What Is the Children's Health Insurance Program (CHIP)?

The Children's Health Insurance Program (CHIP) is a joint federal and state program that provides low-cost or free health coverage to eligible children—and, in some states, pregnant adults—whose families earn too much to qualify for Medicaid but cannot easily afford private health insurance. CHIP covers routine medical care, preventive services, prescriptions, hospital care, and other essential healthcare services.

What is the Children's Health Insurance Program?

The Children's Health Insurance Program (CHIP) helps families obtain affordable health coverage for children who might otherwise go without insurance.

CHIP was created to fill the gap between Medicaid and private health insurance.

Although CHIP is funded jointly by the federal government and the states, each state administers its own program. As a result, eligibility requirements, covered services, enrollment procedures, and program names vary by state.

Some states combine CHIP with their Medicaid program, while others operate CHIP as a separate program.

What does CHIP cover?

While benefits differ by state, CHIP generally covers comprehensive healthcare services for eligible children, including:

• Well-child checkups
• Immunizations
• Primary care visits
• Specialist care
• Hospital services
• Emergency care
• Prescription medications
• Laboratory tests
• X-rays and diagnostic services
• Mental and behavioral health services
• Dental care
• Vision care

States may offer additional covered benefits beyond federal minimum requirements.

Who qualifies for CHIP?

Eligibility is determined by each state within federal guidelines.

Factors commonly considered include:

• Child's age
• Household income
• Household size
• State of residence
• Immigration or citizenship status

Many families qualify for CHIP even if they believe they earn too much for Medicaid.

Applying through the Health Insurance Marketplace® or your state's Medicaid agency will determine whether your family qualifies for Medicaid, CHIP, or Marketplace coverage.

How much does CHIP cost?

Many families pay nothing for CHIP coverage.

Others may pay:

• A modest monthly premium
• Enrollment fees
• Small copayments for certain services

Federal law limits the amount families can be required to pay, and costs vary by state.

Even when premiums or copayments apply, CHIP is generally much less expensive than purchasing comparable private health insurance.

CHIP vs. Medicaid

CHIP and Medicaid are closely related but are not the same program.

CHIP

• Designed for children in families whose income is generally too high to qualify for Medicaid but who still need affordable coverage.
• Eligibility limits vary by state.
• May require modest premiums or cost-sharing in some states.

Medicaid

• Provides health coverage for eligible children, adults, older adults, pregnant individuals, and people with disabilities.
• Eligibility is based on federal and state rules.
• Many beneficiaries pay little or nothing for covered services.

In some states, the distinction between CHIP and Medicaid is largely administrative because the programs operate together.

CHIP vs. private health insurance

Both provide comprehensive health coverage, but they serve different purposes.

CHIP

• Publicly funded.
• Available only to eligible families.
• Costs are generally much lower than private insurance.

Private health insurance

• Purchased through an employer, the Marketplace, or directly from an insurance company.
• Available regardless of income, although financial assistance may be available through the Marketplace.

Families who lose employer-sponsored insurance or experience other life changes may qualify for CHIP if they meet state eligibility requirements.

Can pregnant adults qualify for CHIP?

Yes, in some states.

Federal law allows states to provide CHIP coverage for certain pregnant adults.

Because eligibility rules vary, applicants should check with their state's CHIP agency or apply through the Health Insurance Marketplace to determine available coverage options.

Why this matters

Health insurance helps children receive preventive care, vaccinations, treatment for illnesses, prescription medications, and ongoing medical services that support healthy development. CHIP has become an important source of health coverage for families who earn too much to qualify for Medicaid but still need affordable insurance for their children.

Because eligibility rules differ by state, many families are surprised to learn they qualify.