Haris Ashley
The Children's Health Insurance Program (CHIP) is a state health insurance plan for children from working families with low to moderate incomes who do not have other health insurance. CHIP is funded by the state and federal governments, with families also contributing through co-pays. To apply for CHIP in Utah, you can apply online or print and mail an application. The Department of Workforce Services (DWS) will process your application and determine your eligibility. If you are eligible, you will receive a packet with covered expenses, information about pre-authorization, and a list of providers. CHIP in Utah is administered by the Utah Department of Health and Human Services and provides coverage for well-child exams, immunizations, doctor visits, hospital and emergency care, prescriptions, hearing and eye exams, mental health services, and dental care.
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What You'll Learn
Income and household size requirements
The Children's Health Insurance Program (CHIP) is a state health insurance plan for children from working families with low to moderate incomes who do not have other health insurance. Income and household size are the primary factors that determine eligibility for CHIP.
CHIP is funded by the state and federal governments, with families also contributing through co-pays. However, families with no income in the benefit year do not have to pay co-pays or deductibles for CHIP-covered services. The total family contribution to the cost of coverage cannot exceed 5% of family income annually.
If your income or household size changes, you may qualify for a lower-cost CHIP plan or a different medical assistance program. You may request an early review to determine if you still qualify for CHIP. If your child no longer qualifies for Medicaid, they may be eligible for CHIP.
CHIP benefits are different in each state, but all states provide comprehensive coverage. Some states may charge a monthly premium for CHIP coverage, but the costs differ in each state and are determined by the state within federal parameters.
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Application methods
The Children's Health Insurance Program, or CHIP, is a state health insurance plan for children from working families in Utah who do not have other health insurance. Depending on income and family size, families may qualify for CHIP.
CHIP applications can be completed online or by printing and mailing an application form. The Department of Workforce Services (DWS) processes all applications and determines eligibility. After submitting an application, applicants can call DWS after 2-3 business days to complete their interview and find out what verifications are needed. It typically takes 4-6 weeks to process a CHIP application, and incomplete applications may take longer.
Applicants can also visit their nearest DWS Employment Center in person or go to MyCase to view the status of their case. Additionally, applicants can call DWS to inquire about a complete listing of services and co-pays.
It is important to note that during the eligibility review, if it is determined that a child already has other insurance, they will no longer be eligible for CHIP. DWS will check for eligibility on other medical programs before closing the case and notify the applicant of the decision.
If there are changes in household size, income, or address, applicants must report these changes to their eligibility worker. Applicants must also report within 10 days if their child gains coverage under another insurance policy after being approved for CHIP.
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Eligibility review
The Children's Health Insurance Program (CHIP) is a state health insurance plan for children from working families in Utah who do not have other health insurance. Depending on income and family size, families may qualify for CHIP.
Eligibility for CHIP is determined by the Department of Workforce Services (DWS). After submitting an application, it may take 4-6 weeks to process. During the eligibility review, if it is determined that your child has other insurance, they will no longer be eligible for CHIP.
To apply for CHIP, you can apply online or print and mail an application. After 2-3 business days, you may call the DWS at 1-866-435-7414 to complete your interview and/or find out what verifications are needed to determine your eligibility.
If your income or household size changes, you may qualify for a lower-cost CHIP plan or a different medical assistance program. To find out, you may request an early review. If your child gains coverage on another insurance after being approved for CHIP, you must report it to the DWS.
CHIP is funded by the state and federal governments, with families also contributing through co-pays. However, American Indian and Alaska Native children do not pay co-pays and must provide tribal membership verification from a tribe recognized by the federal government.
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Coverage and expenses
The Children's Health Insurance Program (CHIP) provides health coverage for children in families with low to moderate incomes. CHIP is funded by both the state and federal governments, with families also contributing through co-pays. The amount that families contribute towards coverage cannot exceed 5% of their annual income.
CHIP covers ABA services and ASD-related physical, occupational, and speech therapy for all members eligible for plans B and C. It also covers dental care services, provided by Premier Access.
American Indian and Alaska Native children are exempt from co-pays, but tribal membership verification is required.
Utah's CHIP program does not have a fee-for-service arrangement, instead utilizing a managed care delivery system.
CHIP families that do not have income in the benefit year do not have to pay co-pays or deductibles for CHIP-covered services.
Utah does not provide coverage for pregnant women through CHIP.
States may implement waiting periods of up to 90 days for CHIP.
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CHIP funding
CHIP, or the Children's Health Insurance Program, is a state health insurance plan for children from working families with low to moderate incomes who do not have other health insurance. Depending on income and family size, families may qualify for CHIP. The program is funded jointly by the federal government and states through a formula based on the Medicaid Federal Medical Assistance Percentage (FMAP).
Congress created an "enhanced" federal matching rate for CHIP that is generally about 15 percentage points higher than the Medicaid rate, averaging 71% nationally. For example, if a state has a 50% match rate for Medicaid, they may have a 65% match rate for CHIP. This "enhanced" matching rate incentivizes states to expand their coverage programs for children.
CHIP is currently funded through federal fiscal year (FFY) 2027 (September 30, 2027) by the HEALTHY KIDS and ACCESS Acts. The Acts also extended the maintenance of effort (MOE) provision, which requires states to maintain eligibility standards that were in place in 2010 through FFY 2027. However, beginning in FFY 2020, MOE only applies to children in families with incomes at or below 300% of the federal poverty level (FPL).
Within federal parameters, states can set CHIP program premium and cost-sharing levels. Families contribute to the cost of coverage through co-pays, but their total contribution cannot exceed 5% of family income annually. States can also use a portion of their existing CHIP administrative dollars to develop Health Services Initiatives (HSIs) to improve the health of low-income children and youth. After covering regular CHIP program administrative costs, states can use any remaining funds within the 10% cap for an HSI project, with the federal share funded at the state's CHIP match rate.
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Frequently asked questions
CHIP stands for Children's Health Insurance Program. It is a state health insurance plan for children from low- to moderate-income families who do not have other health insurance.
You can apply for CHIP insurance online or by printing and mailing an application. You can also contact your local Department of Workforce Services Employment Center or call them toll-free at 1-866-435-7414.
CHIP insurance in Utah covers medical, dental, and mental health services, including well-child exams, immunizations, doctor visits, hospital and emergency care, prescriptions, and hearing and eye exams.
