Children’s Health Insurance Program: A Guide to CHIP

For More Information on Health Insurance, Visit Our Health Insurance Guide.
Any responsible parent will agree that health insurance for children is a vital tool for maintaining good health, but many families can’t afford costly premiums. Under the recent expansions provided by the Affordable Care Act (ACA), children may be eligible for government-funded health insurance. Healthcare reform tops many newscasts today, and it may be easy to tune out and miss the important details. When it comes to providing for children, there is a big headline that shouldn’t be overlooked: There are now expanded options for low-income children’s health insurance.

When it comes to providing for children, there is a big headline that shouldn’t be overlooked: There are now expanded options for low-income children’s health insurance

The Children’s Health Insurance Program (CHIP) has been in place since 1997. Created by the U.S. Dept. of Health and Human Services, the CHIP program allocates federal funding to individual states and matches state contributions to provide health insurance to children who do not qualify for Medicaid. With the passage of the ACA, CHIP received new funding in 2009 and again in 2013. The extra funding not only supports the health insurance needs of a greater number of families, but also aims to implement outreach efforts for families who may not be aware that they are eligible.

Who is Eligible for CHIP?

CHIP administrators collaborate with Medicaid programs; certain low-income families who are ineligible for Medicaid are eligible for CHIP enrollment. Individual states are free to establish how they run CHIP programs, though eligibility is always based upon family income. Though state income restrictions vary, it’s common for families who receive up to 250% of the Federal Poverty Level (FPL) to be approved. The median household income for CHIP beneficiaries was $25,400 in 2012.

Individual states are free to establish how they run CHIP programs, though eligibility is always based upon family income

Generally, any child who is under the age of 19 and whose family meets income requirements is eligible. CHIP is a program for children only; adults of enrolled children may not apply. Depending on state parameters, families must be state residents who are ineligible for Medicaid in order to receive CHIP coverage. Immigration status does not apply; legal aliens may enroll. Some states require a six to 12-month waiting period for new enrollees, though this waiting period is often waived in cases of unemployment.

Working families who fall within the income parameters may purchase CHIP insurance for their children. Some families also may choose to use CHIP benefits to cover expenses that are not listed on other health insurance, such as dental or vision care expenses. While many families use CHIP as primary insurance, it may be used as a supplemental policy. All states offer additional leniency within their guidelines for mothers and babies and cover care for pregnant women.

Coverage and Costs

While each state may choose its own benefit plans, all CHIP plans cover the following essential items for children’s health management:

  • Immunizations
  • Prescription medication
  • Routine check-up doctor’s appointments
  • Dental Care
  • Medically necessary orthodontics
  • Mental and behavioral health expenses
  • Substance abuse treatment
  • Hospitalization (up to 90 days annually, with limitations for mental health services)
  • Home health care
  • Rehabilitation
  • Medical equipment
  • Flu vaccines
  • Laboratory and x-ray services

Fee structures vary across states, though no family is ever required to pay for preventive care. Many states offer a sliding fee scale based upon family income, which is used to determine coinsurance costs and premium amounts. Other states allocate CHIP funding as a one-stop-shopping insurance option, issuing flat fees for coinsurance across the state for all qualifying families.

Fee structures vary across states, though no family is ever required to pay for preventive care

How Much Can They Vary?

For example, families in Illinois have several choices among plan benefits and shared costs, based on their annual family earnings. A typical family of four enrolled in Illinois’ CHIP program earns between $34,000 and $45,000 per year and pays a monthly premium of $15 per child. The state charges a standard premium (in this case, $2,500 per month) and then reimburses enrollees via a rebate program. Co-insurance costs include prescriptions; generic prescriptions cost $2, as do approved over-the-counter medications. Emergency room visits are free, though a small fee is assessed for using the ER for non-emergent health care.

Families earning $30,000 to $34,000 but who are still ineligible for Medicaid may receive services entirely free. Conversely, families who earn a higher income have the option of greater cost sharing with Illinois’ CHIP administration. The same amount of government money is allocated to these families through the rebate program, but families who can afford it pay a slightly higher cost in premiums and coinsurance charges. This same family of four earning up to $68,000 annually would pay a $40 premium per child, $10 office visit co-pays, and up to $7 for prescriptions; they also must contribute toward the cost of outpatient services and hospitalizations.

Stipulations in Mississippi, however, are different. Mississippi children must not only be ineligible for Medicaid, but must also be uninsured to enroll in CHIP; there is no option to use these funds as supplemental insurance. Government in Mississippi caps allowable enrollees at 200% of the FPL, so a family with two uninsured children must earn no more than $2,585 per month, or $31,020 per year.

Coverage is comprehensive, in keeping with federal mandates. Mississippi CHIP enrollees share costs, but they do not pay any premiums. Coinsurance rates are flat fees that apply to most medical expenses: office visits, prescription medications, hospitalization, home health services, and vision and dental care. Standard charges are $3 per office visit, $10 per day for hospitalization, and $3 per prescription.

How Do I Get CHIP for My Children?

If you think there is even a slight chance that you meet your state’s requirements for CHIP, investigate the income limits your state legislature uses as benchmarks. New funding for CHIP (and Medicaid, incidentally) has the potential to help thousands of families whose kids are currently underinsured or uninsured. The 2013 program expansion also contains new tools for state administrators to use in recruiting new enrollees, so be on the lookout for news in your area about CHIP plans.

New funding for CHIP (and Medicaid, incidentally) has the potential to help thousands of families whose kids are currently underinsured or uninsured

If you meet income requirements, applying for CHIP coverage is relatively easy. Check your state’s requirements for application options, enrollment and renewal procedures, and other useful data pertinent to you. You may apply online or in person, or download documents and send them via snail mail. You may also call 1-800-KIDS-NOW (1-800-543-7769) to speak with a representative who can assist you.

You will need documentation to complete the application process. Before you begin, have on hand the following items:

  • Social security numbers for you and your children. If you have applied for but not yet received a social security number for a child, you’ll need proof that you applied.
  • If you are pregnant: a signed physician’s statement and the baby’s due date
  • If you are a U.S. citizen: a birth certificate, passport, adoption decree, or other proof of birthplace
  • If you are a documented immigrant: your Alien Registration Number along with your green card, permanent resident card or passport with resident status
  • Applicable health insurance information from the previous 12 months
  • Your child’s recent report cards or other school records
  • A driver’s license, state ID, military ID, or other accepted form of identification
  • Most recent paycheck stub or proof of income such as a disability statement or unemployment receipt
  • Proof of any child support paid or received

While CHIP might be the only insurance option available for your children, take the time to think through each child’s current and future health needs

All states vary, but processing times can be as short as 30 to 45 days. As you investigate your state’s offerings, keep in mind that you are the consumer. While CHIP might be the only insurance option available for your children, take the time to think through each child’s current and future health needs. If the physician and facility network is one that you can easily access, the time spent on the application is time well-spent. If your state allows the use of CHIP plans as supplemental policies, dig deeper to discover the specific benefits your children can gain from these policies.

If you enjoyed reading this, sign up for free updates!

Loading Disqus Comments ...
Loading Facebook Comments ...

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>