◢ Healthcare program · Verified August 23, 2026
Children's Health Insurance Program (CHIP)
Federal-state health coverage for children in families that earn too much for Medicaid but cannot afford private insurance, covering doctor visits, hospital care, dental, vision, and prescriptions with low or zero copays.
Federal cost-sharing cap
5% of annual family income
No CHIP family can be charged more than 5% of their annual gross income in combined premiums, copays, and other cost sharing across all children enrolled (42 CFR 457.560). Preventive care visits, immunizations, prenatal care, well-child checkups, and dental/vision are exempt from copays entirely under federal rule.
Reach
About 7,145,807 children were enrolled in CHIP as of April 2026, per the CMS Medicaid and CHIP Monthly Enrollment Report. Combined with Children's Medicaid, roughly 37 million children under 19 receive coverage through the two programs.
Federal program data
Time to apply
45 days for standard applications; some states process CHIP within 2 to 3 weeks through data-matching with Medicaid. Coverage begins first day of the month after approval
Application is free. Monthly premiums range $0 (most families) up to $70/mo (higher-income tiers). Copays typically $0 to $20. Federal cap: total cost sharing cannot exceed 5% of annual family income.
◢ CHIP at a glance
- Program: Children's Health Insurance Program (CHIP)
- Administered by: Centers for Medicare and Medicaid Services (CMS)
- Federal cost-sharing cap: 5% of annual family income
- Cost to apply: Application is free. Monthly premiums range $0 (most families) up to $70/mo (higher-income tiers). Copays typically $0 to $20. Federal cap: total cost sharing cannot exceed 5% of annual family income.
- Application time: 45 days for standard applications
- Who it serves: About 7,145,807 children were enrolled in CHIP as of April 2026, per the CMS Medicaid and CHIP Monthly Enrollment Report. Combined with Children's Medicaid, roughly 37 million children under 19 receive coverage through the two programs.
- Where to apply: Through the official Centers for Medicare and Medicaid Services (CMS) portal or your state's administering office.
◢ What this program does
The Children's Health Insurance Program (CHIP) is a joint federal-state program that provides comprehensive, low-cost health coverage to uninsured children in families whose income is too high to qualify for Medicaid but too low to afford private insurance. Every state runs its own CHIP program under federal rules, and most states either combine it with Medicaid or run it as a standalone plan with its own name (Florida KidCare, Texas CHIP, PeachCare for Kids in Georgia, All Kids in Alabama).
CHIP covers children under age 19 and, in some states, pregnant women. Federal law requires every state CHIP plan to cover routine checkups, immunizations, doctor visits, hospital care, prescriptions, dental and vision, emergency services, laboratory and X-ray, and behavioral health. Coverage is delivered through managed care organizations in most states, with the same provider networks the state uses for Medicaid.
As of April 2026, roughly 7.15 million children were enrolled in CHIP nationwide, per the CMS Medicaid & CHIP Enrollment Data monthly report. Income eligibility varies by state and ranges from as low as 170% up to 400% of the Federal Poverty Level (FPL). New York's CHIP program (Child Health Plus) covers children up to 400% FPL, while a handful of states cap eligibility at 200% FPL.
Whether CHIP is free or low-cost depends on family income and state design. Most families under 150% FPL pay $0 in premiums and $0 in copays for CHIP. Above that threshold, families may pay modest monthly premiums ($10 to $70 per month is typical) and small copays for non-preventive services ($5 to $20). Federal law caps total annual cost sharing at 5% of family income across all CHIP-covered children in a household.
◢ Who qualifies
Who qualifies for CHIP?
- Child must be under age 19 and a U.S. citizen, U.S. national, or lawfully present in the United States (some states cover DACA recipients and lawfully present immigrant children without a 5-year wait)
- Family income within the state's CHIP range, typically between 138% and 200% of Federal Poverty Level as the floor, up to 400% FPL as the ceiling (varies by state)
- Uninsured for at least a state-defined waiting period (typically 90 days), unless the child qualifies for an exception (loss of parent job coverage, aged out of parent's plan, etc.)
- Not eligible for Medicaid based on income (Medicaid takes precedence if the child qualifies)
- Not covered by a state employee health plan that meets federal minimum standards (unless the plan would cost more than 5% of family income, triggering the hardship exception)
- Pregnant women may qualify for CHIP coverage in states that have elected the pregnancy option (currently 21 states plus DC), typically up to 200% to 300% FPL
A note on eligibility: Final eligibility is determined by the agency administering this program, not by GrantsHubUSA. Confirm current rules with Centers for Medicare and Medicaid Services (CMS) or your state's office before applying.
◢ How to apply
How do you apply for CHIP?
