CHIP insurance, short for the Children’s Health Insurance Program, is a state-run program that provides free or low-cost health coverage to children in families who earn too much to qualify for Medicaid but can’t easily afford private insurance. It covers children from birth through age 18 and pays for doctor visits, hospital care, prescriptions, dental, vision, and mental health services. Most families pay small premiums or nothing at all, and enrollment is open year-round.1Medicaid. CHIP Eligibility and Enrollment
Every state runs its own CHIP program within federal rules, so the income limits, premium amounts, and benefit details vary by where you live. Some states fold CHIP into Medicaid; others run it as a separate program with its own provider network. Either way, families apply through the same channels and the coverage floor is set by federal law.
Who Qualifies for CHIP
Eligibility comes down to household income measured against the federal poverty level. Federal law requires each state to cover children in families earning at least 200% of the FPL, or 50 percentage points above the state’s Medicaid income limit for children, whichever is higher.1Medicaid. CHIP Eligibility and Enrollment Most states set their ceiling between 200% and 300% of the FPL, and a few go as high as 400%.
For a family of four in 2026, the federal poverty level is $32,150. That puts the CHIP income window somewhere between roughly $64,300 and $128,600 for a household of four, depending on the state.2LIHEAP Clearinghouse. Federal Poverty Guidelines for FFY 2026 A state with a 300% cutoff, for example, covers a family of four earning up to about $96,450.
Beyond income, a child has to meet a handful of other requirements:
- Be under 19 years old.3InsureKidsNow.gov. Frequently Asked Questions
- Be a U.S. citizen or a qualified non-citizen, such as a lawful permanent resident.1Medicaid. CHIP Eligibility and Enrollment
- Live in the state where the family is applying.
- Be uninsured. Some states impose a waiting period of up to 90 days after a child voluntarily drops private group coverage.4Medicaid. Waiting Periods in CHIP
Some states also use CHIP funds to cover pregnant women, providing prenatal, delivery, and postpartum care to low-income uninsured individuals who meet the state’s rules.1Medicaid. CHIP Eligibility and Enrollment
Lawfully Present Immigrants
Federal law generally imposes a five-year waiting period before lawfully present immigrants can enroll in CHIP, but there are important exceptions. Refugees, asylees, and lawful permanent residents who were formerly refugees or asylees face no waiting period. States also have the option to waive the five-year wait entirely for lawfully residing children and pregnant women, and many states have done so.5HealthCare.gov. Coverage for Lawfully Present Immigrants
12-Month Continuous Eligibility
Since January 2024, every state must give children under 19 a full 12 months of continuous CHIP eligibility.6Medicaid.gov. Continuous Eligibility for Medicaid and CHIP Coverage In plain terms, once your child is enrolled, a mid-year raise or a jump in overtime pay won’t knock them off coverage. Eligibility is checked again at renewal, not in between.
What CHIP Covers
Federal law sets a floor of benefits that every CHIP program must meet, including:
- Inpatient and outpatient hospital care
- Doctor and surgeon visits
- Lab work and X-rays
- Well-child checkups and age-appropriate immunizations
- Mental health and substance use disorder treatment
Most states also cover prescription drugs, vision, and hearing services, and the overall benefit package has to be at least equivalent to a federal benchmark plan.7Office of the Law Revision Counsel. 42 U.S. Code 1397cc – Coverage Requirements for Children’s Health Insurance Preventive care, including well-child visits and immunizations, is free in every state, regardless of income.8Medicaid. CHIP Cost Sharing
Dental
Dental coverage is one of CHIP’s strongest features, since many private plans exclude pediatric dental or charge extra for it. Separate CHIP programs must cover services that prevent disease, promote oral health, restore function, and treat emergencies. The benefit has to be at least as generous as one of three benchmarks: the most popular federal employee dental plan for dependents, the most popular state employee dental plan for dependents, or the leading commercial dental plan in the state.9Medicaid.gov. CHIP Benefits That covers routine exams, cleanings, fluoride treatments, and medically necessary procedures.
Mental and Behavioral Health
CHIP programs must cover a broad range of mental health and substance use disorder services, including tobacco cessation and medication-assisted treatment. Federal parity rules apply, so copays, visit limits, and other restrictions on mental health care cannot be more restrictive than those for medical and surgical care.9Medicaid.gov. CHIP Benefits
What CHIP Costs
CHIP is built to be affordable. States can charge premiums, copays, and deductibles, but total cost-sharing is capped at 5% of a family’s annual income across the child’s eligibility period. States have to tell each family their individual cost-sharing cap in writing at enrollment and at renewal.10eCFR. 42 CFR 457.560 – Cumulative Cost-Sharing Maximum For a family earning $64,000, that cap is $3,200 for the year, covering all premiums, copays, and deductibles combined.
Premiums vary by state and by income. Some states charge nothing; others charge modest monthly premiums that rise with income. Copays for individual services are typically much lower than what you’d pay on a private plan. Preventive care is always free.8Medicaid. CHIP Cost Sharing
One group pays nothing at all. Children who are American Indian or Alaska Native cannot be charged any premium, enrollment fee, copay, coinsurance, or deductible.11Centers for Medicare & Medicaid Services. Understanding Cost Sharing Protections for American Indian and Alaska Natives in Medicaid, CHIP, and the Marketplace
How to Apply
You can apply through your state’s Medicaid or CHIP agency online, by phone, by mail, or in person. InsureKidsNow.gov connects families to their state’s specific program and application.3InsureKidsNow.gov. Frequently Asked Questions Applying through HealthCare.gov also works, since the Marketplace application screens for Medicaid and CHIP eligibility and routes qualifying children to the right program automatically.12HealthCare.gov. Children’s Health Insurance Program
The application asks for household income, family size, and proof of residency. States are required to verify income electronically first, using data from the Social Security Administration, the Department of Homeland Security, and the Department of Labor, before asking families for pay stubs or tax returns.13Medicaid.gov. Medicaid/CHIP Eligibility Verification Plans That electronic check often speeds things up considerably.
Once approved, families receive a packet explaining how to choose a managed care plan or provider network. Some states assign a plan; others let parents choose. Unlike Marketplace plans, CHIP has no annual open enrollment window. You can apply any time of year.
Renewing Coverage
CHIP coverage renews every 12 months.14Medicaid.gov. Overview of Medicaid and CHIP Eligibility Renewals Before asking a family for anything, the state has to try to renew coverage automatically using electronic data. If the records confirm continued eligibility, you don’t have to do anything.15Medicaid.gov. Basic Requirements for Conducting Ex Parte Renewals of Medicaid and CHIP
When automatic renewal isn’t possible, the state mails a renewal form. Missing that deadline is the most common reason children lose CHIP, and it’s usually not because they stopped qualifying. Watch your mail around the anniversary of your enrollment, and respond quickly. If coverage is terminated for any reason, you have the right to appeal.
When Coverage Ends
CHIP ends when a child turns 19.3InsureKidsNow.gov. Frequently Asked Questions Losing CHIP counts as a life event that triggers a Special Enrollment Period on the Health Insurance Marketplace, so the young adult has a window to sign up for a Marketplace plan.16HealthCare.gov. Special Enrollment Period – Loss of Medicaid or CHIP Depending on household income, they may qualify for premium tax credits that cut the monthly cost, and in states that expanded Medicaid under the Affordable Care Act, young adults with income up to 138% of the FPL may qualify for Medicaid directly. Start planning a few months before the 19th birthday so there’s no gap in care.