CHIP for Kids: Free or Low-Cost Coverage When You Earn Too Much for Medicaid
A raise or a second job can push a family just over the Medicaid limit. That doesn't have to mean your kids lose coverage. The Children's Health Insurance Program (CHIP) covers children in families that earn too much for Medicaid but not enough to easily afford private insurance. Here's who CHIP is for, what it covers, what it can cost, and how to apply at any time of year.
AT A GLANCE
|
What CHIP is
CHIP is a joint federal and state program. Medicaid.gov describes it this way: children eligible for CHIP are in families "with incomes too high to qualify for Medicaid, but too low to afford private coverage." States run the program under federal rules, and states and the federal government pay for it together.
Every state offers CHIP and works closely with its Medicaid program. Some states run CHIP as part of Medicaid. Others run a separate CHIP program. In either case, one application gets your child checked for both.
If you apply to your state for Medicaid, you'll also find out whether your children qualify for CHIP. You don't need two applications.
---
Who qualifies
Each state sets its own CHIP rules, so the income limits and program names vary. Federal rules in 42 CFR 457.310 and 457.320 set the outer limits.
Requirement | What the federal rules say |
|---|---|
Age | Under 19 |
Income | Above your state's Medicaid limit for the child's age, up to the state's CHIP limit |
Medicaid | The child can't be eligible for Medicaid. Medicaid is checked first. |
Other insurance | The child generally can't already be covered by a group health plan or other health insurance |
Residency | Must live in the state |
Citizenship or immigration status | An adult in the household declares the child's status (see below) |
Under the financial need standard, a state's CHIP can cover children at or below 200% of the federal poverty level. In states with a Medicaid income level, it can cover children up to 50 percentage points above that level. Your state's actual cutoff is what matters. InsureKidsNow.gov has a state-by-state lookup.
What states can't hold against your child
Under 42 CFR 457.320(b), a state can't:
Deny CHIP because of a preexisting medical condition
Discriminate based on a diagnosis
Cover higher-income children while leaving out lower-income children in the same group
Require a Social Security number from a family member who isn't asking for coverage
Exclude American Indian or Alaska Native children because they can use Indian Health Service care
That Social Security point matters for mixed-status families. A parent who isn't applying for themselves doesn't have to give an SSN for the child to apply.
Children of state and public employees
There's one exclusion that surprises some families. A child generally can't get CHIP if they can get a state health benefits plan through a family member's job with a public agency, even if the family turns that coverage down. The rule applies only when the agency's contribution toward dependent coverage is more than nominal.
Immigration status changes
HealthCare.gov now shows a warning about a law change. It says only people with these statuses are eligible for full Medicaid or CHIP:
Lawful Permanent Residents (green card holders)
Cuban or Haitian entrants
Compact of Free Association (COFA) migrants
In certain states, "lawfully residing" children and pregnant women may also qualify for full coverage. HealthCare.gov says states have the option to remove the usual 5-year waiting period for these groups. It also notes that Lawful Permanent Residents who previously held certain other statuses, like refugee or asylee, don't face that 5-year wait.
If you're worried about how applying could affect an immigration case, HealthCare.gov points families to U.S. Citizenship and Immigration Services' "public charge" guidance before they apply.
---
What CHIP covers
Benefits differ by state, but HealthCare.gov says all states provide comprehensive coverage that includes:
Routine check-ups and immunizations
Doctor visits
Prescriptions
Dental and vision care
Inpatient and outpatient hospital care
Lab work and X-rays
Emergency services
Behavioral health services
States can add more benefits on top of this list. InsureKidsNow.gov also has a dentist locator for finding a dentist who sees children and accepts Medicaid and CHIP.
---
What CHIP costs
Federal rules limit what states can charge.
Cost | The rule |
|---|---|
Well-baby and well-child care | No copays, deductibles or coinsurance (42 CFR 457.520) |
Routine preventive dental care | Free. This includes exams, cleanings, fluoride, sealants and X-rays. |
Immunizations | Free, along with the related office visits |
Other services | States may charge copays |
Monthly premiums | Some states charge them |
Total yearly cap | All premiums, fees and cost-sharing together can't exceed 5% of family income for the child's eligibility period (42 CFR 457.560) |
The state has to tell you your family's personal maximum, in writing, when you enroll and each time you renew. Keep that letter. If you get close to the cap, it shows when charges should stop.
Families with lower incomes get extra protection. For children at 101% to 150% of the poverty level, the rules set small maximum copays that rise each year with medical inflation.
If you fall behind on a premium
Missing a premium doesn't mean your child is cut off right away. Under 42 CFR 457.570:
The state must give you reasonable notice and a chance to pay before disenrolling your child.
You get a chance to show that your income has dropped. If it has, the state must move your child to Medicaid or a lower cost-sharing level.
The state can't lock your child out for a set period because of an unpaid premium.
It can't require you to pay old premiums before your child can re-enroll.
You have the right to an impartial review of a disenrollment.
If money is tight, tell the CHIP office before the premium is due. Don't just let it lapse.
---
Keeping coverage once you have it
Under the continuous eligibility rules (42 CFR 457.342, which points to 435.926), states must give children 12 months of continuous eligibility. During that period, a child's coverage can't be ended because of a change in circumstances like a raise. It can end only if the child:
Turns 19
Moves out of the state
Asks to end coverage, or a representative does
Was enrolled because of an agency error, or fraud by the child or their representative
Dies
There's another protection for families who just lost other coverage. Under 42 CFR 457.805, a state can't make a child wait to enroll in CHIP after losing job-based coverage, Medicaid or another affordability program.
InsureKidsNow.gov reminds families who are already enrolled to keep their contact information current with the state and to watch for a renewal letter.
---
CHIP or a Marketplace plan?
If your children qualify for CHIP, they can't get savings on a HealthCare.gov Marketplace plan. HealthCare.gov says CHIP coverage "will probably be more affordable." But you and other adults in the family may still qualify for Marketplace savings even when the kids are on CHIP.
When you apply on HealthCare.gov, it checks everyone at once. If it looks like someone qualifies for Medicaid or CHIP, it securely sends their information to your state agency, which then contacts you. Adults who don't qualify for Medicaid find out whether they can get a Marketplace plan with savings.
---
How to apply
You can apply in either of these ways, any time of year:
Through your state's Medicaid or CHIP agency. InsureKidsNow.gov lists each state's programs, or you can call 1-877-KIDS-NOW (1-877-543-7669).
Through HealthCare.gov. Apply online, or call 1-800-318-2596 (TTY 1-855-889-4325).
It helps to have these ready:
Income information for everyone in the household, like pay stubs
Each child's date of birth
Social Security numbers or immigration documents for the people applying
Information about any health insurance anyone has now or can get through a job
Your checklist
☐ Check your state's CHIP income limit on InsureKidsNow.gov
☐ Gather pay stubs and current insurance information
☐ Apply through your state or HealthCare.gov, since it's open year-round
☐ Save the letter showing your family's 5% cost-sharing maximum
☐ Update your address and phone with the state, and watch for renewal mail
WHAT TO DO THIS WEEK
|
More help
Related guides
Official sources
Last checked: October 30, 2026. Program basics, benefits, costs, phone numbers and immigration notes come from HealthCare.gov, Medicaid.gov and InsureKidsNow.gov. Eligibility standards, cost-sharing limits, disenrollment protections and continuous eligibility come from 42 CFR 457.310, 457.320, 457.342, 457.520, 457.560, 457.570 and 457.805, and from 42 CFR 435.926.
This is general information, not legal or immigration advice. Your state's CHIP or Medicaid agency makes the final decision about eligibility and costs.
Comments