- 1
Find your state's CHIP program name and portal
CHIP goes by different names in different states. Look up your state's program at insurekidsnow.gov or call the national CHIP hotline at 1-877-KIDS-NOW (1-877-543-7669). Common state names: Florida KidCare, Texas CHIP, PeachCare for Kids (Georgia), All Kids (Alabama), Child Health Plus (New York), Denali KidCare (Alaska), HUSKY Health (Connecticut).
- 2
Gather documents before you start the application
You will need: proof of identity for each family member (birth certificate, driver's license, or state ID), proof of income for the last 30 days (pay stubs, tax return, unemployment statement), proof of residency (utility bill, lease), Social Security numbers or immigration documents for the child, and current health insurance information if any family member has coverage.
- 3
Apply through your state's CHIP portal, healthcare.gov, or by phone
Most states let you apply online through the same portal that handles Medicaid (BenefitsCal, Your Texas Benefits, MyACCESS Florida, etc.). You can also apply through healthcare.gov, which forwards CHIP applications to your state automatically. Phone applications go through your state Medicaid agency or 1-877-KIDS-NOW. Paper applications are accepted by every state and can be mailed to your local Department of Human Services.
- 4
Wait for the eligibility determination and enrollment packet
States must process CHIP applications within 45 days for standard applications, or within 90 days if disability determination is required. Once approved, you will receive an enrollment packet listing the managed care plans available in your service area. Your child's coverage begins the first day of the month following approval in most states.
- 5
Choose a health plan and pediatrician for your child
Most states deliver CHIP through managed care organizations (MCOs). You typically have 30 to 90 days to choose an MCO or the state will auto-assign one. Pick an MCO whose provider network includes your child's current pediatrician if possible, and confirm any specialist providers your child sees regularly are in-network. Preventive dental and vision are covered by every state CHIP plan.
- 6
Renew coverage annually
CHIP eligibility must be renewed every 12 months. Most states auto-renew using state tax data and Medicaid data-matching when possible; when they cannot, you will receive a renewal packet by mail 60 days before your renewal date. Report income changes, family size changes, or new insurance coverage within 10 days to avoid overpayment recovery or coverage gaps.
Apply through the official agency
Centers for Medicare and Medicaid Services (CMS)
◢ Benefit amounts
How much CHIP can you actually get?
The typical CHIP benefit is 5% of annual family income, per the Centers for Medicare and Medicaid Services (CMS). No CHIP family can be charged more than 5% of their annual gross income in combined premiums, copays, and other cost sharing across all children enrolled (42 CFR 457.560). Preventive care visits, immunizations, prenatal care, well-child checkups, and dental/vision are exempt from copays entirely under federal rule.
Your actual amount depends on household size, gross monthly income, allowed deductions, and where you live. Most federal assistance programs are administered by state agencies with their own income limits and processing rules.
Who receives CHIP? About 7,145,807 children were enrolled in CHIP as of April 2026, per the CMS Medicaid and CHIP Monthly Enrollment Report. Combined with Children's Medicaid, roughly 37 million children under 19 receive coverage through the two programs.. Not every eligible household applies, and participation rates vary by state.
If you have never applied before because you assumed you would not qualify, the practical income limits are often higher than people expect once deductions are factored in. Most working households with children in high-cost states qualify for at least the minimum benefit.
How the amount is calculated. Federal programs use national formulas, but every state adjusts income limits, standard deductions, and household size categories under its own regulations.
The exact dollar amount you receive in CHIP depends on which state processes your application. For state-specific numbers, check your state's administering agency on the state directory page or visit the official Centers for Medicare and Medicaid Services (CMS) site.
Application timing matters. Most CHIP decisions take 45 days for standard applications; some states process CHIP within 2 to 3 weeks through data-matching with Medicaid. Coverage begins first day of the month after approval. Applying at the start of a program cycle or fiscal year usually gets you into the queue before annual funding runs low.
Some programs like LIHEAP have seasonal windows that close mid-year; others like SNAP and Medicaid process year-round with rolling eligibility.
What if your amount seems wrong? Every state provides a written notice explaining the calculation, and every applicant has the right to a fair hearing to challenge a benefit amount or denial.
Bring the notice, your income documents, and any deduction receipts to the hearing. Most challenges succeed when a household proves a deduction was not applied.
◢ Quick facts
- Application time
- 45 days for standard applications; some states process CHIP within 2 to 3 weeks through data-matching with Medicaid. Coverage begins first day of the month after approval
- Cost to apply
- Application is free. Monthly premiums range $0 (most families) up to $70/mo (higher-income tiers). Copays typically $0 to $20. Federal cap: total cost sharing cannot exceed 5% of annual family income.
