What is CHIP and how is it different from Medicaid?
CHIP — the Children's Health Insurance Program — is the program that picks up where Medicaid leaves off for kids. If your family earns just a little too much for Medicaid, your kids may still qualify for free or low-cost health coverage through CHIP. Same kid, same doctors, just a different door.
Dr. Ed Weir, PhD · 20 years inside Social Security · "Former" Sergeant, USMC
Updated April 2026
What is CHIP and how is it different from Medicaid?
CHIP and Medicaid are separate programs that often share a front door. CHIP covers kids under 19 in families with income above Medicaid limits — federal floor is 200 percent of the poverty level, and many states go higher. Most families pay little or nothing; federal rules cap total cost-sharing at five percent of family income.
When the eligibility lines feel confusing.
Free help finding what you may qualify for
If you're not sure whether your kids fit Medicaid or CHIP, you don't have to guess. Your state Medicaid agency screens for both programs from the same application. You can also dial 2-1-1 to reach a local human being who knows the rules in your state, or call 1-877-KIDS-NOW to be routed to your state's CHIP program. None of that costs anything.
Here's what to do, in 4 steps.
Here's the order of operations I'd use. Start with your state's eligibility lookup so you know which program your kids fall into, then apply through the same door — Healthcare.gov screens for Medicaid and CHIP together. If anything feels off, get a free human on the phone before you give up.
1. Check eligibility on InsureKidsNow.gov
Use the state lookup tool to see your state's exact CHIP income limit and program name. Every state runs CHIP a little differently — some call it KidCare, some PeachCare, some Child Health Plus. The federal floor is 200% FPL, but many states go higher.
InsureKidsNow.gov state lookup ›2. Apply through Healthcare.gov or your state
Healthcare.gov screens you for Medicaid and CHIP together — one application, both programs evaluated. If your state runs its own marketplace, the state Medicaid agency portal does the same thing. You won't have to guess which program; the application figures it out.
Healthcare.gov apply ›3. Find your state's specific CHIP name
States rename CHIP whatever they want. Florida calls it KidCare. Georgia calls it PeachCare. Virginia calls it FAMIS. New York calls it Child Health Plus. Knowing your state's name makes it much easier to search for forms, find a doctor, or call for help.
Medicaid.gov CHIP state info ›4. Get free help if any of this is confusing
Dial 2-1-1 from any phone to reach a local United Way navigator who knows your state's rules. Or call 1-877-KIDS-NOW (1-877-543-7669) to be routed to your state's CHIP program directly. Your kid's pediatrician's office and school nurse usually know the local enrollment helpers too.
Call 1-877-KIDS-NOW ›The CHIP numbers parents ask me about most
Which of these sounds more like you?
Most parents I talk to are in one of these spots. Pick the one that sounds closest to your situation — the answer points you to the right next step.
My kids don't qualify for MedicaidIncome just over the line
This is exactly what CHIP exists for. The federal floor for CHIP is 200 percent of the poverty level, and most states stretch the ceiling higher — some up to 400 percent. The same application that says no to Medicaid will usually say yes to CHIP automatically.
Apply through Healthcare.gov or your state Medicaid portal. One form covers both programs.
I'm worried CHIP premiums will be too muchCost-sharing limits are stricter than people think
Federal rules cap total CHIP cost-sharing — premiums, copays, all of it combined — at five percent of your family's income for the whole eligibility period. That's a hard ceiling written into 42 CFR § 457.560, not a state choice.
At lower CHIP income levels, most families pay nothing. At the higher end, you might see a small monthly premium, often in the 10 to 50 dollar range per family. Always smaller than commercial coverage.
I don't know what CHIP is called in my stateSame federal program, different label
Don't get hung up on the name. If you Google your state plus the word CHIP, the right program comes up. If you'd rather hear a human say it, call 1-877-KIDS-NOW and they'll route you to whatever your state calls it.
The state name only matters once you're inside; the federal floor and cost-sharing rules apply the same way no matter what's printed on the card.
What I saw working alongside state agencies is that every state names CHIP something different. Florida KidCare, Georgia PeachCare, Virginia FAMIS, New York Child Health Plus, Texas CHIP. Same federal program, same federal rules, different sticker on the door.
I'm undocumented but my kids are U.S. citizensApply for the kids based on their status
Your kids' eligibility is decided on your kids' status, not yours. If they're U.S. citizens or qualified immigrants, they may qualify for Medicaid or CHIP regardless of what your status looks like.
The application asks about the applicant — your child — not the whole household's immigration paperwork. State agencies are not allowed to share your information with immigration enforcement when you apply on behalf of an eligible child. If you want to double-check that with someone you trust, dial 2-1-1 or call your state's CHIP line.
My child has a chronic conditionCHIP coverage is comprehensive
Federal CHIP rules require coverage of routine check-ups, immunizations, doctor visits, prescriptions, dental, vision, emergency care, and hospitalization. Most states cover specialists, mental health, and therapies on top of that.
