3/21/2023
In the United States, financial and health assistance is available to vulnerable populations. Among low-income families, children are the most vulnerable, and for them there is a medical coverage program known as CHIP or Medicaid for children.
Here we tell you what it consists of, its requirements and how to apply for it.
What is CHIP and how did it originate?
CHIP stands for the Children's Health Insurance Program. This government assistance is funded by the Department of Health and Human Services (HHS) and administered by each state.
It is intended to help families with children who cannot obtain private health insurance and do not qualify for Medicaid.
CHIP was conceived to offer various health benefits for the youngest members of the household. For this reason, governorships have the flexibility to implement it according to their criteria and following federal guidelines. Each state can choose between a separate program, an extension of Medicaid, or a combination of both.
This program was included in the Balanced Budget Act of 1997 and its regulations are set forth in Title 21 of the Social Security Act.
It was enacted by former President Bill Clinton and at the time represented one of the most important coverage for children in the U.S. since the creation of Medicaid.
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It is important to note that the Bipartisan Budget Act of 2018 extended the existence of CHIP until 2027. Similarly, the Children's Health Insurance Reauthorization Act of 2009 was incorporated into that program to include 4 million additional pregnant women and infants.
What are the requirements to apply for CHIP?
As we have seen, the Children's Health Insurance Program is a shared initiative between the federal government and the states. Here are the minimum requirements to qualify for this assistance program.
Minimum income requirements
In this regard, the upper end of eligibility for stand-alone CHIP ranges from 170% to 400% of income above the Federal Poverty Level (FPL).
The MAGI (Modified Adjusted Gross Income) value is used to determine this income as it is a homogenous criterion, makes it easier to understand, avoids variations by state/population, and does not allow for asset/resource-based assessment.
CHIP Eligible Citizens
States have the option to insure low-income pregnant women and children under CHIP in a stand-alone mode.
The requirements for children are as follows:
- Under age 19
- Not have health insurance
- Residing in the state in which you apply
- Be a U.S. citizen or meet immigration requirements
- Your household meets the minimum income requirements specified above.
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Children who are in any of the following situations are not eligible for CHIP:
- Inmates in public institutions
- Patients in mental health facilities
- Those who may have health benefits under a state plan because a family member works in the civil service
Each state has the option to provide prenatal, childbirth and postnatal care to pregnant women under CHIP. However, they must abide by certain conditions:
- Coverage for pregnant women under Medicaid with income up to 185% above the FPL.
- Coverage for children under age 19 under CHIP or Medicaid and with an income 200% above the FPL.
How to apply for CHIP?
There are two ways to apply for the Children's Health Insurance Program in the United States:
How much does CHIP cost?
Scheduled visits, both for your child's checkup and dental health, are free of charge. For other services there are a number of co-payments that depend on the state.
In any case, the total annual cost will never exceed 5% of the family income.
Application of CHIP by state
Each state in the union has the option of implementing the children's health program by choosing one of the following options:
- Stand-alone CHIP. The state receives federal funds to implement the program for children without medical assistance and low family income.
- CHIP with Medicaid expansion. The state receives funds to implement an extension of Medicaid coverage to eligible low-income children.
- Combination of both options. Funds received by the state go toward implementing the above two modalities, depending on the case.
Regardless of the option chosen by the state, there are minimum coverages that must be guaranteed:
| Scheduled visits | For the control of the good development and evolution of the child. |
| Dental coverage | As stated in the Social Security Act, the CHIP program implemented by each state must include what is "necessary to prevent disease and promote oral health, repair dental structures, and treat emergency situations." |
| Behavioral health | Minimum coverage is specified for the treatment of mental health and addiction problems. |
| Vaccines | Essential vaccinations for children, such as measles, rubella and meningitis, are covered. |
Stand-alone CHIP benefits
Under this arrangement, state administrations can choose between benchmark coverage, national benchmark-equivalent coverage, and coverage approved by the Secretary of State.
The first, which we have mentioned, includes medical benefits much like those in the following plans:
- State Employees. Represents health coverage that is generally available to these employees.
- Federal Employee Health Benefits. This is a standard policy from the Blue Cross/Shield provider as an option for these employees.
- HMO or Health Maintenance Organization. This health coverage offering is defined in the Public Health Service Act.
CHIP benefits through Medicaid Extension
Under this modality, CHIP provides the same benefit package offered by each state's Medicaid plan and/or under the section 1115 demonstration program.
In this case, Medicaid coverage for children and adolescents known as Early and Periodic Screening, Diagnosis and Treatment or EPSDT must be provided.
EPSDT provides a broad range of preventive, diagnostic and treatment services for low-income infants, children and adolescents under age 21.
Español: Qué es el CHIP, el Medicaid para niños, y sus requisitos