The Children’s Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. CHIP is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.
Benefits
The Children's Health Insurance Program (CHIP) provides comprehensive benefits to children. Since states have flexibility to design their own program within Federal guidelines, benefits vary by state and by the type of CHIP program.
Medicaid Expansion Benefits
Medicaid Expansion CHIP programs provide the standard Medicaid benefit package, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, which includes all medically necessary services like mental health and dental services.
Separate CHIP Benefits Options
States can choose to provide benchmark coverage, benchmark-equivalent coverage, or Secretary-approved coverage:
Benchmark coverage based on one of the following:
The standard Blue Cross/Blue Shield preferred provider option service benefit plan offered to Federal employees
State employee's coverage plan
HMO plan that has the largest commercial, non-Medicaid enrollment within the state
Benchmark-Equivalent coverage must be actuarially equivalent and include:
Inpatient and outpatient hospital services
Physician's services
Surgical and medical services
Laboratory and x-ray services
Well-baby and well-child care, including immunizations
Secretary-approved coverage: Any other health coverage deemed appropriate and acceptable by the Secretary of the U.S. Department of Health and Human Services.
Separate CHIP Dental Benefits
States that provide CHIP coverage to children through a Medicaid expansion program are required to provide the EPSDT benefit. Dental coverage in separate CHIP programs is required to include coverage for dental services "necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions."
States with a separate CHIP program may choose from two options for providing dental coverage: a package of dental benefits that meets the CHIP requirements, or a benchmark dental benefit package. The benchmark dental package must be substantially equal to the (1) the most popular federal employee dental plan for dependents, (2) the most popular plan selected for dependants in the state’s employee dental plan, or (3) dental coverage offered through the most popular commercial insurer in the state.
States are also required to post a listing of all participating Medicaid and CHIP dental providers and benefit packages on www.insurekidsnow.gov.
Vaccines
Coverage for age-appropriate immunizations is required in CHIP. States with a separate CHIP program (including the separate portion of a combination program) must purchase vaccines to be administered to enrolled children using only CHIP federal and state matching funds. Vaccines for federally vaccine-eligible children (through the Vaccines For Children program) should not be used by children enrolled in separate CHIP programs, and funds available under section 317 of the Public Health Service Act are designated for the purchase of vaccines for the uninsured and may not be used to purchase vaccines for children who have separate CHIP coverage.
States have two options for purchasing vaccines for children enrolled in separate CHIP programs: (1) purchase vaccines using the CDC contract and distribution mechanism, or (2) purchase vaccines through the private sectsepara
The Children's Health Insurance Program (CHIP) serves uninsured children up to age 19 in families with incomes too high to qualify them for Medicaid. States have broad discretion in setting their income eligibility standards, and eligibility varies across states.
Income Eligibility
46 States and the District of Columbia cover children up to or above 200% of the Federal Poverty Level (FPL) ($44,700 for a family of four in 2011), and 24 of these states offer coverage to children in families with income at 250% of the FPL or higher. States may get the CHIP enhanced match for coverage up to 300% of the FPL ($67,050 for a family of four in 2011), which is higher than the Medicaid federal funding matching rate. See information on CHIP Financing.
States that expand coverage above 300% of the FPL get the Medicaid matching rate. States have the option to provide continuous eligibility to children who remain eligible for CHIP.
New Medicaid & CHIP Coverage Options
Lawfully Residing Children and Pregnant Women
Many states have elected the option under CHIPRA to restore Medicaid and/or CHIP coverage to children and pregnant women who are lawfully residing in the United States.
Pregnant Women
CHIPRA created an explicit eligibility category for pregnant women to receive coverage through CHIP in certain circumstances. states have also chosen to provide prenatal care for pregnant women through the CHIP program through other available vehicles.
Children of Public Employees
The Affordable Care Act of 2010provides states the option to extend CHIP eligibility to state employees' children. Before enactment of the Affordable Care Act children of public employees were not eligible for CHIP, regardless of their income.
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