CHIP vs Medicaid for Kids 2026 — Which Program Covers Your Child

Both Medicaid and CHIP provide comprehensive health insurance for children at little or no cost — but at different income levels. Here's how they differ and why it usually doesn't matter much in practice.

Updated: June 15, 2026

Read time: 7 min

Reviewed by: BenefitsWatch Editorial Team

The Key Difference — Income Threshold

Medicaid covers children in families with lower incomes (typically up to 133–138% FPL). CHIP covers children in families with income above that Medicaid threshold, up to 200–400% FPL depending on the state. Both require the child to be a U.S. citizen or qualifying non-citizen. The handoff between programs happens automatically — healthcare.gov routes the child to whichever program they qualify for.

Coverage Comparison

Both programs provide comprehensive coverage. Medicaid for children is governed by EPSDT — any medically necessary treatment identified in a screening must be provided, which is an unusually strong coverage guarantee. CHIP must provide benchmark coverage comparable to typical employer insurance. In practice the packages are very similar, both including doctor visits, hospital care, dental, vision, immunizations, mental health, and prescription drugs. EPSDT in Medicaid may provide slightly broader access to specialty services for children with complex medical needs.

Cost Comparison

Medicaid for children: $0 premiums, $0–$3 copays for most services. CHIP: $0–$50/month premiums depending on income and state; copays of $1–$15 for services; total cost-sharing capped at 5% of family income annually. For families at the lower end of the CHIP range, costs are minimal. Both are dramatically more affordable than private insurance for the income ranges they cover.

One Application for Both

Healthcare.gov and state Medicaid/CHIP portals process both programs simultaneously — you don't choose between them. Your application is evaluated against both, and your child is enrolled in whichever they qualify for. If income is on the boundary, Medicaid takes priority. This automatic routing means you never need to know in advance which program applies.

Transitioning Between Programs

When family income changes, children transition between Medicaid and CHIP at annual redetermination. The transition should be seamless: coverage doesn't lapse, and providers who accept Medicaid typically also accept CHIP since they're administered through the same state agency. You'll receive a notice explaining any coverage type change.

Which Is Better

For most families, the programs are functionally equivalent for care access. Medicaid has slightly lower cost-sharing and the EPSDT standard provides stronger access rights for children with complex needs. CHIP costs slightly more but provides equivalent comprehensive care. Both are dramatically better than no coverage. The priority is ensuring your child is in one or the other — apply if you haven't.