{"id":355846,"date":"2018-07-20T14:07:21","date_gmt":"2018-07-20T19:07:21","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/healthcare\/patient-rights\/what-is-chip.html"},"modified":"2023-12-27T09:39:06","modified_gmt":"2023-12-27T14:39:06","slug":"what-is-chip","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/healthcare\/patient-rights\/what-is-chip.html","title":{"rendered":"What is CHIP?"},"content":{"rendered":"\n<div class=\"wp-container-core-columns-is-layout-9d6595d7 fl-sectionWithSidebar fl-container fl-flex fl-flex-wrap fl-gap30\">\n    \n    <div class=\"fl-page-articles fl-section-main fl-section-main-full-width\">\n        <h1 class=\"fl-no-margin-top\">What is CHIP? <\/h1>\n<section class=\"fl-gutenberg-byline\">\n    <div class=\"fl-gutenberg-byline-content\">\n                    By <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/melissa-mccall-j-d\/\">Melissa McCall, J.D.<\/a> | Legally reviewed by <a\n                href=\"https:\/\/www.findlaw.com\/company\/our-team\/aviana-cooper-esq\/\">Aviana Cooper, Esq.<\/a>\n                | Last updated\n        <time>\n                            December 27, 2023\n                    <\/time>\n    <\/div>\n\n    \n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-legally-reviewed\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Legally Reviewed\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>This article has been written and reviewed for legal accuracy, clarity, and style by <a href=\"https:\/\/www.findlaw.com\/company\/our-team.html\">FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with <a href=\"https:\/\/www.findlaw.com\/company\/company-history\/editorial-policy.html\">our editorial standards<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n\n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-fast-checked\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Fact-Checked\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>The last updated date refers to the last time this article was reviewed by FindLaw or one of our <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/contributing-authors.html\">contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please <a href=\"https:\/\/lawyers.findlaw.com\/?fli=bylinelink\" target=\"_blank\" rel=\"noopener\">contact an attorney in your area<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n<\/section>\n<p>Low-income people and families unable to afford health insurance may qualify for state Medicaid coverage based on income. Some states have&nbsp;<a href=\"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/state-medicaid-expansion.html\">expanded Medicaid<\/a>&nbsp;coverage to serve low-income people whose income isn&#8217;t otherwise low enough to qualify.<\/p>\r\n<p>Children in the coverage gap (the &quot;donut hole&quot;) also have options. The federal government established the&nbsp;<a href=\"https:\/\/www.healthcare.gov\/medicaid-chip\/childrens-health-insurance-program\/\" target=\"_blank\" rel=\"noopener\">Children&#8217;s Health Insurance Program<\/a>&nbsp;(CHIP) to address this public health matter by expanding coverage options for children. CHIP is a Medicaid program that ensures children and adolescents enjoy healthy childhoods.<\/p>\r\n<p>This Findlaw article provides an overview of the Children&#8217;s Health Insurance Program.<\/p>\r\n<h2>CHIP Basics<\/h2>\r\n<p>CHIP is a medical assistance program jointly funded by the U.S. Department of Health and Human Services (HHS) and individual states. CHIP provides health coverage to children through Medicaid and&nbsp;<a href=\"https:\/\/www.medicaid.gov\/chip\/index.html\" target=\"_blank\" rel=\"noopener\">separate CHIP programs<\/a>. Individual states administer CHIP following federal guidelines. CHIP eligibility and health coverage, therefore, varies by state. States must conform to federal guidelines for comprehensive children&#8217;s health care services.<\/p>\r\n<p>The Center for Medicaid Services and CHIP (CMSC), through the Children and Adults Health Programs Group (CAHPG),&nbsp;<a href=\"https:\/\/www.medicaid.gov\/about-us\/Center-for-Medicaid-and-CHIP-Services\/index.html\" target=\"_blank\" rel=\"noopener\">oversees all aspects of CHIP<\/a>. The CMSC approves new initiatives and amendments to CHIP.