When it comes to affordable healthcare for children and families, Medicaid and the Children’s Health Insurance Program (CHIP) are two of the most important resources in the U.S. While they’re often mentioned together, they’re not the same—and knowing the difference could mean getting your child covered when traditional Medicaid doesn’t apply. If you’re unsure which program your family qualifies for, or how the two work together, here’s a simple breakdown of how CHIP and Medicaid compare, and how to apply.
What Is Medicaid?
Medicaid is a state and federally funded program that provides free or low-cost health coverage to eligible low-income individuals and families. It covers a wide range of services, including doctor visits, hospital stays, mental health services, prescriptions, and more.
Each state has its own Medicaid program, with different income limits and eligibility criteria. Children, pregnant women, parents, seniors, and people with disabilities are common groups that qualify.
What Is CHIP?
CHIP (Children’s Health Insurance Program) is designed for families who earn too much to qualify for Medicaid but can’t afford private insurance for their children. It was created to close the coverage gap for working families and ensure that children have access to regular healthcare.
Like Medicaid, CHIP is administered by each state with federal guidelines. In some states, CHIP operates as a separate program; in others, it’s folded into the Medicaid system.
Who Qualifies for Medicaid vs. CHIP?
Eligibility depends on your state’s income guidelines and your family’s circumstances. Here’s a general comparison:
| Criteria | Medicaid | CHIP |
|---|---|---|
| Income limits | Lower (varies by state) | Higher than Medicaid, but still limited |
| Who’s covered | Children, parents, pregnant women, seniors, and people with disabilities | Children under 19 and, in some states, pregnant women |
| Cost | Free or very low-cost | May include small premiums or co-pays, depending on the state |
| Enrollment | Year-round | Year-round |
| Services covered | Comprehensive, including medical, dental, vision, and mental health | Similar to Medicaid, but benefits may vary slightly by state |
Example: A family of four earning $35,000 a year might make too much to qualify for Medicaid in their state but could still be eligible for CHIP coverage for their children.
What Does CHIP Cover?
CHIP coverage varies slightly by state, but typically includes:
Routine check-ups and immunizations
Doctor and specialist visits
Hospital care and emergency services
Dental and vision care
Prescription drugs
Mental health and behavioral services
Physical therapy and rehabilitation
Even though CHIP may have small co-pays or premiums, it’s designed to keep costs minimal for families.
Why CHIP Matters
CHIP plays a crucial role in ensuring children don’t go without healthcare simply because their families fall into a coverage gap. Since its launch, CHIP has helped millions of children get access to care they otherwise couldn’t afford.
Benefits of CHIP include:
Fewer missed school days due to illness
Better long-term health outcomes
Reduced emergency room visits
Greater peace of mind for parents
How to Apply for CHIP or Medicaid
The process is similar for both programs and usually begins in the same place:
Visit Healthcare.gov or your state’s Medicaid/CHIP website
Fill out an application—you’ll be asked for income, household size, and other personal details
Submit required documents like proof of income or residency
Get notified of eligibility—your state will tell you which program your child qualifies for
Tip: You can apply for Medicaid or CHIP at any time—there’s no open enrollment window, so you don’t have to wait for specific dates.
What If You’re Pregnant or Have Other Children?
In many states, pregnant women and other children in the household may qualify for Medicaid even if the rest of the family does not. Some states also extend CHIP benefits to pregnant women, providing prenatal care and delivery coverage.
It’s common for one child in a family to qualify for Medicaid while another is enrolled in CHIP, depending on age and specific income guidelines.
Maintaining Coverage
Once your child is enrolled, it’s important to:
Renew coverage annually or when requested by your state
Report any income or household changes as they happen
Keep your contact information updated so you don’t miss renewal notices
Failing to renew on time can result in losing coverage, even if your child still qualifies.
If You Don’t Qualify for Either Program
If your income is too high for both Medicaid and CHIP, you may still be eligible for Marketplace health plans with subsidies under the Affordable Care Act. These plans offer comprehensive coverage, and children may still qualify for lower premiums or cost-sharing reductions.
Final Thoughts
Understanding the differences between CHIP and Medicaid can help you make informed decisions about your family’s health coverage. If you’re not sure which program you qualify for, apply anyway—your state will assess your information and determine the best fit. With low costs and comprehensive benefits, both Medicaid and CHIP ensure that your children can grow up with the healthcare they need to thrive.
