Medicaid/CHIP - Questions and Answers

You may have many questions about applying for low or no-cost health insurance for your children. Here are some questions and answers to get you started.

About CHIP and Medicaid

I need health insurance for my children. What are my options?

States have different income eligibility, but in most states, uninsured children 18 years old and younger whose family incomes are up to $45,000 per year (for a family of four) can qualify for either Medicaid or CHIP.

Is this program new?

Medicaid has been around since 1965 and CHIP since 1997. In February 2009 and March 2010, President Obama signed legislation that provided additional new funding for the Medicaid and CHIP programs, with a special focus on enrolling kids that have been eligible but have not signed up for coverage. States have expanded and changed their programs over the years, and in many cases, it is easier than ever to apply for CHIP and Medicaid.

Services Covered

What services does Medicaid and CHIP cover?

This insurance pays for doctor visits, immunizations, dental care, prescription medicines, hospital care, and much more. Visit you State's web site for a list of covered services.

Why is health insurance for children and teens important?

Children who have health insurance generally have better health throughout their childhood and into their teens. They are more likely to:

  • Get sick less often
  • Get preventative care to keep them well
  • Get the treatment they need when they are sick
  • Receive needed shots that prevent disease
  • Get treatment for recurring illnesses such as ear infections and asthma
  • Get dental care
  • Compared to insured children, uninsured children are:
    - Over five times more likely to have an unmet need for medical care.
    - Over three times more likely not to get a needed prescription drug.
    - Much less likely to receive preventive services including immunizations, dental and vision care and medical care for conditions such as sore throats, ear infections and asthma.
    - 30% less likely than insured children to receive medical treatment if they are injured.

How will having insurance help my child stay healthy?

You'll be able to pick a doctor for your child and get the health care they need when they need it, without having to worry about how you are going to pay for it. With health insurance, your child will be able to get immunizations and well-child visits required to attend school and play sports. If your child gets sick, you can get prescription medicines to help him or her get better fast.

How does having health insurance affect my child's ability to learn?

Having health insurance improves a child's academic performance. Studies have found that reading scores and school attendance of uninsured children improve dramatically after they become insured.

Having health insurance will allow your kids to get the medical and dental care they need to stay healthy. Children with health insurance are less likely to miss school because they are sick and kids who are feeling healthy have an easier time focusing on their studies.

Eligibility Requirements and Qualifications

Is there a limit on the amount of time my child can remain enrolled?

Your child can stay in the program as long as he or she qualifies. Although there is no limit on the amount of time your child can remain in the program, you will need to renew their coverage periodically, typically once a year in most states. The state will contact you to let you know that it is time to renew your coverage.

I have teenagers. Are they eligible, too?

Yes, in every state, all children from birth until their 19th birthday are eligible for coverage if your family income is below $44,100 per year (for a family of four) and in many states, income levels are higher.

I have a job. Can my children still qualify?

Yes, the majority of children covered by these health insurance programs come from working families. Many working families who cannot afford health insurance or whose children are not covered through their job or other private health insurance may be eligible.

Who can apply for health insurance for my child?

You or your spouse can apply for Medicaid and CHIP for your children. In addition to parents, grandparents and legal guardians can also enroll children.

What if my children are covered by Medicaid already?

Congratulations, they already have comprehensive health insurance.

What if my state tells me that my children are eligible for Medicaid but I don't want to enroll them in Medicaid? Can I qualify for another insurance program?

All children that apply for coverage are screened both for Medicaid and CHIP and your child will be enrolled in the program for which they are eligible. Your state representative will explain the eligibility rules to you when you apply for coverage for your children. If your child is eligible for Medicaid, s/he will be entitled to a comprehensive set of health benefits.

Costs for Families

Who pays for these health insurance programs?

How much a family pays for coverage depends on their income and the number of people in their family, but these programs are designed to be affordable. Your tax dollars help to cover the rest of the costs for the insurance. Your state and federal governments want to help working families like yours protect their children's health and invest in their future.

Assistance Programs