Medicaid and Children’s Health Insurance Program

Children’s Medicaid is health coverage provided to those who belong in families who have low income and limited resources. It is offered at no cost to children of families who qualify but unfortunately, there are families left in limbo due to the program’s strict income guidelines. The Children’s Health Insurance Program or CHIP was designed to catch these families who are falling through the cracks.

CHIP is sponsored by the Federal government and the States, in close partnership with Medicaid, to ensure that proper health insurance is provided for the children who need it. Not unlike Medicaid, administration of CHIP varies from state to state but the essence is the same. It is intended for children in families who are earning too much to be eligible for Medicaid yet still not enough to be able to afford private health insurance coverage. Because of CHIP, more children are now eligible for health coverage.

CHIP is operated in every state, although most states have distinctive names for it. For example, in New York it is called Child Health Plus, in California it is Healthy Families, in Indiana it is known as Hoosier Healthwise. Still there are other states that have combined CHIP and Medicaid into one program.


Each state follows their own eligibility guidelines but basically, children up to the age of 19 belonging in families with incomes of up to $45,000 per year (for a family of four in 2010) are likely to be qualified for CHIP.

States also have the option to extend coverage of CHIP to children and pregnant women who are legal immigrants in the United States. For pregnant women, lab testing, labor and delivery costs and at least 60 days of care after delivery is typically included in the coverage.

To find out more about eligibility to CHIP and coverage in your state, click here.


Similar to the eligibility guidelines, CHIP coverage varies from state to state. However, the following are required coverage in all states:

  • Routine check-ups
  • Immunization
  • Dental care
  • Vision care
  • Hospital care (in-patient and out-patient)
  • Laboratory and X-ray services

In some states, services covered include but are not limited to:

  • Prescriptions
  • Eyeglasses and hearing aids
  • Physical and speech therapy
  • Family planning
  • Counseling


Health coverage through CHIP is designed to be inexpensive. Generally, some services are offered at no cost to families, such as routine check-ups. However, certain services may require co-payments, while other states charge a minimum monthly premium. These costs differ in each state but cannot exceed more than 5% of a family’s monthly income.

Applying for CHIP Coverage

Once you have determined that you meet the guidelines of your state’s CHIP program (an income chart is usually available for families to check their income against and see if they are eligible), application can be done one of two ways:

  1. Online. – You can search online for the CHIP program in your state, and depending on the state where you live, the website may have the facility to generate a form for you to fill up after registering with your unique user name and password and send it in right then and there, or just ask you to download an application form which you will then need to fill up and subsequently mail or fax.
  2. Department of Health and Human Services Office. – You may ask for a copy of an application form from your state’s Department of Health and Human Services office and fill it up. Then you may submit the form personally or mail or fax.

Whichever mode of application you use, make sure that you fill up the required fields appropriately and truthfully. Also make sure that you read each instruction carefully, and provide the necessary documentation required to facilitate your application. These may include social security cards for parents and legal guardians and the child who is being applied for, the child’s birth certificate, proof of residence and proof of income, etc.