Orlando Harmon
The Children's Health Insurance Program (CHIP) is a key piece of the social safety net in the US, providing low-cost health coverage to children in families that earn too much to qualify for Medicaid but too little to afford private insurance. CHIP was created in 1997 and covers around 10% of the nation's children, or over 7 million children, as well as about 400,000 pregnant women. Each state has its own rules about who qualifies for CHIP, and the program is jointly funded by federal and state governments, with states having the flexibility to design unique features.
| Characteristics | Values |
|---|---|
| Name | Children's Health Insurance Program (CHIP) |
| Coverage | Health coverage for eligible children and pregnant women |
| Eligibility | Families with incomes too high to qualify for Medicaid but too low to afford private coverage |
| Income Eligibility | Differs by state, ranging from 190% of the federal poverty level (FPL) in Idaho to 405% of the FPL in New York |
| Cost | Low-cost or free for eligible individuals |
| Application | Can be applied for at any time through state agencies |
| Coverage Start | Immediate upon qualification |
| Funding | Jointly funded by federal and state governments |
| Flexibility | States can set benefit requirements, premiums, and cost-sharing within program limits |
| Affordability | Limits premiums and cost-sharing to keep insurance affordable for families |
| Enrollment | Covers about 10% of the nation's children, including more than 7 million children and around 400,000 pregnant women |
| Reauthorization | Reauthorized periodically, with current funding extended through the end of FY 2023, and an additional 4-year extension signed into law in 2018 |
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What You'll Learn
- CHIP covers children in families who earn too much for Medicaid but can't afford private insurance
- CHIP is jointly funded by federal and state governments
- CHIP limits premiums and cost-sharing to keep insurance affordable for families
- Income eligibility for CHIP differs by state
- CHIP covers more than 7 million children and around 400,000 pregnant women
CHIP covers children in families who earn too much for Medicaid but can't afford private insurance
The Children's Health Insurance Program (CHIP) is a key part of the social safety net in the US. CHIP provides low-cost health coverage to children in families who earn too much money to qualify for Medicaid but not enough to buy private insurance. Each state has its own rules about who qualifies for CHIP, and in some states, CHIP also covers pregnant women.
CHIP was created in 1997 and covers around 10% of the nation's children, or over 7 million children. Since its enactment, the percentage of uninsured children has dropped from 14% to 4%. CHIP is jointly funded by the federal and state governments and is designed to give states flexibility in tailoring the program to fit their unique needs. States may expand Medicaid to cover children, establish stand-alone CHIP programs, or use a combination of both. Most states have a combination program.
CHIP plays an important role in keeping insurance affordable for families. Families with children enrolled in stand-alone CHIP plans can be charged premiums, copayments, deductibles, and other fees up to 5% of their household income. Premiums are prohibited for families below 150% of the poverty level whose children are enrolled in a CHIP plan provided through the state's Medicaid program. A study found that CHIP plans cost families $158 per child annually, while comparable employer plans cost $891 per child. CHIP plans also tend to cover a higher percentage of costs than marketplace plans and must include dental care.
Anyone can apply for CHIP coverage at any time of year and, if they qualify, their coverage can begin immediately. If a family applies for Medicaid coverage through their state agency, they will also find out if their children qualify for CHIP.
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CHIP is jointly funded by federal and state governments
The Children's Health Insurance Program (CHIP) is a key part of the social safety net in the US. CHIP provides low-cost health coverage to children in families that earn too much to qualify for Medicaid but not enough to buy private insurance. In some states, CHIP also covers pregnant women. CHIP is jointly funded by federal and state governments and is designed to give states the flexibility to tailor the program to fit their unique needs.
CHIP was created in 1997 by the Balanced Budget Act and reauthorized in 2009 by the Children's Health Insurance Program Reauthorization Act, which appropriated funding through fiscal year 2013. The program has since been extended several times, most recently through the end of fiscal year 2027. CHIP covers about 10% of the nation's children, or more than 7 million children, and around 400,000 pregnant women.
CHIP is managed by individual states according to federal requirements. Each state has its own rules about who qualifies for CHIP, with income eligibility ranging from 190% of the federal poverty level in Idaho to 405% in New York. All states offer CHIP coverage and work closely with their state Medicaid programs. Families can apply for CHIP coverage at any time through their state agency, and if they qualify, their coverage can begin immediately.
The federal government matches state spending on CHIP at a rate that is 15 percentage points higher than the Medicaid matching rate. In 2022, CHIP cost a total of $22.3 billion, with the federal government funding about 76% of that amount. States have the flexibility to design unique features, such as expanding Medicaid to cover children, establishing stand-alone CHIP programs, or using a combination of both. States can also set benefit requirements, premium levels, and cost-sharing within the program's limits.
