How to Apply for CHIP Health Insurance for Your Child in Your State

How do you apply for CHIP health insurance?

The Children's Health Insurance Program (CHIP) provides free or low-cost health coverage for eligible children in families that may earn too much to qualify for Medicaid but cannot easily afford private insurance.

To begin, use the official InsureKidsNow.gov state coverage directory. Select your state to find the appropriate program, contact information and application route.

You can also apply through HealthCare.gov's Medicaid and CHIP application guidance or call 1-877-KIDS-NOW (1-877-543-7669) for help finding your state's program.

Applications are accepted throughout the year. You do not need to wait for the annual Health Insurance Marketplace Open Enrollment Period.

The state agency decides whether your child qualifies. Income limits, premiums, enrollment procedures and some benefits differ by state.

What is CHIP, and who is it designed to help?

CHIP is a joint federal-state health coverage program administered by states under federal requirements.

Its primary purpose is to cover eligible children whose families have incomes above the Medicaid eligibility range but within the state's CHIP limits.

States may operate CHIP through a separate program, a Medicaid expansion or a combination of approaches. The name families see on the application may therefore differ from the federal program name.

Some states also provide CHIP coverage for certain pregnant individuals, but this guide focuses on applying for a child's health insurance.

CHIP versus Medicaid for children

Medicaid and CHIP are coordinated so families can apply for coverage without having to decide in advance which program their child qualifies for.

When you apply through the state Medicaid agency, your child's eligibility for CHIP can also be evaluated. When you apply through the Marketplace and the information indicates possible Medicaid or CHIP eligibility, it is transferred securely to the state agency for a determination.

Do not reject the possibility of coverage merely because you were previously told that your own income is too high for adult Medicaid.

Is your child eligible for CHIP?

CHIP eligibility depends on both financial and nonfinancial requirements.

The federal CHIP Eligibility and Enrollment guidance identifies the main requirements for targeted low-income children.

• Age: The child generally must be younger than 19.
• State residency: The child must reside in the state providing coverage.
• Household income: The family must meet the state's applicable CHIP income range.
• Other health coverage: Separate CHIP generally serves uninsured children who are not eligible for Medicaid.
• Citizenship or immigration status: The child must meet applicable federal and state eligibility requirements.
• Other program exclusions: Certain institutional or public-employee coverage situations can affect eligibility.

The state's eligibility agency evaluates the child's complete circumstances rather than using one nationwide income cutoff.

What are the CHIP income limits?

There is no single CHIP income limit for every U.S. state. States set different eligibility levels within federal requirements.

Financial eligibility generally uses Modified Adjusted Gross Income (MAGI), with rules for household size and income.

Some states cover children at substantially higher household incomes than their Medicaid thresholds. A family's eligibility may also differ according to the child's age.

Use the official state coverage directory to find the correct state-specific information.

For example, a family whose income is above the limit for children's Medicaid may still qualify for separate CHIP. Another family with a lower income may be placed in Medicaid instead. Both outcomes can provide health coverage for the child.

A federal poverty-level percentage from another state or a previous year is not a reliable substitute for your state's current eligibility rules.

Can your child qualify if you cannot get Medicaid?

Yes. Children's Medicaid and CHIP eligibility rules can be different from the rules governing Medicaid coverage for adults.

A parent who is not eligible for adult Medicaid may still have a child who qualifies for Medicaid or CHIP.

HealthCare.gov also explains that parents and other household members may qualify for Marketplace coverage even when their children are eligible for CHIP.

If you need help finding care for another child or support for your household, you can separately review child care financial assistance programs. Those programs have different eligibility rules and applications.

Can a child with an immigration status qualify for CHIP?

Citizenship and immigration requirements affect eligibility.

Current HealthCare.gov guidance identifies specific immigration categories eligible for full Medicaid or CHIP coverage under updated federal rules and explains that state-specific provisions may also apply.

Do not assume that every lawfully present immigration status automatically qualifies for CHIP.

Use the official CHIP eligibility page and your state agency's instructions to check the child's particular status.

The child's eligibility must be assessed under the applicable rules. A household should provide accurate information about the individuals actually applying for coverage.

Where do you apply for CHIP in your state?

Every state has a Medicaid and CHIP application pathway, but the program names and websites are not identical nationwide.

The most direct federal starting point is the Find Coverage for Your Family directory.

1. Open the directory.
2. Select the state where your child lives.
3. Review the state Medicaid and CHIP program information.
4. Follow the state application link or contact the listed agency.
5. Ask whether the application covers both children's Medicaid and CHIP.

If you prefer telephone assistance, call 1-877-KIDS-NOW. The federal hotline helps families connect with the appropriate state program.

Option 1: Apply through your state agency

You can apply directly to the state Medicaid or CHIP agency responsible for your child's coverage.

Depending on the state, applications may be available online, by telephone, by mail or in person.

This route is useful when you already know your state's program, need help with state-specific eligibility questions or want to provide documents directly to the responsible agency.

