CHIP vs. Medicaid for Kids: Understanding the Key Differences

When you are trying to get health coverage for your child, two programs usually come up: Medicaid and CHIP (Children’s Health Insurance Program). They sound similar and sometimes even share the same application, which can be confusing.

This guide explains, in plain English, how Medicaid and CHIP differ for children, who typically qualifies for each, and what to expect when you go through official state channels to apply.

HowToGetAssistance.org is an independent, informational website. It is not a government agency, not an enrollment site, and not an official benefits portal. Our goal is to help you understand how these programs usually work so you can take your next steps with your state or local benefits office.

Medicaid vs. CHIP: The Basics

What is Medicaid for kids?

Medicaid is a public health coverage program that usually helps:

• Low-income children
• Pregnant people
• Many adults with low income, including some seniors and people with disabilities

For kids, Medicaid typically offers comprehensive coverage with little to no cost, depending on your state and your household income. In many states, children can qualify for Medicaid at higher income levels than adults.

Medicaid is funded by both the federal government and the states, but each state runs its own program, sets its own income limits (within federal rules), and decides exactly what is covered.

What is CHIP (Children’s Health Insurance Program)?

CHIP is designed for children in families who earn too much to qualify for Medicaid but still struggle to afford private insurance. In some states, CHIP also covers pregnant people.

Key points about CHIP:

• It focuses on children’s health coverage
• It often fills the gap between Medicaid and employer/private insurance
• States can run CHIP as:
  • A separate program
  • A Medicaid expansion (kids are technically covered under Medicaid rules)
  • Or a combination of both

Even when CHIP is run together with Medicaid, states often present it to families as a distinct option, especially when talking about income limits or costs.

Side-by-Side Comparison: CHIP vs. Medicaid for Children

Below is a typical comparison. Exact details vary by state, so always confirm with your state Medicaid/CHIP office or official benefits portal.

Who Usually Qualifies for Medicaid vs. CHIP?

Because both programs are state-run, exact rules differ. However, there are some common patterns.

Typical Medicaid eligibility for children

Children may qualify for Medicaid if:

• Your household income is below your state’s Medicaid limit for their age group
• The child is a resident of the state
• The child is a U.S. citizen or meets immigration status requirements (varies by state)
• The child meets any age requirements set by the state

Some states have special Medicaid rules for:

• Children with disabilities or special health needs
• Foster children or children in state custody
• Certain former foster youth up to a higher age

In many states, children can qualify for Medicaid at higher income levels than adults in the same family.

Typical CHIP eligibility for children

Children usually qualify for CHIP when:

• Family income is too high for Medicaid, but still under the CHIP income limit
• The child is a resident of the state
• The child is a U.S. citizen or meets immigration status requirements (varies by state)
• The child is uninsured (some states restrict CHIP if a child already has other coverage)

Some states also consider:

• Whether the child has been without insurance for a certain time
• Whether a parent declined employer-sponsored coverage (rules vary)

Since income limits for CHIP are often higher than for Medicaid, CHIP can help many working families who don’t qualify for Medicaid but cannot afford private coverage.

What Does Each Program Usually Cover for Kids?

Coverage can vary, but most states aim to give children broad access to healthcare through both Medicaid and CHIP.

Common Medicaid benefits for children

Medicaid for kids often includes:

• Doctor visits, including primary care and specialists
• Well-child checkups and immunizations
• Emergency care and hospital stays
• Prescription medications
• Dental and vision care
• Lab tests and X-rays
• Mental and behavioral health services
• Therapies (physical, occupational, speech), especially for certain conditions
• Medical equipment when medically necessary (wheelchairs, some devices)
• For many children, Medicaid also includes EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) services, which aim to ensure comprehensive screening and treatment for health issues.

Common CHIP benefits for children

CHIP typically covers:

• Routine checkups and sick visits
• Immunizations
• Emergency services
• Prescription drugs
• Dental and vision services (coverage details vary by state)
• Mental and behavioral health care

Coverage under CHIP is often similar to a child-focused insurance plan, with low copays and sometimes modest premiums, depending on income.

Cost Differences: What Families Usually Pay

Medicaid costs for children

For most children on Medicaid:

• Monthly premiums: Usually none
• Copays: Often none or very low
• Deductibles: Typically none for children

Some states may charge small copays for certain services, but Medicaid for kids is often very low cost or no cost at the point of service.

