What CHIP Is and How It Works
The Children's Health Insurance Program (CHIP) provides low-cost comprehensive health insurance to children in families with income too high for Medicaid but who can't afford private coverage. CHIP is jointly funded by the federal government and states. All 50 states, DC, and U.S. territories have CHIP programs, though program names vary — in many states CHIP is run through the same agency as Medicaid and the enrollee may simply be enrolled in "Medicaid." CHIP fills the gap between Medicaid (lower-income families) and employer/private insurance (which may be unaffordable).
Who Qualifies
CHIP eligibility: child must be under 19, a U.S. citizen or qualifying non-citizen, with family income above the state's Medicaid threshold but within the CHIP limit, and generally without access to affordable employer-sponsored coverage. Some states have "crowd-out" policies restricting CHIP to children who couldn't access affordable employer coverage; others don't.
Income Limits — 200–300% FPL in Most States
Most states cover children to 200–300% FPL. For 2026: 200% FPL for a family of four ≈ $62,280/year; 300% FPL ≈ $93,420/year. Several states go higher: New York covers to 400% FPL; California to 266%; Massachusetts to 300%. See CHIP Income Limits by State for your state's specific threshold.
What CHIP Covers
CHIP provides comprehensive coverage including: well-child visits and immunizations, doctor visits (sick and wellness), emergency and hospital care, mental health and substance use treatment, dental care (preventive and restorative), vision care and eyeglasses, lab work, and prescription drugs. Children under 21 are also covered under EPSDT standards, which require all medically necessary treatment identified in screening to be provided. See CHIP Dental and Vision for dental and vision specifics.
Cost — Premiums and Copays
Federal law limits CHIP cost-sharing based on family income. Families at or below 133% FPL pay no premiums and minimal copays. Families above 133% FPL may pay modest premiums (typically $0–$50/month) and small copays. Total annual CHIP cost-sharing is capped at 5% of family income — no family pays more than this regardless of how much care their child uses.
CHIP vs Medicaid — Quick Difference
Medicaid covers children at lower incomes (up to 133–138% FPL); CHIP covers children in the next income band above that threshold. Coverage under both is comprehensive. The difference is mainly cost-sharing — slightly higher in CHIP — and administrative structure. Healthcare.gov routes children to the right program automatically. See CHIP vs Medicaid for Kids.
How to Apply
Apply at healthcare.gov (automatically routes to Medicaid or CHIP), your state's CHIP/Medicaid agency website, or through your child's doctor's office. You'll need the child's Social Security number, citizenship documentation, and your household income. Coverage can begin within 45 days, or immediately through presumptive eligibility at an FQHC or hospital. See How to Apply for CHIP.