the decision and instructions for requesting a fair hearing. Common reasons for denial include income above the state threshold, immigration status, or missing documentation — many of which can be addressed through the appeals process or by reapplying with corrected information.

You may also want to ask whether your child qualifies for coverage through the Health Insurance Marketplace, where premium tax credits may reduce the cost of a private plan.

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Sources & Further Reading

Frequently Asked Questions

Does CHIP cover dental and vision for children?

Yes, most state CHIP programs include dental and vision coverage for enrolled children. This typically covers routine exams, cleanings, and corrective lenses. Some states also include orthodontia under certain conditions. Specific benefits vary by state, so check your state's CHIP benefit summary for exact details.

Can undocumented children enroll in CHIP?

Federal CHIP funding generally requires children to be U.S. citizens or meet specific immigration status requirements. However, some states use state-only funds to extend coverage to children regardless of immigration status. California's Medi-Cal program, for example, has expanded to cover all income-eligible children. Check your state's rules directly.

Is there a waiting period before CHIP coverage starts?

Some states previously required a waiting period of up to 90 days before CHIP coverage could begin, but federal rules have limited this practice. Many states now offer immediate or near-immediate coverage upon approval. Confirm your state's specific timeline when you apply.

What happens when a child turns 19?

CHIP coverage generally ends when a child turns 19. At that point, they may be eligible for Medicaid as an adult depending on state rules, a parent's employer plan up to age 26 under the ACA, or a Marketplace plan with potential premium tax credits.

Can children be enrolled in CHIP if a parent has employer-sponsored insurance?

In many cases, yes — if the employer-sponsored plan is considered unaffordable or inadequate under federal standards, a child may still be eligible for CHIP. Some states allow enrollment regardless of other coverage availability, especially if current plan premiums are high or pediatric benefits are limited.

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.

CHIPChildren's Health Insurance Programhealthcare assistanceMedicaidchildren's health coveragelow-income familieshealth insurancefederal poverty levelpediatric caregovernment assistance

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