The federal government and the states together offer health insurance coverage for children through Medicaid and the Children’s Health Insurance Program (CHIP) . These programs serve families who are not able to afford health insurance coverage in the private market or do not have coverage available to them.
Every state’s program is unique and has individual income eligibility rules and benefits covered, but in general, children in families with incomes up to $44,100 per year (for a family of four) are likely to be eligible for coverage.
Medicaid and CHIP cover doctor visits, dental care, prescription medicines and immunizations, as well as services like hospitalizations and care for children with special health care needs. There may be premiums or other cost sharing associated with this coverage, but the programs are designed to be affordable.
Thanks to the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of February 4, 2009, the Medicaid and CHIP programs have more funding available than ever before to provide coverage to uninsured children and make sure they stay enrolled and have access to high quality care.
Search the InsureKidsNow.gov map to find state-specific information about Medicaid and CHIP programs.
Children’s Health Insurance Program (CHIP)
Originally created in 1997, the Children’s Health Insurance Program (CHIP) is a state and federal partnership that provides low-cost health insurance coverage for children in families who earn too much income to qualify for Medicaid but cannot afford to purchase private health insurance coverage. States have considerable flexibility to establish income eligibility rules for CHIP, but children enrolling in the program must be otherwise uninsured.
Within federal guidelines, each state determines the design of its individual CHIP program, including eligibility parameters, benefit packages, payment levels for coverage, and administrative procedures. States have flexibility in designing the benefit package for CHIP, but states are required to cover routine check-ups, immunizations, dental, inpatient and outpatient hospital care, and laboratory and x-ray services. Preventive care must be provided at no cost to the family; but premiums and other cost-sharing may be required for other services, within certain limits.
Applying for CHIP Is Easy, Free and Confidential. To get started, make a free call to 1-877 KIDS NOW (1-877-543-7669). Every state and U.S. Territory operates a CHIP program, although most states have unique names for their programs. To find state-specific information about Medicaid and CHIP programs use the InsureKidsNow.gov map. When you call our free and confidential hotline, you’ll be connected directly to someone from your state. The CHIP or Medicaid staff will help you decide whether your child might be eligible and help you complete the application. In some cases, they will walk you through the on line application or offer to send you an application in the mail. In most states, you can complete the application through the mail or over the phone.
Medicaid is jointly-funded federal-state partnership that is administered by the states. Medicaid provides health care coverage to certain low-income people and families. Whether you qualify for Medicaid may depend on your age; whether you’re pregnant, disabled, or blind; your income and resources; and whether you’re a U.S. citizen. Each state has a unique set of eligibility rules and benefits covered.
Medicaid coverage for children is available in every state for children living below the federal poverty level ($18,310 for a family of 3 in 2009) and children up to age 21 are eligible. In addition, states must provide Medicaid coverage for children up to age 6 with incomes below 133% FPL ($24,413 for a family of 3 in 2009). The Medicaid program served 29 million children in 2006.
Medicaid pays for a full set of services for children, including preventive care, screening and treatment of health conditions, physician and hospital visits, and vision and dental care. In most cases, these services are provided at little to no cost to the family.
How to Apply
Each state has different rules about Medicaid eligibility and services. If you or someone in your family needs health care, you should apply for Medicaid even if you aren’t sure if you qualify, and let a qualified caseworker in your state to help evaluate your situation.
To find state-specific information about Medicaid use the free call to 1-877-KIDS NOW (1-877-543-7669) to discuss your situation with someone from your state.