What Is CHIP Insurance? Children's Health Insurance Coverage Explained

The Children's Health Insurance Program (CHIP) offers children low cost, full health coverage to eligible families whose income is too high for Medicaid coverage but not high enough to afford private insurance. CHIP was established by Congress in 1997 because of this unique coverage gap, and currently provides coverage to around 9.4 million children in all 50 states and Washington D.C. CHIP is a federal-state program with the federal government paying 65-80% of the costs, and the states administering the programs in a manner that has design flexibility. Income eligibility ranges are also varied from state to state, ranging from 200% to 400% of the Federal Poverty Level (FPL) for a 4-person family, which is $33,000 in the 48 contiguous states in 2026. The majority of States widen eligibility for CHIP up to 250% FPL and New York goes the farthest to 400% FPL. CHIP benefits are for well-child visits, immunizations, doctor visits, hospital care, dental coverage, vision services, mental health treatment, prescription medications, emergency services and more. Premiums are low (typically $20-$50 per family per month with no premiums in many states), and will never be more than 5% of family income. CHIP doesn't have an open-enrollment period like Marketplace plans, so eligible families can enroll at any time of year.

This guide covers eligibility, income requirements, and services covered by CHIP, as well as how to enroll during 2026. Data is provided by Medicaid.gov, CMS, KFF and the U.S. Department of Health and Human Services. 

What CHIP covers

CHIP is a comprehensive health plan that is specifically for children. The services provided in a CHIP program are similar, but have some variation by state. All CHIP programs must cover at a minimum the services mandated by federal requirements.

Preventive care – well checks, immunizations, health screenings, growth/developmental checks – no cost-sharing. States make an active choice to cover these services: they are designed to encourage children to use preventive services before they require more costly services.

Primary care, specialist care, urgent and emergency room visits are all included as doctor visits. Hospital coverage covers hospital visits and inpatient/outpatient visits, surgical procedures and emergency care.

Full coverage for routine dental cleanings, fluoride, fillings, extractions and orthodontia (in many states), emergency dental services. This is a one of the best part of CHIP for families. The price of private dental insurance for children is usually $30-$50 per month or higher.

Generally, vision services are the eye exam, eyeglasses, contact lenses and vision correction. Coverages vary from state to state.

Covers mental health and substance abuse services such as therapy, counseling, psychiatric services and substance abuse services. Federal mental health parity requirements ensure mental health benefits are equivalent to medical/surgical benefits.

The copays for prescription drugs are generally low, about $0-$10 per prescription based on income and state.

The cost of laboratory and X-ray services, from blood tests to imaging studies and diagnostics, is covered.

Physical, occupational and speech therapy is provided if medically necessary.

To compare Medicaid coverage with CHIP, see our Medicaid guide. 

CHIP eligibility and income limits

To qualify for CHIP, a child must: be uninsured; be under age 19; be a U.S. citizen or qualified non-citizen; live in the state; be in a family whose income falls within the CHIP eligibility range.

Income limits are determined by Modified Adjusted Gross Income (MAGI), which is the same way used to qualify for Medicaid and ACA Marketplace subsidies. The adjusted gross income, tax-exempt interest, untaxed Social Security benefits, and other adjustments are included in MAGI.

State CHIP eligibility income limits vary from 170% to 400% of the Federal Poverty Level. The 2026 FPL guidelines (published by HHS in January 2026, effective January 14, 2026) have been established at the following levels: $15,960 for the individual; $21,720 for a family of two; $27,480 for a family of three; $33,240 for a family of four; and $39,000 for a family of five (higher thresholds in Alaska and Hawaii).

For a family of four, common CHIP income thresholds translate to: 200% FPL = $66,480, 250% FPL = $83,100, 300% FPL = $99,720, 317% FPL = $105,371 (a common threshold), and 400% FPL = $132,960 (New York).

States that have lower CHIP income limits are New York (400% FPL), Maryland (322% FPL), California (266% FPL), and others. Idaho is at the lower income limit states (190% FPL) and some others. Check the Medicaid agency in your state or at InsureKidsNow.gov for your state's specific limit.

Income limits are updated each year according to the FPL changes. The 2026 increases will mean that some families that were not previously eligible for CHIP benefits will be eligible for the first time without a change in income. In 2025 a family of four earning $103,000 was just above the CHIP income threshold, but in 2026 the income will be below the threshold.