<\/p>\r\n<h3>CHIP Coverage<\/h3>\r\n<p>Although CHIP coverage may vary from state to state, all states must provide eligible children with&nbsp;<a href=\"https:\/\/www.healthcare.gov\/medicaid-chip\/childrens-health-insurance-program\/\" target=\"_blank\" rel=\"noopener\">comprehensive<\/a>&nbsp;health insurance coverage including, but not limited to:<\/p>\r\n<ul>\r\n<li>Routine wellness visits<\/li>\r\n<li>Preventive care, including immunizations<\/li>\r\n<li>Prescription medication<\/li>\r\n<li>Emergency medical care<\/li>\r\n<li>Laboratory and X-ray services<\/li>\r\n<li><a href=\"https:\/\/www.insurekidsnow.gov\/initiatives\/mental-health\/index.html\" target=\"_blank\" rel=\"noopener\">Mental health care<\/a><\/li>\r\n<li><a href=\"https:\/\/www.insurekidsnow.gov\/initiatives\/improving-oral-health\/index.html\" target=\"_blank\" rel=\"noopener\">Oral health benefits<\/a>&nbsp;(pediatric dentistry)<\/li>\r\n<li>Vision care<\/li>\r\n<li>Inpatient and outpatient hospital care<\/li>\r\n<\/ul>\r\n<p>There is no difference in health care quality or access to health care providers for CHIP beneficiaries. Under CHIP, children have access to the same quality of care and privacy protections as other children.<\/p>\r\n<h3>CHIP Costs<\/h3>\r\n<p>CHIP costs and premiums vary from state to state. Children can get wellness visits and dental visits for free. In some states, parents must satisfy a co-pay for some services. Although these health care costs may vary depending on the state, parents will not have to spend more than 5% of the family&#8217;s annual income on CHIP expenses.<\/p>\r\n<h2>CHIP Eligibility<\/h2>\r\n<p>Although eligibility for the CHIP program varies by state, only those 18 and under can apply for CHIP. The federal&nbsp;<a href=\"https:\/\/www.healthcare.gov\/create-account\" target=\"_blank\" rel=\"noopener\">Health Insurance Marketplace<\/a>&nbsp;will send your information to your state agency if anyone in your household qualifies.<\/p>\r\n<p>Generally, your household income (modified adjusted gross income, or&nbsp;<a href=\"https:\/\/www.healthcare.gov\/glossary\/modified-adjusted-gross-income-magi\/\" target=\"_blank\" rel=\"noopener\">MAGI<\/a>) determines your eligibility according to the&nbsp;<a href=\"https:\/\/aspe.hhs.gov\/topics\/poverty-economic-mobility\/poverty-guidelines\" target=\"_blank\" rel=\"noopener\">federal poverty guidelines<\/a>. MAGI is your adjusted gross income plus any of the following:<\/p>\r\n<ul>\r\n<li>Untaxed foreign income<\/li>\r\n<li>Social Security benefits<\/li>\r\n<li>Tax-exempt interest<\/li>\r\n<\/ul>\r\n<p>Medicaid and CHIP eligibility is a percentage of the poverty level. For example, New York offers the best coverage for CHIP, at 400% of the poverty level, while North Dakota provides the least at 170%. Yet, it&#8217;s essential to consider how the cost of living differs around the country relative to the federal poverty guidelines.<\/p>\r\n<h2>CHIP Benefits<\/h2>\r\n<p>As noted earlier, CHIP coverage varies by state within specific federal guidelines. Coverage also depends on whether your child has CHIP coverage through&nbsp;<a href=\"https:\/\/www.medicaid.gov\/chip\/benefits\/index.html\" target=\"_blank\" rel=\"noopener\">Medicaid expansion or separate CHIP coverage<\/a>.<\/p>\r\n<h3>Medicaid Expansion CHIP Benefits<\/h3>\r\n<p>If state Medicaid expansion, under the Affordable Care Act (ACA), covers CHIP benefits, then they&#8217;ll conform to the state&#8217;s standard Medicaid benefit package. This includes the following medically necessary services:<\/p>\r\n<ul>\r\n<li>Early and periodic screening services<\/li>\r\n<li>Diagnostic services<\/li>\r\n<li>Treatment services<\/li>\r\n<\/ul>\r\n<h3>Separate CHIP Benefits<\/h3>\r\n<p>If your child has separate (non-Medicaid) CHIP benefits, coverage will depend on whether your state provides benchmark, benchmark-equivalent, or secretary-approved coverage.