What is the CHIP? | blogMD
A physician examining a small child to represent CHIP care
May 23

What is the CHIP?

Key Facts about the Children’s Health Insurance Program (CHIP)

CHIP has been around since 1997. Recently CHIP gained an increase in national attention when its funding lapsed in late 2017. This lapse led to a government shutdown. Since this program is currently fresh in our minds, now is the perfect time to review the details of this program and how it can work for your patients.

What is the CHIP?

This program was enacted with bipartisan support in 1997. The goal was to encourage the expansion of access to affordable health insurance coverage at the state level. This expansion was in response to a decline in employer-sponsored children’s insurance and an increase in uninsured rates among children. As an incentive for expanding eligibility, the federal government pays in a larger share of costs for CHIP enrollees, compared to Medicaid patients; typically 65% to 81% versus 50% to 73% for Medicaid.

CHIP is different in each state with some states electing to use funds for the expansion of Medicaid for children, a program known as M-CHIP.  Other states create a separate CHIP program. Additionally, some states elect to combine the two approaches and do both. When states use these funds to expand Medicaid, creating an M-CHIP program, they are required to follow the same rules as Medicaid with the exception of requiring children to be uninsured. These programs have increased flexibility related to cost-sharing requirements for families and specific benefits that are offered.

Who qualifies for CHIP?

In general, this program serves uninsured children age 19 or younger whose family incomes are too high for Medicaid eligibility. Each state has a significant level of discretion for setting their specific income eligibility for CHIP coverage. Not to mention, most states and the District of Columbia offer coverage for children whose family incomes are up to or above 200% of the Federal Poverty Level. 24 states offer coverage for children with family incomes up to 250% of the Federal Poverty Level. For coverage levels in your state, visit medicaid.gov.

What does CHIP cover?

While specific CHIP benefits vary slightly from state to state, each state offers comprehensive coverage for children in the program. Families utilizing this coverage generally receive coverage for the following:

  • Routine check-ups
  • Doctor visits
  • Immunizations
  • Dental and vision care
  • Prescriptions
  • Laboratory and X-ray services
  • Emergency services
  • Inpatient and outpatient hospital care
How much does CHIP cost?

Routine well visits to both doctors and dentists incur no fees under CHIP, while other services may carry co-payments. In some states there is a monthly premium charged for coverage, however, while these costs differ from state to state they will never be more than 5% of a family’s income for a given year.

CHIP was created to decrease the amount of children without health insurance. The goal of the program is creating better health outcomes for children regardless of their socioeconomic status. Without adequate access to healthcare, children are unable to get the strong start in life they deserve. Thanks to this program, more families receive coverage for their children. This gives them the opportunity to keep up on routine visits ensuring children gain adequate care in the earliest years of their lives.

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