If your child is currently seeing specialists, ask the state CHIP program for the provider directory before you switch. Most pediatric specialists who take Medicaid take CHIP too — in many states the network is identical.
My income went up — are we losing CHIP?Report changes, but don't panic
Most states give CHIP kids 12 months of continuous eligibility once they're approved — meaning a mid-year income bump doesn't kick them off until the next renewal. But the rules around reporting changes are still strict.
Report the change. Then if you do age out at renewal, your kids may shift up to a Marketplace plan with subsidies. Don't try to hide it; the IRS and the state agency talk to each other through ACA data matching.
Don't get caught by this — if you fail to report a material change in income, the state can claw back coverage retroactively or come after the family for repayment. Always report income changes promptly through your state portal.
I'm helping a relative get CHIP for their kidsWhat you can and can't do for them
The application has to be signed by the parent or legal guardian — a grandparent, aunt, or family friend can't be the signer unless you have legal custody. But everything else, you can do alongside them.
Gather the documents (proof of income, kids' birth certificates or Social Security numbers, residency proof). Sit with them on InsureKidsNow.gov and run the state lookup. Call 2-1-1 or 1-877-KIDS-NOW together if anything's unclear. Most parents I talk to didn't apply earlier because the form felt overwhelming — a steady second person changes that.
My situation is more complicated than thisWhen the rules don't fit cleanly
Some situations don't fit on a self-service application: kids in foster care or kinship care, families crossing state lines, denied applications, kids with disabilities that might qualify them for separate Medicaid pathways, or adoption-assistance Medicaid.
For any of those, free legal help is real. Search your state plus "legal aid Medicaid" or call 2-1-1 and ask for the legal aid intake line. Most cases are routine for them — they've seen yours before.
I'm a flashlight, not a courtroom. If your situation involves custody disputes, immigration complexity, or a denial you want to appeal, talk to a Medicaid-experienced legal aid attorney before you give up on coverage.
What else your family may qualify for
CHIP isn't the only safety-net program your family may be eligible for. If money is tight enough that your kids qualify for CHIP, there's a good chance you may qualify for one or more of the programs below too. Apply for what you may qualify for; let the agencies sort the rest.
MAGI Medicaid for working-age adults
If your kids qualify for CHIP, you and your spouse may qualify for MAGI Medicaid — the income-based pathway for working-age adults. In expansion states the line is 138 percent of poverty for adults; non-expansion states are stricter.
Family Medicaid eligibility
If multiple family members might qualify (parents and kids together), the family Medicaid pathways pull a single application apart and route each person to the right program. Useful when household sizes or relationships are non-standard.
Pregnancy Medicaid
If you or someone in your family is pregnant, pregnancy Medicaid has higher income limits than regular adult Medicaid in most states — often 200 percent of poverty or higher — and runs through 12 months postpartum in adopting states.
WIC
WIC — the Special Supplemental Nutrition Program for Women, Infants, and Children — covers food, formula, and nutrition counseling for pregnant women, new moms, and kids under 5. CHIP families almost always may qualify for WIC too.
SNAP
SNAP — food stamps — follows household income rules close to Medicaid. If your kids may qualify for CHIP and money is tight, your family may qualify for SNAP too. Apply through your state's social services portal.
Marketplace coverage with subsidies
If your kids age out of CHIP or your income rises above the CHIP ceiling, the ACA Marketplace has subsidies that scale with income. Most CHIP-graduating families pay much less than published premiums after the tax credit applies.
Everything parents ask me about CHIP
What is CHIP?
CHIP — the Children's Health Insurance Program — is a federal-state partnership that provides health and dental coverage to kids under 19 in families with income above Medicaid limits but below the state's CHIP ceiling. Congress created it in 1997 under Title XXI of the Social Security Act. Federal rules and a state-run program work together; states can name it whatever they want.
How is CHIP different from Medicaid?
Medicaid covers the lowest-income kids. CHIP picks up the next bracket — families above the Medicaid line but still struggling to afford private coverage. Same federal partnership, same state agency in most cases, slightly different rules. CHIP allows small premiums and copays; Medicaid generally doesn't. CHIP funding is a capped federal allotment to states; Medicaid is open-ended.
What's the income limit for CHIP?
The federal floor is 200 percent of the Federal Poverty Level for the size of your household. States choose where to set the ceiling above that. Most states land between 200 and 300 percent FPL; some, like New York, go up to 400 percent FPL. Use InsureKidsNow.gov to look up your specific state.
Are there premiums or copays?
It depends on income. Lower-income CHIP families typically pay nothing. Higher-income CHIP families may have small monthly premiums (often $10–$50 per family) and small copays. Federal rule (42 CFR § 457.560) caps total cost-sharing at 5% of family income for the eligibility period — a hard ceiling.
What does CHIP cover?
Federal CHIP rules require: routine check-ups, immunizations, doctor visits, prescriptions, dental, vision, emergency room, hospitalization, and lab and X-ray services. Most states cover specialists, mental health, behavioral health therapy, and developmental services on top of that.
Where do I apply for CHIP?