<\/p>\r\n<p>Benchmark coverage is based on either:<\/p>\r\n<ul>\r\n<li>The Blue Cross\/Blue Shield preferred provider option health plan offered to federal employees<\/li>\r\n<li>&nbsp;<\/li>\r\n<li>The state employee&#8217;s coverage plan<\/li>\r\n<li>The HMO plan with the state&#8217;s largest commercial, non-Medicaid enrollment<\/li>\r\n<\/ul>\r\n<p>Benchmark-equivalent coverage is the literal equivalent of benchmark coverage that includes:<\/p>\r\n<ul>\r\n<li>Inpatient\/outpatient hospital services<\/li>\r\n<li>Physician&#8217;s services<\/li>\r\n<li>Surgical and medical services<\/li>\r\n<li>Lab and X-ray services<\/li>\r\n<li>Well-baby and well-child care (including immunizations)<\/li>\r\n<\/ul>\r\n<p>Secretary-approved coverage&nbsp;is any other type of health care coverage approved by the U.S. Health and Human Services secretary.<\/p>\r\n<h3>CHIP Dental Benefits<\/h3>\r\n<p>Medicaid expansion CHIP coverage must include dental services necessary to:<\/p>\r\n<ul>\r\n<li>Prevent oral diseases<\/li>\r\n<li>Promote oral health<\/li>\r\n<li>Treat emergency conditions<\/li>\r\n<\/ul>\r\n<h2>Get Legal Help<\/h2>\r\n<p>If you or a loved one is experiencing difficulty applying for CHIP, a qualified health care attorney can help. They are experts in health care law and can help you through the process. Speak to an experienced&nbsp;<a href=\"https:\/\/lawyers.findlaw.com\/health-health-care-law\/?fli=dcta\" target=\"_blank\" rel=\"noopener\">healthcare attorney<\/a>&nbsp;near you.<\/p>\r\n<div class=\"was-this-helpful\">\n    <div\n            class=\"was-this-helpful__question-container\"\n            aria-labelledby=\"was-this-helpful__question\"\n            role=\"group\"\n    >\n        <span\n                id=\"was-this-helpful__question\"\n                class=\"was-this-helpful__question fl-text-lg-bold\"\n        >Was this helpful?<\/span>\n        <button\n                class=\"was-this-helpful__button fl-text-sm\"\n                aria-label=\"Yes\"\n                value=\"yes\"\n        >\n            <span class=\"was-this-helpful__button-text fl-text-bold\">Yes<\/span>\n            <i class=\"was-this-helpful__button-icon\">\n                <svg width=\"22\" height=\"22\" viewBox=\"0 0 22 22\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n               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width=\"22\" height=\"22\" fill=\"white\"><\/rect>\n                        <\/clipPath>\n                    <\/defs>\n                <\/svg>\n            <\/i>\n        <\/button>\n        <button\n                class=\"was-this-helpful__button fl-text-sm\"\n                aria-label=\"No\"\n                value=\"no\"\n        >\n            <span class=\"was-this-helpful__button-text fl-text-bold\">No<\/span>\n            <i class=\"was-this-helpful__button-icon\">\n                <svg width=\"22\" height=\"22\" viewBox=\"0 0 22 22\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <g id=\"thumbs-down\" clip-path=\"url(#clip0_604_3423)\">\n                        <path id=\"Vector\"\n                              d=\"M16 0.999995H18.67C19.236 0.989986 19.7859 1.18813 20.2154 1.55681C20.645 1.9255 20.9242 2.43905 21 3V10C20.9242 10.5609 20.645 11.0745 20.2154 11.4432C19.7859 11.8119 19.236 12.01 18.67 12H16M9.00003 14V18C9.00003 18.7956 9.3161 19.5587 9.87871 20.1213C10.4413 20.6839 11.2044 21 12 21L16 12V0.999995H4.72003C4.2377 0.994543 3.76965 1.16359 3.40212 1.47599C3.0346 1.78839 2.79235 2.22309 2.72003 2.7L1.34003 11.7C1.29652 11.9866 1.31586 12.2793 1.39669 12.5577C1.47753 12.8362 1.61793 13.0937 1.80817 13.3125C1.99842 13.5313 2.23395 13.7061 2.49846 13.8248C2.76297 13.9435 3.05012 14.0033 3.34003 14H9.00003Z\"\n                              stroke=\"#666666\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/>\n                    <\/g>\n                    <defs>\n                        <clipPath id=\"clip0_604_3423\">\n                            <rect width=\"22\" height=\"22\" fill=\"white\"\/>\n                        <\/clipPath>\n                    <\/defs>\n                <\/svg>\n            <\/i>\n        <\/button>\n    <\/div>\n    <span class=\"was-this-helpful__taken-action fl-text-sm-bold\"><\/span>\n    <div class=\"was-this-helpful__feedback-container\">\n        <div class=\"was-this-helpful__choose-option-message\" role=\"status\">\n            <p class=\"was-this-helpful__choose-option-message-text\"><\/p>\n        <\/div>\n        <form class=\"was-this-helpful__feedback-form\">\n            <div class=\"was-this-helpful__feedback was-this-helpful__feedback--positive\">\n                <fieldset>\n                    <legend class=\"was-this-helpful__feedback-form-title\" tabindex=\"0\">Why was this helpful?