CHIP costs for children

For CHIP, states may charge:

• Low monthly premiums, based on income
• Copays for doctor visits, prescriptions, or emergency care
• Sometimes annual out-of-pocket caps, so you don’t pay beyond a certain total each year

Many lower-income families on CHIP pay no premium, while families closer to the income limit may pay modest monthly amounts.

How Do You Know Which One Your Child Might Get?

One of the most confusing parts is figuring out whether your child should be on Medicaid or CHIP. In many states, you don’t have to decide. You simply:

1. Submit one application through your:

   • State Medicaid agency
   • State health coverage marketplace
   • Or combined Medicaid/CHIP office

2. The state system reviews your income and household details

3. The state determines whether your child is eligible for:

   • Medicaid, or
   • CHIP, or
   • Another state program, or
   • No program (if income is beyond the limit or other criteria are not met)

The decision is usually made behind the scenes based on your answers and the documents you provide.

Documents Families Are Commonly Asked to Provide

Requirements differ by state, but when applying for Medicaid or CHIP for a child, you should generally be ready with:

Identity and household information:

• Child’s full name, date of birth, and address
• Parent or guardian information (names, dates of birth)
• Social Security numbers for each person applying (if available and required; some noncitizen family members may not need to provide one if they are not applying for coverage)

Immigration and citizenship information (as applicable):

• U.S. birth certificate or other proof of citizenship
• Immigration documents for noncitizen applicants, if the program accepts them (e.g., a green card or other status documents), depending on state rules

Income and employment information:

• Recent pay stubs or proof of wages
• Self-employment records, if applicable
• Information on unemployment benefits, Social Security benefits, or other income
• Employer information, if requested

Residence documentation:

• A lease, utility bill, or official mail showing your current address, if asked

Some states verify much of this electronically, but it is usually helpful to have these items ready. If you are unsure, you can call your state Medicaid/CHIP hotline or local benefits office and ask what documents to bring.

Where and How to Apply (Official Channels Only)

HowToGetAssistance.org cannot process applications and cannot check your eligibility or enrollment status. To apply, you must use your state’s official channels.

Common ways to apply include:

1. Online through your state’s official benefits portal

   • Many states have a single website where you can apply for Medicaid, CHIP, and sometimes other benefits (like SNAP or cash assistance).
   • Search for terms like “[Your State] Medicaid application” or “[Your State] CHIP program” and look for a website that clearly belongs to a state agency (often ending in .gov or showing a state seal).

2. By phone

   • Most states have a Medicaid or CHIP hotline listed on their official health or human services website.
   • You can call to:
     • Ask questions
     • Start an application
     • Request a paper form
     • Find local office locations

3. In person at a local office

   • This is often a county human services office, Medicaid office, or social services department.
   • You can usually:
     • Pick up and submit paper applications
     • Get help filling out forms
     • Turn in verification documents

4. By mail or fax

   • Some states accept mailed or faxed applications.
   • Instructions are typically provided on the official state forms.

If you are not sure which office is correct, you can:

• Call 211 in many areas and ask for the Medicaid or CHIP office in your county
• Call your state Department of Health, Department of Human Services, or Medicaid agency and ask where families should apply for children’s coverage

What Happens After You Apply?

The process after you submit an application through your state’s official system usually looks like this:

1. Review of your application

   • The state looks at your income, household size, and other details.
   • They may try to electronically verify your information.

2. Requests for more information (if needed)

   • You might receive a letter, portal message, or phone call asking for:
     • Additional pay stubs
     • Proof of address
     • Citizenship or immigration status documents
   • There is often a deadline for sending these in, and missing it can delay or stop your application.

3. Eligibility decision

   • The state decides whether your child qualifies for:
     • Medicaid
     • CHIP
     • Another program
     • Or is not eligible for public coverage
   • You usually receive a notice by mail (and sometimes online) explaining the decision.

4. Enrollment and health plan selection

   • If approved, you may:
     • Be automatically enrolled in a Medicaid or CHIP plan, or
     • Be asked to choose a managed care plan from a list
   • You should receive an insurance card or a coverage letter, plus information on how to find doctors and providers.

5. Annual review or renewal

   • Eligibility is usually reviewed once a year or when there is a major change in income or household.
   • You may be asked to confirm or update your information by a specific deadline.