Use the state contact information in the official InsureKidsNow.gov directory rather than an unverified third-party enrollment website.

Option 2: Apply through the Health Insurance Marketplace

HealthCare.gov offers an application pathway that can identify household members who may qualify for Medicaid or CHIP.

Use the Medicaid and CHIP application instructions to begin.

If the Marketplace application indicates possible Medicaid or CHIP eligibility, the information is securely sent to the state agency.

The state agency then contacts you about the eligibility determination and enrollment.

A Marketplace screening result is not the same as a final CHIP approval. The state agency remains responsible for determining eligibility.

Option 3: Apply without an online account

InsureKidsNow.gov confirms that families may apply online, by phone, by mail or in person.

The available procedures and addresses depend on the state.

If you cannot use an online application, contact your state agency or call 1-877-KIDS-NOW for instructions.

Do not send an application to a federal mailing address unless your state's official instructions specifically direct you there.

What should you prepare before applying?

Most applications ask for information about the child, household and family income.

Gather the details before starting so you can answer accurately and respond quickly if the state requests verification.

Child and household details

• Child's full name and date of birth.
• Current home address and contact information.
• Parent or caregiver information.
• Household members relevant to the application.
• Social Security number when required.
• Citizenship or immigration-status information when applicable.
• Information about any existing health insurance.

The state may request additional details depending on household circumstances.

Income and employment details

Prepare information about the household's current income, including wages and other income sources requested by the application.

Eligibility is generally based on MAGI rules, but the state determines which household members and income amounts count.

If your income recently changed, provide accurate current information and follow the application's instructions about expected income.

Do not assume that a previous tax return alone will establish your child's current eligibility.

Do you need to upload pay stubs or identity documents?

Not every family must submit the same documents.

CMS explains that Medicaid and CHIP agencies use available electronic data sources to verify eligibility information where possible.

If the information cannot be verified, the agency may request supporting records or an explanation.

Examples may include income documents, proof of residence or information about citizenship or immigration status, depending on the unresolved eligibility question.

Follow the exact request from the state agency. Sending unrelated records does not necessarily speed up processing.

The federal Medicaid and CHIP eligibility verification guidance explains the use of electronic data and state verification procedures.

How much does CHIP cost?

There is no charge to submit a CHIP application.

Many eligible children receive free coverage. Other families may pay premiums, enrollment fees or copayments, depending on state rules and income.

Federal CHIP rules limit applicable family cost-sharing. HealthCare.gov explains that CHIP families do not pay more than 5% of annual family income in covered cost-sharing.

Federal rules also prohibit cost-sharing for covered well-baby and well-child care services.

The exact premium and copayment amounts must be checked with your state program.

CMS also identifies special cost-sharing protections for certain children, including American Indian and Alaska Native children.

Review the official CHIP cost-sharing rules and your state's published plan information.

What does CHIP cover for children?

CHIP provides comprehensive health benefits for eligible children.

HealthCare.gov identifies the following types of services covered by state CHIP programs:

• Routine checkups and preventive care.
• Immunizations.
• Doctor visits.
• Prescription medicines.
• Dental care.
• Vision care.
• Inpatient and outpatient hospital services.
• Laboratory and X-ray services.
• Emergency services.
• Behavioral health services.

Specific covered treatments, participating providers, referral requirements and health-plan arrangements differ by state.

Before scheduling nonemergency treatment, confirm that the provider accepts the child's CHIP plan and that any required referral or authorization has been obtained.

Use the official CHIP benefits overview and your state's plan documents.

When can you apply, and how long does approval take?

You can apply for Medicaid or CHIP at any time of year.

There is no annual CHIP Open Enrollment Period comparable to the Marketplace enrollment window.

If your child qualifies, coverage can begin without waiting for the next Marketplace enrollment season.

CMS requires states to process applications promptly and without undue delay.

For a typical CHIP application not involving a disability determination, federal rules generally require an eligibility determination within 45 days.

This is a maximum timeliness standard under the applicable rules, not a promise that every application will take exactly 45 days.

Actual processing may be faster. The state determines the effective coverage date according to the applicable program rules.

If your state requests missing information, respond by the deadline in its notice.

See the CMS application and eligibility determination resources.

How will you know whether your child was approved?

The state Medicaid or CHIP agency reviews the application and determines the child's eligibility.

If you applied through HealthCare.gov, the Marketplace may transfer the relevant application information to the state for its decision.

The agency may contact you to confirm information or request additional evidence.

Keep your contact information current and read notices carefully.

If your child qualifies

The state will provide enrollment instructions and information about the coverage available.

Depending on the state, you may need to select a health plan, choose a participating doctor or complete another enrollment step.

Some states charge premiums or other permitted costs.

Confirm the coverage start date before assuming that a medical appointment or prescription will be paid for.

Keep the child's insurance information available when visiting doctors, hospitals, dentists or pharmacies.

