Children's Health Insurance

CHIP

The Children's Health Insurance Program (CHIP) was signed into law in 1997 during the Clinton administration. The program provides federal matching funds to states.

Although the Consolidated Appropriations Act, 2023 extended CHIP for an additional two years, until FY 2029, the program remains the only federal insurance program that is temporary and continuously needs to be extended.

CHIP is designed to help families who make too much to qualify for Medicaid but who cannot afford private health insurance.

Many services covered by CHIP are free, but some require a co-payment. Some states also require a monthly premium payment that cannot exceed 5% of family income.

♦ On average 71% of funds for CHIP comes from the federal government. States administer the program and name it differently by each state.

• 7.0 million children under the age of 19 receive health coverage every year through a CHIP program.

States are able to utilize the federal funds to expand their Medicaid program, create a standalone program or a combination of both.

♦ The primary goal of CHIP is to expand the reach of government-funded healthcare coverage to more low-income children.

All states have expanded children's coverage significantly through their CHIP programs.

As of December 2023, most states provide coverage for children up to at least 200% of the Federal Poverty Level (FPL).

A number of states provide coverage up to 300% of FPL.

• The most generous state is New York, up to 400%. And the least generous state is North Dakota, up to 170%.

CHIP is not Welfare. CHIP is a separate program overseen by the Centers for Medicare & Medicaid Services (CMS). CHIP was created to build upon Medicaid for children.

Obamacare and CHIP

The Affordable Care Act provided increased federal support for the Children's Health Insurance Program (CHIP).

States were required to maintain income eligibility levels for CHIP through September 30, 2019.

Between fiscal years 2014 and 2019, states could receive a 23% increase in the CHIP federal matching funds, subject to a 100% cap.

♦ At the end of 2017, Republicans in Congress allowed funding to run out.

This was the first time since CHIP was enactment in 1997 that Congress fought over reauthorizing.

They eventually reauthorized funding for another six years.

♦ The Biden administration was able to get it reauthorize once again — through FY2029.

Does my child qualify for CHIP?

The application process for CHIP is simplified compared to Medicaid, making it easier for children to obtain coverage. Although CHIP covers more children, its coverage options are more limited than Medicaid.

If your children are eligible for CHIP, you won't have to buy an insurance plan to cover them.

In many markets the number of insurance plans offered at the Marketplace have become very slim and the network of doctors sparse. Coverage under CHIP may give you more choices.

♦ Each state program has its own rules about who qualifies for CHIP. You can call your state’s agency directly. The government run website Insure Kids Now has links to your state.

Don’t be surprised if you don’t see the word CHIP. Most states want to put their label on the program. In Georgia, it is called Peach Care for Kids. Georgia grows a lot of peaches, peanuts and onions. Peach has the nicest ring.

Healthcare.gov is another option.

After you submit your application at Healthcare.gov you will see your eligibility results.

♦ Adults in the family may qualify for help paying for health insurance so this process is well worth the effort.

If it looks like anyone in your household qualifies for Medicaid or CHIP the Marketplace will send your information to your state agency.

Your eligibility results will say where the Marketplace sent your information. If to CHIP then you should call your state’s agency overseeing CHIP to see if your child qualifies and what other steps you need to follow.

• If you are using the Marketplace it is best to allow a couple days for the information to get passed to your state’s agency.

• Depending upon your state you may need to complete a separate application for CHIP. Call first before worrying about that.

You may be able to get help from Obamacare but you must first see if your child can received coverage through CHIP. Because states have different rules the Marketplace can only get the process started for children.

♦ If you learn that your child cannot receive CHIP coverage you can then return to the Marketplace and see about getting coverage through a Marketplace plan.

Important

If your child is eligible for CHIP, but you would rather buy a Marketplace insurance plan for the whole family, you won’t be able to receive any financial help for your child.

Children that are eligible for CHIP won't be eligible for any savings on Marketplace insurance. CHIP coverage will probably be the most affordable option.

What does CHIP cover?

CHIP benefits are different in each state. But all states provide comprehensive coverage, including:

• Routine check-ups

• Immunizations

• Doctor visits

• Prescriptions

• Dental and vision care

•Inpatient and outpatient hospital care

• Laboratory and X-ray services

• Emergency services

How much does CHIP cost?

Routine "well child" doctor and dental visits are free under CHIP. But there may be copayments for other services.

♦ Some states charge a monthly premium for CHIP coverage.

For families with incomes at or below 150% of the Federal Poverty Level (FPL), premiums cannot exceed the amount permitted in Medicaid.

For families with incomes above 150% of FPL, cumulative state cost sharing requirements cannot exceed 5% of family income.

♦ In Georgia the CHIP program is called PeachCare.

Premiums are required for children ages 6 and older.

The cost per month for PeachCare for Kids coverage ranges from $11 to $36 for one child and a maximum of $72 for two or more children living in the same household.

The cost is based upon an income range.