How to Qualify For Medicaid and CHIP Health Care Coverage

What Do Medicaid and CHIP Cover? what is the process to enroll for medicaid and chip? medicaid eligibility income

CHIP provides matching funds to states for health insurance to families with children. Matching funds are funds that are set to be paid in proportion to funds available from other sources.

Matching fund payments usually arise in situations of charity or public good. The terms cost sharing, in-kind, and matching can be used interchangeably but refer to different types of donations.

The program was designed to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid.

It was formerly known as the State Children’s Health Insurance Program (SCHIP). It is a program administered by the United States Department of Health and Human Services.

The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services.

CHIP Benefits | Medicaid and CHIP

The Children’s Health Insurance Program (CHIP) provides comprehensive benefits to children. CHIP benefits are different in each state. States have flexibility to design their own program within federal guidelines, so benefits vary by state and by the type of CHIP program.

States may choose between a Medicaid expansion program, a separate CHIP, or a combination of both types of programs.  In some states, CHIP covers pregnant women.

Each state offers CHIP coverage, and works closely with its state Medicaid program. But all states provide comprehensive coverage, like routine check-ups, immunizations, doctor visits, and prescriptions. 

CHIP benefits are different in each state. But all states provide comprehensive coverage, including:

-Routine check-ups
-Doctor visits
-Dental and vision care
-Inpatient and outpatient hospital care
-Laboratory and X-ray services
-Emergency services

CHIP Eligibility | Medicaid and CHIP

In order to be eligible for CHIP, a child must be:

-Under 19 years of age,
-Uninsured (determined ineligible for Medicaid, and not covered through a group health plan or creditable health insurance),
-A citizen or meet immigration requirements,
-A resident of the state, and
-Eligible within the state’s CHIP income range, based on family income, and any other state specified rules in the CHIP state plan.

The following children cannot be eligible for CHIP

-Inmates of a public institution
-Patients in an institution for mental diseases
-Children who are eligible for health benefits coverage under a State health benefits plan due to a family member’s employment with a public agency (unless a state qualifies for either the maintenance of agency contribution, or hardship exception described below).

States have the flexibility to adopt their own eligibility

Within these guidelines, states have the flexibility to adopt their own eligibility standards. For example, some states have designed programs for specific geographic areas, or for children with a disability status.

However, states are precluded from establishing certain types of eligibility criteria, such as discriminating on the basis of diagnosis.

The eligibility criteria for a targeted low-income child is described in Section 2110(b) of the Social Security Act.

In some cases, the income eligibility for children can be higher. Depending on your income level, you may need to pay low premiums and cost-sharing for some services. See your state’s program information for details.

What’s the income level to qualify for Medicaid? It depends on the you live in. If your state has expanded Medicaid, you can qualify based on income alone.

If your state has not expanded Medicaid, you may qualify based on your state’s existing rules. These vary from state to state and may take into account income, household size, family status (like pregnancy or caring for young children), disability, age, and other factors.

Because each state and each family situation is different, there’s no way to find out if you qualify without filling out an application.

2 ways to apply for CHIP | Medicaid and CHIP

1. Through the Health Insurance Marketplace

-Fill out an application through the Health Insurance Marketplace
-If it looks like anyone in your household qualifies for Medicaid or CHIP, we’ll send your information to your state agency. They’ll contact you about enrollment.
-When you submit your Marketplace application, you’ll also find out if you qualify for an individual insurance plan with savings based on your income instead. Plans may be more affordable than you think.

2. Through your state Medicaid agency

-You can also apply directly to your state Medicaid agency. Select your state below for your Medicaid agency’s contact information.
-If my children can get CHIP but I don’t qualify for Medicaid, how can I get insured?
-You may be able to get an insurance plan through the Marketplace, with savings based on your income.

-Create an account or log in to an existing account to get started. If it looks like anyone in your household qualifies for Medicaid or chip, we’ll send your information to your state agency.

-They’ll contact you about enrollment. When you submit your Marketplace application, you will also find out if you qualify for an individual insurance plan with savings based on your income instead.

What if my children are eligible for CHIP, but I would rather buy a Marketplace insurance plan?

If your children are eligible for CHIP, they won’t be eligible for any savings on Marketplace insurance. CHIP coverage will probably be more affordable. Remember, you and other family members may be eligible for savings on Marketplace insurance coverage.

Get Marketplace coverage if you lose or are denied Medicaid or CHIP coverage

You may be able to get health coverage through the Marketplace with savings if you or others in your household:

-Had Medicaid or CHIP coverage, but recently lost your coverage.
-Currently have Medicaid or CHIP coverage, but will lose your coverage soon.
-Applied for Medicaid or CHIP coverage through your state agency and the state denied your application.
-Applied for coverage with the Marketplace and were found potentially eligible for Medicaid or CHIP coverage. Your state checked if you could get Medicaid or CHIP, but said you (or your household member(s)) don’t qualify.

already have a Marketplace account then apply this | Medicaid and CHIP

If you don’t already have a Marketplace account, start a new application, or update your existing one. To start a new application, choose your state and then select “Start my application”.

If you have an existing application, select “Go to my applications & coverage,” and choose the one you want to update under “Your existing applications”. Be sure your application includes:

-Your state’s recent decision about Medicaid and CHIP coverage.
-Information like your current income.

Submit your completed application. You’ll get your eligibility results right away. Enroll in a Marketplace plan, if eligible. Once you enroll, you’ll need to pay your plan’s premium to start your coverage.

Your eligibility results will also tell you if you or anyone in your household qualifies for a Special Enrolment Period, to enroll outside the Open Enrolment Period, or get an earlier coverage start date. If someone in your household recently lost, will soon lose, or were denied Medicaid or CHIP coverage, they may qualify for a Special Enrolment Period. Get more details from here

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