If your application is incomplete

The state may request additional documents or clarification when it cannot verify an eligibility factor.

Read the request carefully to identify what information is missing and how to submit it.

Respond within the stated deadline and retain proof of submission where possible.

If you do not understand the request, contact the agency using the telephone number on the notice.

Can you appeal a CHIP denial?

Yes. Medicaid and CHIP applicants have rights to challenge certain adverse eligibility decisions through the applicable state review or hearing process.

If the state denies your child's application, it should provide a notice explaining the decision and the available review or appeal rights.

Read the notice to identify the reason for denial, the appeal deadline and the correct submission method.

Appeal deadlines and procedures depend on the applicable program and state rules. Do not assume that the deadline used in another state applies to your case.

If the denial appears to result from incorrect income or household information, contact the state agency and ask how to correct the record. Follow the formal appeal instructions when you want the adverse decision reviewed.

CMS provides official application and fair-hearing resources.

Can your child get Marketplace coverage instead?

Possibly. If your child is not eligible for Medicaid or CHIP, you may be able to obtain Marketplace coverage.

HealthCare.gov explains that a Medicaid or CHIP denial or loss of coverage can create an opportunity to enroll in a Marketplace plan, depending on the circumstances.

Use the official Marketplace transition guidance to review your options and deadlines.

Do not assume that every CHIP denial automatically qualifies your family for subsidized Marketplace coverage. Marketplace eligibility and financial assistance are assessed separately.

Can your child have CHIP while you have different coverage?

Yes. Members of the same household can qualify for different health coverage programs.

For example, a child may qualify for CHIP while a parent qualifies for Marketplace coverage or employer-sponsored insurance.

HealthCare.gov explains that if a child is eligible for CHIP, that child generally cannot receive Marketplace financial assistance for a private Marketplace plan.

However, parents and other household members may still qualify for Marketplace savings based on their own eligibility.

If a parent recently lost other coverage, the separate guide on Marketplace enrollment after losing coverage explains that application process.

Do not cancel existing insurance before confirming when replacement coverage begins.

Does CHIP coverage need to be renewed?

CHIP coverage is subject to ongoing program eligibility and renewal requirements.

Federal rules generally require 12 months of continuous eligibility for children under 19 enrolled in Medicaid or CHIP, subject to applicable exceptions.

This protection helps prevent certain midyear coverage interruptions, but families must still follow renewal instructions and report changes required by their state program.

CMS explains the continuous-eligibility requirements in its continuous eligibility guidance.

Keep your mailing address, telephone number and other required contact details current with the state agency.

When you receive a renewal notice, respond by the stated deadline and provide any requested information.

Do not assume that a child will remain enrolled indefinitely without renewal or eligibility review.

What should you avoid when applying?

• Assuming your income is too high: children's CHIP limits may be higher than adult Medicaid limits.
• Using another state's income threshold: eligibility differs by state.
• Waiting for Marketplace Open Enrollment: CHIP applications are accepted year-round.
• Applying to the wrong state: use the state where the child resides.
• Omitting household information: provide the information needed to assess eligibility accurately.
• Ignoring an evidence request: respond to the state agency's verification notice.
• Confusing a Marketplace screening result with CHIP approval: the state makes the eligibility decision.
• Assuming coverage starts on the application date: confirm the official effective date.
• Ignoring renewal notices: follow state instructions to protect ongoing coverage.
• Paying an unofficial enrollment service: CHIP applications are free through official channels.

Example: Your child needs insurance but your income is above Medicaid limits

A parent works full time and has been told that their household income is too high for adult Medicaid.

The parent's child has no health insurance, so the parent opens InsureKidsNow.gov and selects the state where the family lives.

The parent completes the state's combined Medicaid and CHIP application using current household information.

The state checks whether the child qualifies for children's Medicaid. If the child does not qualify for Medicaid, the agency evaluates eligibility for CHIP under the state's rules.

If the child qualifies, the family receives enrollment instructions and information about any applicable costs.

If the child is denied both programs, the parent reviews the written decision and explores Marketplace coverage or an appeal, as appropriate.

This example illustrates the decision process; it does not assume a particular household income, premium or eligibility result.

Where can you get help applying?

Use official federal and state resources to find the correct program and submit an application.

• InsureKidsNow.gov - Find Coverage for Your Family.
• InsureKidsNow.gov - Frequently Asked Questions.
• HealthCare.gov - Children's Health Insurance Program.
• HealthCare.gov - Apply for Medicaid and CHIP.
• Medicaid.gov - CHIP Eligibility and Enrollment.

For help locating the correct state program, call 1-877-KIDS-NOW (1-877-543-7669).

For assistance with a HealthCare.gov application, call 1-800-318-2596 (TTY: 1-855-889-4325).

Before applying, confirm the child's state of residence, prepare accurate household and income information, and use the official state application route. Once submitted, keep the confirmation details and respond promptly to agency notices.