Three doors lead to the same place: (1) Healthcare.gov — screens for both Medicaid and CHIP from one application; (2) your state's Medicaid agency portal — also screens for both; (3) call 1-877-KIDS-NOW (1-877-543-7669) and they'll route you to your state. You don't have to know in advance whether you fit Medicaid or CHIP — the application figures it out.
What if my state runs out of CHIP funds?
CHIP is a capped federal allotment, unlike Medicaid's open-ended match. In theory a state could run short. In practice, Congress has stepped in repeatedly with extensions — most recently MACRA in 2015, the Bipartisan Budget Act and Continuing Appropriations Act in 2018, and continuing appropriations since. If funding ever lapsed, your state would notify you in writing.
My kids age out of CHIP at 19 — what then?
CHIP coverage ends at age 19. Most kids who age out qualify for the ACA Marketplace with subsidies that scale with income. If your young adult is still a tax dependent and the household income is low enough, they may also qualify for adult Medicaid in expansion states. Healthcare.gov screens for all of that on the same form.
What is CHIP perinatal?
Some states use a CHIP option to cover prenatal care for the unborn child of a pregnant person who wouldn't otherwise qualify for Medicaid (often used for undocumented pregnant immigrants whose babies will be U.S. citizens at birth). The coverage is for the unborn child, not the parent. Not every state offers it; check with your state Medicaid agency.
What's the income limit in my state specifically?
State-by-state CHIP income limits change. The cleanest way to look yours up is the state lookup tool on InsureKidsNow.gov — pick your state and the page shows the current FPL ceiling, what the program is named locally, and the application link. You can also call 1-877-KIDS-NOW (1-877-543-7669) for a human voice answer.
Sources
Every figure and rule on this page is verified against primary sources. Last verified 2026-04-28.
- Federal CHIP regulations are codified at 42 CFR Part 457. —ecfr.gov(verified 2026-04-28)
- Federal CHIP eligibility floor: a 'targeted low-income child' is a child with household income at or below 200 percent of the Federal Poverty Level for a family of the size involved (42 CFR § … —ecfr.gov(verified 2026-04-28)
- States operate CHIP under one of three structures: Medicaid-expansion CHIP (extending Medicaid eligibility to higher-income kids), separate CHIP (a standalone CHIP program), or a combination of both. —ecfr.gov(verified 2026-04-28)
- Federal CHIP rules cap total cost-sharing (premiums, enrollment fees, copayments, coinsurance, deductibles, or similar charges, in the aggregate) at 5 percent of a family's total income for the length … —ecfr.gov(verified 2026-04-28)
- CHIP funding has been reauthorized multiple times since its 1997 creation, including extensions through MACRA (P.L. 114-10, 2015), the HEALTHY KIDS Act (P.L. 115-120, Jan. 22, 2018, six-year extension … —govinfo.gov(verified 2026-04-28)
- States may elect a CHIP perinatal option that covers prenatal care for the unborn child of an otherwise-ineligible pregnant person, classifying the unborn child as a 'targeted low-income child' for … —ecfr.gov(verified 2026-04-28)
- CHIP is administered by the same state agency as Medicaid in the majority of states, allowing a single application to screen for both programs. —ecfr.gov(verified 2026-04-28)
- Federal CHIP benefit standards require coverage of well-baby and well-child care, immunizations, doctor visits, prescriptions, dental services, vision services, emergency services, hospitalization, … —ecfr.gov(verified 2026-04-28)
- CHIP eligibility uses the Modified Adjusted Gross Income (MAGI) calculation, harmonized with Medicaid and ACA Marketplace eligibility under post-2014 ACA implementation rules. —ecfr.gov(verified 2026-04-28)
- CHIP was created by the Balanced Budget Act of 1997, codified as Title XXI of the Social Security Act. —law.cornell.edu(verified 2026-04-28)
- CHIP is codified at 42 USC § 1397aa et seq. —law.cornell.edu(verified 2026-04-28)
- As of 2026, CHIP income ceilings vary by state, with most states setting upper-income limits well above the federal 200% FPL floor; state-level upper bounds are reported by MACPAC and CMS in annual … —macpac.gov(verified 2026-04-28)
- CHIP is funded through a capped federal allotment to states (vs. Medicaid's open-ended federal match), set by Congress and periodically reauthorized. —law.cornell.edu(verified 2026-04-28)
- CHIP enrollment is approximately 7–10 million children annually, with the figure varying year to year based on enrollment, redeterminations, and Medicaid-CHIP transitions. —macpac.gov(verified 2026-04-28)
- Children losing CHIP eligibility (due to age-out at 19, income increase, or family relocation) may qualify for ACA Marketplace coverage with premium tax credits. —healthcare.gov(verified 2026-04-28)
Helping a relative figure out CHIP for their kids?
If you're a grandparent, aunt, uncle, or family friend trying to help a parent get their kids covered — you're exactly the person these programs depend on. The application has to be filed by the parent or legal guardian, but you can sit beside them, gather the documents, and walk through the state lookup together. That's not nothing. That's how kids get covered.
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