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CHIP limits premiums and cost-sharing to keep insurance affordable for families
The Children's Health Insurance Program (CHIP) is a social safety net program that provides low-cost health coverage to children in families. CHIP was created in 1997 to ensure that children have health coverage even if their families cannot afford private health insurance. CHIP is funded by state and federal governments and is designed to give states flexibility to tailor the program to fit unique needs.
States have the flexibility to set benefit requirements, premium levels, and cost-sharing within the program's limits. Most states have a combination of Medicaid and stand-alone CHIP programs, with varying income limits for eligibility. While some states charge modest monthly or quarterly premiums or annual enrollment fees for CHIP, most do not. States are prohibited from imposing cost-sharing on certain individuals and in certain situations, such as for American Indian/Alaskan Native children, or in any way that favors children from higher-income families.
CHIP plays an important role in ensuring that children from families with incomes too high to qualify for Medicaid but too low to afford private coverage have access to health insurance. By limiting premiums and cost-sharing, CHIP helps to keep insurance affordable for these families.
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Income eligibility for CHIP differs by state
The Children's Health Insurance Program (CHIP) provides low-cost health coverage to children in families who earn too much to qualify for Medicaid but too little to afford private insurance. In some states, CHIP also covers pregnant women. Each state has its own rules about who qualifies for CHIP, and the costs differ between states.
Eligibility for CHIP is based on Modified Adjusted Gross Income (MAGI) and household size. Household gross income is then compared to the limits shown based on household size for the applicable program. A 5% disregard based on the federal poverty level (FPL) is applied if needed. For example, in Mississippi, eligibility for Medicaid is determined first, and then CHIP eligibility is assessed using the 5% FPL disregard.
CHIP beneficiaries must be residents of the state in which they are receiving CHIP and must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. Some eligibility groups are limited by age or pregnancy status. For instance, children who are inmates of a public institution or patients in an institution for mental diseases are generally not eligible for CHIP.
The CHIP statute and regulations specify that eligibility is limited to the higher of 200% of the FPL or 50 percentage points above the Medicaid applicable income level. Many states have exceeded the maximum for expansion of children's eligibility with title XXI funds for children under the age of 19. States that have exceeded the maximum can choose from two options to expand eligibility.
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CHIP covers more than 7 million children and around 400,000 pregnant women
The Children's Health Insurance Program (CHIP) is a key component of the social safety net in the United States. CHIP was established in 1997 to provide low-cost health coverage to children from families who earn too much to qualify for Medicaid but not enough to afford private insurance. Each state has its own CHIP program, which operates in conjunction with the state's Medicaid scheme and has its own eligibility criteria. Some states have chosen to extend CHIP coverage to pregnant women.
CHIP is a vital program that currently covers over 7 million children, or about 10% of the nation's child population. This figure represents a significant decrease in the number of uninsured children since the program's inception, with rates falling from 14% to 4%. In addition to children, CHIP also covers around 400,000 pregnant women.
CHIP is funded jointly by the federal and state governments. The federal government matches state spending on CHIP at a rate 15% higher than the Medicaid matching rate, incentivizing states to expand coverage. This funding structure allows states to design unique features and set their own benefit requirements, premiums, and cost-sharing levels within the program's limits.
To keep insurance affordable for families, CHIP limits premiums and cost-sharing. Families with children enrolled in stand-alone CHIP plans may be charged premiums, copayments, deductibles, and other fees, but these are capped at 5% of their household income. For families below 150% of the poverty line, premiums are prohibited. A study in 2015 found that CHIP plans cost families significantly less than comparable employer plans, with comprehensive benefits including mandatory dental care coverage.
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Frequently asked questions
CHIP stands for the Children's Health Insurance Program. It is a federal-state funded program that provides low-cost health coverage to children in families that earn too much to qualify for Medicaid but too little to afford private insurance.
Eligibility for CHIP insurance differs by state. For example, in Idaho, the income eligibility is 190% of the federal poverty level (FPL), while in New York, it is 405% of the FPL.
You can apply for CHIP insurance through your state agency at any time of year. If you apply for Medicaid coverage through your state agency, they will also let you know if your children qualify for CHIP.
CHIP insurance is designed to keep insurance affordable for families. Families with children enrolled in stand-alone CHIP plans can be charged premiums, copayments, deductibles, and other fees up to 5% of their household income.