<\/legend>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--understandable\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"positive-feedback\"\n                                value=\"Easy to understand\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--understandable\"\n                        >Easy to understand<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--solved-problem\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"positive-feedback\"\n                                value=\"Solved my problem\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--solved-problem\"\n       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<fieldset>\n                    <legend class=\"was-this-helpful__feedback-form-title\" tabindex=\"0\">Why was this not helpful?<\/legend>\n                    <div class=\"was-this-helpful__choose-option-message\" role=\"status\">\n                        <p class=\"was-this-helpful__choose-option-message-text\"><\/p>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--missing-info\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Missing Information\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--missing-info\"\n                        >Missing the information I need<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--complicated\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Too complicated\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--complicated\"\n                        >Too complicated \/ too many steps<\/label>\n                    <\/div>\n                    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          class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Other\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--negative-other\"\n                        >Other<\/label>\n                    <\/div>\n                <\/fieldset>\n            <\/div>\n            <div class=\"was-this-helpful__form-buttons-container\">\n                <button\n                    class=\"was-this-helpful__feedback-button was-this-helpful__feedback-button--positive at-feedback-submit fl-button secondary\"\n                    type=\"submit\"\n                >\n                    <span class=\"fl-button-content\">Submit<\/span>\n                    <i\n                      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health care system is complex\n\n                <\/li>\n                            <li data-testid=\"fl-editors-summary-content-item\">\n                    <i class=\"fa fa-check medium fl-editors-summary-content-item-icon\" aria-hidden=\"true\"><\/i>\n                    Complex heath care cases (such as medical malpractice, bioethics, or health advocacy) may need the support of an attorney\n\n                <\/li>\n                    <\/ul>\n                    <div class=\"fl-editors-summary-content-description\" data-testid=\"fl-editors-summary-content-description\">\n                <p>Protect your patient rights with an attorney at your side. An attorney can offer tailored advice and help prevent common mistakes.<\/p>\n\n            <\/div>\n                            <div class=\"fl-editors-summary-content-link fl-flex\" data-testid=\"fl-editors-summary-content-link\">\n                <i class=\"fa fa-angle-right medium\" aria-hidden=\"true\"><\/i>\n                <p class=\"find-attorney\"><a href=\"https:\/\/lawyers.findlaw.com\/health-health-care-law\/#USER_GEO\/?fli=esum:FL28\" target=\"_blank\" rel=\"noopener\">Find a local attorney<\/a><\/p>\n\n            <\/div>\n            <\/div>\n<\/div>\n\n\n<div class=\"email-subscription fl-mb30\">\n    <div class=\"email-subscription-header\">\n        <div class=\"email-subscription-header-content\">\n            <h3 class=\"fl-callout-sm fl-no-margin\">Stay Up-to-Date With How the Law Affects Your Life<\/h3>\n        <\/div>\n        <div class=\"email-subscription-header-image fl-flex fl-items-end\">\n            <img decoding=\"async\"\n                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<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>The Children&#8217;s Health Insurance Program (CHIP) ensures all children have access to health care. 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