Health Care


What is SCHIP?

The State Children’s Health Insurance Program (SCHIP, also just called CHIP) is a federal government program to provide health insurance to low-income children whose families do not qualify for Medicaid. Although it does not cover adults, CHIP can be a great relief to unemployed parents, because they can cover their kids with CHIP and buy less expensive individual coverage for themselves. CHIP is funded by both the federal and state governments, but administered by the states, which means that eligibility, coverage, application process, and claim process may vary from state to state.

Who is eligible for CHIP coverage?

Children under 18, whose family’s income is too high to qualify for Medicaid, but not covered by employers or privately purchased health insurance. Each state has some additional conditions to qualify for coverage, usually related to the family’s income relative to the federal poverty level.

What does CHIP cover?

The services covered by CHIP vary from state to state, but generally speaking, coverage includes:

  • Doctor’s office visits
  • Hospital care (including emergency room care)
  • Dental checkups, cleanings, and fillings
  • Prescription drugs
  • Vaccinations
  • Eye Exams and glasses
  • Medical specialists
  • Mental health care
  • Medical tests and x-rays
  • Medical supplies and special health needs
  • Treatment of Pre-existing conditions

What do I have to pay?

Because CHIP is intended to assist low-income children, families do not pay monthly premiums as they would in a typical health insurance plan. Parents may be required to pay small co pays for office visits, but these will typically be much lower than normal insurance co pays.

How does CHIP pay claims?

Doctors who treat children covered by CHIP bill the state, which pays them directly.

How do I apply for CHIP coverage?

Apply through your state health and social services department.

What if my child is denied coverage?

You have the right to appeal a denial of CHIP coverage in all states. When the state denies your child for coverage, they will send you a letter telling you why. You usually have 30 days after that to submit an appeal in writing to the state health and social services department, explaining why you believe they made an error, and why your child should be covered.

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Health Care