Common Reasons for Delays or Denials

Families often run into problems that can slow things down or lead to a denial. Some of the most common include:

• Incomplete applications

  • Leaving out required information about income, household members, or addresses

• Missing documents

  • Not turning in requested proof of income, identity, or citizenship/immigration status by the deadline

• Income above the limit

  • Household income is higher than the state’s cutoff for both Medicaid and CHIP

• Not meeting residency rules

  • Trying to apply in a state where you do not currently live

• Issues with immigration status

  • Some programs have specific rules about which immigration statuses qualify and what documentation is needed

If your application is denied, the decision notice usually includes:

• The reason for denial
• Instructions on how to appeal or request a fair hearing
• Deadlines for taking action

How Appeals and Reviews Usually Work

If you believe your child was wrongly denied Medicaid or CHIP coverage, you generally have the right to appeal through official channels.

Common steps:

1. Read the denial or closure notice carefully

   • Look for the reason given and appeal instructions.
   • Note any deadline to request an appeal or hearing (these can be short).

2. Request an appeal or fair hearing

   • Usually done by:
     • Mailing or faxing an appeal form or letter
     • Calling the number provided on the notice
   • Follow your state’s specific instructions; missing steps can delay your case.

3. Prepare supporting documents

   • Updated pay stubs if income was miscalculated
   • Correct household information
   • Any letters or records that clarify mistakes

4. Attend the hearing or phone meeting (if scheduled)

   • Some states hold appeals by phone or video, others in person.
   • You can explain your situation, and in some cases, you can bring an advocate or representative.

If you are unsure how to proceed, you can ask:

• The state Medicaid or CHIP office
• A legal aid organization in your area
• A community health center or navigator that helps families with coverage applications

If Your Child Doesn’t Qualify for Medicaid or CHIP

If your child is found ineligible, there may still be other options.

Possible alternatives include:

• Marketplace health plans

  • You may be able to apply for coverage through your state’s health insurance marketplace.
  • Depending on your income and family size, you might qualify for premium tax credits to lower monthly costs.

• Employer-sponsored coverage

  • If a parent or guardian has access to health insurance through an employer, you may look into adding the child, even if it costs more.

• Community health centers and sliding-scale clinics

  • Many areas have community health clinics offering services on a sliding fee scale based on income.
  • You can ask local hospitals or call 211 to find clinics in your area.

• Hospital financial assistance programs

  • Some hospitals offer charity care or discount programs for uninsured children.

• School-based health services

  • Certain school districts operate school-based health centers that provide basic care, immunizations, or mental health services.

While these options may not fully replace Medicaid or CHIP, they can help reduce the cost of necessary care.

How to Make Sure You’re Using an Official Channel (Avoiding Scams)

Because Medicaid and CHIP involve sensitive information, it is important to be sure you are working with official sources.

Here are some tips:

• Look for state or government identifiers

  • Official websites often end in “.gov” or clearly show your state’s name and agency logo.
  • Avoid applying through unfamiliar sites that look like they are “middlemen” or charge fees.

• Be cautious with fees

  • Applying for Medicaid or CHIP is typically free. Be wary of anyone asking for an application fee.

• Protect your personal information

  • Only provide Social Security numbers or immigration documents to:
    • Official state portals
    • State or county offices
    • Official program hotlines

• Call to confirm

  • If you are unsure a website or phone number is real, call your state Medicaid office, health department, or 211 and ask for the correct contact for Medicaid or CHIP.

• Don’t rely on unofficial approval promises

  • No private website or person outside the program can guarantee approval or speed up your case in exchange for payment.

Key Takeaways for Parents and Caregivers

• Medicaid is usually for children in lower-income families, often with very little to no cost and comprehensive coverage.
• CHIP generally serves children whose families earn too much for Medicaid but still struggle with private insurance costs, often with low premiums and copays.
• States often use one combined application to decide if your child qualifies for either program.
• To apply, you must go through your state’s official Medicaid/CHIP office, benefits portal, or local county agency—not through HowToGetAssistance.org.
• Have identity, income, and residency documents ready, and respond quickly if your state asks for more information.
• If you are denied, you can usually appeal through official channels by following instructions in your decision notice.
• If your child does not qualify, explore marketplace plans, employer coverage, community clinics, and hospital financial assistance as back-up options.

Understanding how CHIP vs. Medicaid works for kids can help you choose the right next step: contacting your state’s Medicaid or CHIP office, visiting the official state benefits website, or calling a local agency or 211 to get connected to the correct application channel.