CHIP: Health Coverage for Children When the Family Earns Too Much for Medicaid

A large share of uninsured children in the United States are eligible for free or very cheap coverage that their families have never applied for. The reason is almost always the same: the parents checked whether they qualified for Medicaid, found they did not, and stopped there.

Children are assessed on a different scale entirely. That scale is CHIP.

What CHIP is

The Children’s Health Insurance Program covers children up to age 19 in families who earn too much for Medicaid but cannot realistically buy private cover. It is jointly funded by the federal government and the states, and every state has one.

States run it in one of three ways, which is why the name on the letter differs everywhere: as an expansion of Medicaid, as a separate program with its own name and rules, or as a combination. Texas calls it CHIP; Pennsylvania too; other states use names such as Dr. Dynasaur, Peach Care or Healthy Families. If you are looking for “CHIP” in a state that calls it something else, you can easily conclude it does not exist.

The income limits are much higher than parents expect

Each state sets its own upper limit. Across the country they run from roughly 175% to 400% of the federal poverty level, with the median around 255%.

Percentage of poverty	Family of 3	Family of 4
200% FPL	$54,640	$66,000
250% FPL	$68,300	$82,500
300% FPL	$81,960	$99,000
400% FPL	$109,280	$132,000

Annual income, 48 contiguous states and DC, using the 2026 poverty guidelines. Your state’s actual threshold is what counts — check it at InsureKidsNow.gov or through your state Medicaid agency.

In a state at 300%, a family of four earning $95,000 has children who qualify. That is a household that would never think to apply, and in many cases is paying several hundred dollars a month to add the children to an employer plan.

You are not judged as a family unit here. Parents on a Marketplace plan with children on CHIP is a normal, intended outcome — not a sign that something went wrong with the application. One application at HealthCare.gov assesses everybody and routes each person to the right place.

What it costs

In Medicaid-expansion CHIP states, generally nothing. In separate CHIP programs, states may charge a modest monthly premium or enrollment fee and small co-payments — typically in the range of a few dollars to a few tens of dollars a month, scaled to income.

There is a hard federal ceiling: total cost-sharing — premiums, co-pays and everything else — cannot exceed 5% of the family’s annual income. Once you hit that cap for the year, the rest is covered. If a state is billing you past it, that is a mistake worth raising.

No cost-sharing at all is permitted for preventive care, immunisations, or for pregnancy-related services.

What is covered

• Routine check-ups and well-child visits
• Immunisations
• Doctor visits, hospital care and surgery
• Prescriptions
• Laboratory tests and X-rays
• Emergency care
• Mental health and substance use services
• Dental care — required in CHIP, and considerably better than most adult coverage
• Vision, including glasses

Dental is worth pausing on. Federal law requires CHIP to cover dental services necessary to prevent disease, restore teeth and maintain oral health. Families comparing CHIP against an employer plan often find the children’s dental cover is the clear winner.

Four rules that trip families up

There is no enrollment season

Unlike Marketplace plans, CHIP and Medicaid accept applications every day of the year. If a child is uninsured today, apply today. Coverage frequently backdates to the first of the month of application, and in some states up to three months earlier if the child had medical costs in that period — worth asking about explicitly if there are unpaid bills.

Children get a full year of coverage

Since 2024, states must provide 12 months of continuous eligibility for children in Medicaid and CHIP. A pay rise mid-year no longer ends a child’s coverage; it is reassessed at the next renewal. Families who declined a promotion or extra shifts to protect a child’s insurance no longer need to.

Some states impose a waiting period

A handful still require a period — up to 90 days — without private coverage before a child can join separate CHIP, to discourage employers’ cover being dropped in favor of the public program. Most states have abolished it, and exceptions almost always apply where coverage was lost involuntarily, became unaffordable, or where the child has serious health needs. Ask about the exceptions rather than assuming the waiting period applies to you.

Immigration status: the child’s status is what matters

Most states have taken the federal option to cover lawfully residing children without the usual five-year waiting period. A parent’s own status does not determine the child’s eligibility, and applying for a child does not expose the household to a public charge finding — CHIP and Medicaid for children are not counted in that test.

Families are kept out of this program by fear far more often than by rule. A free, confidential conversation with a local assister will give you the position for your state: localhelp.healthcare.gov.

How to apply

• Online — HealthCare.gov, or your state’s own exchange. One application covers Medicaid, CHIP and Marketplace subsidies.
• By phone — 1-800-318-2596, or your state Medicaid agency.
• Find your state’s program and its real name — InsureKidsNow.gov, or 1-877-KIDS-NOW.
• In person, free — navigators and certified assisters at localhelp.healthcare.gov.

Have ready: income for everyone in the household, dates of birth, Social Security numbers for those applying, and immigration documents where relevant. Decisions typically arrive within 45 days and often much sooner.

If a renewal notice arrives, act on it immediately. The commonest way children lose CHIP is not a change in income — it is a form that was not returned, often because it went to an old address. Keep your address current with the state agency, and if coverage lapses for that reason, ask for reinstatement rather than reapplying from scratch.