What is CHIP? 7 things to know about the Children’s Health Insurance Program


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Amid efforts to unsuccessfully repeal and replace the Affordable Care Act in the fall, lawmakers let the Children’s Health Insurance Program (or CHIP) to expire on Sept. 30.

And now, doctors and patients are worried that money for the program, which provides 9 million kids across the country with low-cost health insurance, will run out.

In fact, according to the Kaiser Family Foundation, 16 states expect to run out of CHIP reserve funds by the end of January, and three-quarters of the states expect to run out by March.

Here are 7 things to know about CHIP:

What is CHIP?

According to HealthCare.gov, CHIP is a no-cost or low-cost health insurance program that provides coverage to children in families that earn too much money to qualify for Medicaid, but who can’t afford private coverage.

The program is funded by both states and the federal government, but it is state-administered, meaning each state sets their own guidelines on eligibility and services.

In Georgia, the CHIP program is PeachCare for Kids.

CHIP’s history

In 1997, Congress passed Title XXI of the Social Security Act, which enabled states to create programs for the growing number of uninsured children in the country.

The program was created during the Clinton administration by the Balanced Budget Act of 1997. At the time, 10 million children were without health insurance and many of those children were part of working families with incomes slightly above states’ Medicaid eligibility levels, according to the Medicaid and CHIP Payment and Access Commission.

The Children’s Health Insurance Program Reauthorization Act (CHIPRA) reauthorized CHIP in April 2009.

The next year, the Affordable Care Act contained provisions to strengthen the program and later extended CHIP funding until September 30, 2015. It also required states to maintain eligibility standards through 2019.

By 2015, 18 years after its enactment, 3.3 million children in the U.S. were without health insurance.

In October 2017, however, Congress missed a deadline to reauthorize CHIP, which expired on Sept. 30.

“Lawmakers and staffers in Congress say CHIP funding will likely be included in an end-of-year spending bill,” NPR reported Tuesday. “But as of now, there is no CHIP funding bill scheduled for consideration.”

Who is eligible for CHIP?

Eligibility varies by state, but in most states, children up to age 19 with a family income up to $49,200 per year (for a family of four) may qualify for Medicaid or CHIP, according to insurekidsnow.gov.

But even if your family income is higher, children may still qualify.

Some states (Colorado, Missouri, New Jersey, Rhode Island and Virginia) also provide coverage to pregnant women through CHIP.

Coverage is for U.S. citizens and certain lawfully present immigrants.

What does CHIP cover?

State benefits may vary, but all states provide comprehensive coverage for routine check-ups, immunizations, doctor visits, prescriptions, dental/vision care, inpatient /outpatient hospital care, laboratory/X-ray services and emergency services.

How much does CHIP cost?

The cost depends on family income. Many families may get free health insurance coverage for their kids and others may have to pay a modest enrollment fee or premiums, as well as copayments for specific services.

But according to healthcare.gov, you won’t have to pay more than 5 percent of your family’s income for the year.

How do you apply for CHIP?

There are three ways to apply. You can either call 1-800-318-2596 (1-855-889-4325 for TTY), fill out an application through the health insurance marketplace or apply directly with your state’s CHIP agency.

How many children get health insurance from CHIP?

Nine million kids get health insurance under CHIP.

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