See our Medicaid qualification for details on Medicaid qualification. 

How CHIP and Medicaid work together

In most states, Medicaid and CHIP operate as a seamless pipeline. When you apply, the system automatically checks Medicaid eligibility first. If your child qualifies for Medicaid, they're enrolled in Medicaid. If your child's family income is above the Medicaid threshold but below the CHIP threshold, they're enrolled in CHIP.

Both programs share the same application in most states. You can apply through HealthCare.gov, your state's Medicaid portal, or directly at your state CHIP office. Some states integrate Medicaid and CHIP into a single program; others operate them separately. The differences usually aren't visible to families.

The key practical difference families notice: Medicaid is free in most cases, while CHIP may charge modest monthly premiums ($20-$50 typically, never exceeding 5% of household income). Even with premiums, CHIP is far less expensive than private insurance, which can cost $300-$600+ monthly for child coverage in private plans.

For children of pregnant individuals, special "From-Conception-to-End-of-Pregnancy" (FCEP) coverage is available in some states. As of 2026, more than 30 states have adopted this option, covering the unborn child from conception through birth regardless of the pregnant person's immigration status.

For Medicaid coverage for pregnant women, see our pregnant women's coverage guide.

State variations in CHIP

States have significant flexibility in CHIP program design. Three main structures exist:

Separate CHIP: A state runs CHIP as a separate program with different eligibility levels, benefits, and cost-sharing from Medicaid. Children move from CHIP to Medicaid (and vice versa) as family income changes.

Medicaid expansion CHIP: A state uses federal CHIP funding to expand its Medicaid program to children at higher income levels. Children at all eligible income levels receive Medicaid benefits.

Combination programs: Many states use both Medicaid expansion and a separate CHIP program for different income ranges.

Specific state variations include: New York's program reaches 400% FPL (highest in the nation), Maryland's program reaches 322% FPL, and Utah operates a separate State CHIP program for non-citizen children that closed enrollment on January 31, 2026 (existing enrollees retain coverage).

State CHIP programs may charge premiums for higher income tiers. Federal rules cap total premiums and out-of-pocket costs at 5% of household income. About one-third of states charge modest premiums or annual enrollment fees; most states charge no fees for CHIP.

Express Lane Eligibility, available in some states, simplifies enrollment by using information from other programs (like SNAP or WIC) to determine eligibility without requiring a separate application.

How to apply for CHIP

Applications can be submitted year-round. There is no open enrollment period. If eligible, coverage typically begins immediately.

Apply online at HealthCare.gov, your state's Medicaid portal, or InsureKidsNow.gov. You can also apply by phone, mail, or in person at your state CHIP office or community health center.

Documents typically needed include child's birth certificate, child's Social Security card, proof of residency (utility bill, lease), recent income documentation (pay stubs, tax return), and immigration documents if applicable.

Most states process applications within 45 days. Faster processing applies to children with urgent medical needs. After approval, your child receives a CHIP card and information about how to access care.

Annual renewal is required. The state sends a renewal notice typically 60-90 days before the renewal date. Respond promptly with any requested information to avoid coverage gaps.

Community health centers, schools, and libraries offer free enrollment assistance. Nonprofit organizations often help with applications and explain state-specific rules.

For how to qualify for Medicaid, see our Medicaid qualification guide.

CHIP transitions when income changes

Family income changes can affect CHIP eligibility. The pipeline structure ensures children move seamlessly between Medicaid and CHIP as income changes.

If your income decreases, your child may transition from CHIP to Medicaid. If your income increases beyond the CHIP threshold, you may qualify for ACA Marketplace coverage with subsidies, or your child may transition to your employer plan if available.

The 2026 changes for Medicaid have made this transition more complex. Some state expansions affect adults' transitions but CHIP children's coverage remains generally protected by the federal funding structure.

Report income changes promptly to your state CHIP office. Most states require notification within 10-30 days of significant changes.

CHIP coverage ends when a child turns 19. At that point, they may qualify for Medicaid as an adult (in expansion states with income below 138% FPL), an ACA Marketplace plan with subsidies, or their parents' employer insurance plan up to age 26.