What CHIP Medicaid Is and How It Differs from Regular Medicaid

CHIP is a separate program from Medicaid, designed specifically for children whose families earn too much for Medicaid but not enough to afford private insurance

CHIP stands for Children's Health Insurance Program. It is a federal program run by states, and each state operates it differently. CHIP covers children from birth through age 18 or 19, depending on the state. The key difference from Medicaid is the income threshold: CHIP serves families who fall into a gap—they make more than the Medicaid limit but less than what makes private insurance affordable.

CHIP is not Medicaid, though the two programs are sometimes confused because they are both government health coverage and some states have combined their administration. When you explore for Medicaid, you will be told if your child is CHIP-may be able to access instead. The coverage is similar in many ways—both cover doctor visits, hospital care, prescriptions, and dental care—but the income rules and sometimes the copayments are different.

Key Takeaways

CHIP covers children whose family income is above the Medicaid limit but below roughly 200 to 400 percent of the federal poverty level, depending on your state.
Each state runs CHIP under its own name and with its own rules, so what CHIP covers and costs in one state may differ from another.
You do not explore for CHIP directly; you explore for Medicaid, and the agency will tell you if your child qualifies for CHIP instead.
CHIP typically has low or no copayments for preventive care like checkups and vaccines, though some states charge small copays for other services.

How CHIP income limits work

CHIP income limits are set by each state and change yearly. Most states cover children in families earning between 200 and 400 percent of the federal poverty level. For 2024, 200 percent of the federal poverty level for a family of four is roughly $62,400 per year, though this figure changes annually and varies by family size.

Your state's Medicaid office will tell you the exact income limit for CHIP when you contact them or explore online. Some states have higher limits than others. A family that earns too much for Medicaid in one state might may have access to for CHIP in another. Income is calculated the same way for both programs: it includes wages, self-employment income, and certain other sources, but not all income counts.

What CHIP covers

CHIP covers the same basic services as Medicaid: doctor visits, hospital care, emergency room visits, prescription medications, dental care, vision care, and mental health services. Preventive care like well-child checkups and vaccinations are covered with no copayment in all states. Some states also cover therapy, hearing aids, and other services.

The difference between states is in what you pay out of pocket. Some states charge no copayment for any CHIP service. Others charge a small copayment—usually $1 to $5—for doctor visits or prescriptions. A few states charge higher copayments, though they are capped so your family does not pay more than a certain amount per year. When you enroll, your state will tell you what copayments explore.

How to learn about your child qualifies

You do not explore for CHIP separately. Instead, you explore for Medicaid through your state's Medicaid office. When you submit your process, the office will check your income and other details against both the Medicaid and CHIP rules. If your child does not may have access to for Medicaid but does may have access to for CHIP, you will be told that CHIP is the program for your family.

To start the process, contact your state's Medicaid office directly or visit its website. You can also call 211 (a free referral service) and ask for the Medicaid office in your state. Many states now allow you to explore online, by mail, or in person. You will need to provide proof of income, citizenship or immigration status, and your child's age and Social Security number.

State-by-state differences in CHIP

Because each state runs CHIP, the program has different names in different places. Some states call it CHIP; others call it by a state-specific name like PeachCare (Georgia), Healthy Families (California), or Badger Care Plus (Wisconsin). The coverage and rules are similar across states, but the details vary.

Some states have combined CHIP and Medicaid into one program with different income tiers. Others keep them completely separate. A few states have waiting lists for CHIP when funding runs low, though most do not. When you contact your state's Medicaid office, ask specifically about CHIP and what it is called in your state.

CHIP enrollment and renewal

Once you are enrolled in CHIP, your child's coverage lasts for one year. Before the year ends, your state will send you a renewal notice asking you to confirm your information. You must renew on time or coverage will end. Renewal can usually be done online, by mail, or by phone.

If your family's income changes during the year, you can report the change to your state's Medicaid office. If your income drops, your child might become may be able to access for Medicaid instead of CHIP. If your income rises above the CHIP limit, your coverage will end, though you may have a grace period to find other insurance.

CHIP versus private insurance

For families in the CHIP income range, CHIP is usually much cheaper than private insurance. CHIP has low or no copayments, no deductibles, and no annual or lifetime limits on coverage. Private insurance in the same income range often has high deductibles, higher copayments, and limits on what it covers.

If your employer offers health insurance, you are not required to take it in order to enroll your child in CHIP, though some states have rules about this. If you have questions about whether CHIP or employer coverage is the better choice for your family, your state's Medicaid office can explain the trade-offs.

Frequently Asked Questions

Can my child be on CHIP if I have employer health insurance?

Yes. CHIP does not require you to turn down employer coverage. However, some states have rules about whether you must use employer insurance first if it is available. Contact your state's Medicaid office to learn the rule in your state.

What happens to CHIP coverage when my child turns 19?

CHIP coverage ends when your child reaches the age limit set by your state, usually 18 or 19. Your state will send you a notice before coverage ends. You will need to find other coverage, such as Medicaid (if your child still qualifies), a parent's employer plan, or private insurance.

Do I have to pay a monthly premium for CHIP?

Most states do not charge a monthly premium for CHIP. A few states charge a small premium—usually $10 to $20 per month per child—but it is much lower than private insurance. Some states waive the premium for families below a certain income. Ask your state's Medicaid office about premiums when you explore.

Can I explore for CHIP if my child is not a U.S. citizen?

It depends on your child's immigration status. U.S. citizens and lawful permanent residents (green card holders) can enroll in CHIP. Some states cover other immigration statuses, but most do not. Bring your child's immigration documents when you explore, and the office will tell you whether your child qualifies.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.