- Administering agency
- Centers for Medicare and Medicaid Services (CMS)
- Last verified
- August 23, 2026
◢ Frequently asked
Common CHIP questions
Medicaid and CHIP both cover children, but they serve different income ranges. Medicaid covers children in families with the lowest incomes (typically under 138% to 200% FPL depending on state) and is federally mandated. CHIP covers children in families that earn too much for Medicaid but still cannot afford private insurance (typically 138% to 400% FPL depending on state). Coverage is very similar (both cover preventive care, hospital, dental, vision, prescriptions), but Medicaid is always free with $0 copays while CHIP may charge modest premiums and copays for higher-income families.
CHIP income limits vary by state and are set as a percentage of the Federal Poverty Level (FPL). The federal minimum is 200% FPL, and states may go higher. In 2026, this means a family of four qualifies for CHIP at family income up to $64,300 (200% FPL, floor) or up to $128,600 (400% FPL, cap in states like New York). Most states set eligibility between 200% and 300% FPL. Check your state's exact income limits at insurekidsnow.gov or your state Medicaid agency portal.
For most families, CHIP is free. States can charge monthly premiums for families above 150% FPL, typically ranging from $10 to $70 per month depending on income tier and state. Copays for doctor visits, prescriptions, or emergency room use range from $5 to $20 for higher-income families. Federal law caps total combined cost sharing at 5% of annual family income across all CHIP-covered children in a household. Preventive care, immunizations, well-child visits, and prenatal care are always free with no copay.
Every state CHIP plan is required to cover routine checkups and immunizations, doctor visits, hospital care (inpatient and outpatient), prescriptions, dental and vision care, laboratory and X-ray services, emergency services, and behavioral and mental health services. Most states also cover speech therapy, occupational therapy, physical therapy, and durable medical equipment when medically necessary. Coverage is generally as comprehensive as private employer-based insurance.
CHIP itself is designed for children under age 19, but 21 states plus DC have elected the CHIP pregnancy coverage option, which extends CHIP to pregnant women in the same income range as the state's children's coverage. If your state does not offer CHIP for pregnant women, you may still qualify for pregnancy-related Medicaid or the healthcare.gov Marketplace. Adults without children generally cannot enroll in CHIP but may qualify for Medicaid expansion or Marketplace coverage with premium tax credits.
◢ Primary sources
Where every claim comes from
Every fact on this page is verifiable against one of the primary sources below. Follow any link to confirm, that's our standing commitment.
- 01Medicaid.gov: Children's Health Insurance Program (CHIP) overview
www.medicaid.gov/chip
- 02Medicaid.gov: CHIP Eligibility & Enrollment
www.medicaid.gov/chip/chip-eligibility-enrollment
- 03CMS April 2026 Medicaid & CHIP Enrollment Data Highlights (7.15M enrolled)
www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights
- 04Medicaid.gov: Medicaid, CHIP, and Basic Health Program Eligibility Levels by state
www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-childrens-health-insurance-program-basic-health-program-eligibility-levels
- 05Insure Kids Now (find your state CHIP program)
www.insurekidsnow.gov/
- 0642 CFR 457.560: Aggregate cost-sharing limit (5% of family income)
www.ecfr.gov/current/title-42/chapter-IV/subchapter-D/part-457/subpart-E/section-457.560
- 07Healthcare.gov: The Children's Health Insurance Program (CHIP)
www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/
- 08KFF Medicaid and CHIP Enrollment Tracker
www.kff.org/medicaid/medicaid-enrollment-tracker/
Editorial fact-check
This program profile was verified on August 23, 2026.
Every eligibility rule, dollar amount, and deadline on this page was cross-checked against the primary sources listed above before publication, and is reviewed on a rolling schedule as federal and state rules change. Spotted something out of date? Tell us , corrections typically ship within 48 hours.
Not legal, tax, or financial advice. GrantsHubUSA is an independent editorial blog, we're not a government agency and we don't administer this program. Always confirm current eligibility, deadlines, and benefit amounts with the administering agency before applying. See our full disclaimer.
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More aid you might qualify for
Medicaid
Free or low-cost health coverage for eligible low-income Americans, funded jointly by federal government and states.
Free or low-cost
Supplemental Security Income (SSI)
Monthly federal cash payments for disabled, blind, or 65+ Americans with very limited income and resources, funded by general Treasury (not Social Security payroll taxes).
$994 individual / $1,491 couple
Social Security Disability Insurance (SSDI)
Monthly cash payments for workers who paid Social Security taxes and can no longer work due to a long-term medical disability, funded by FICA payroll taxes, not general revenue.
$1,635 average / $4,152 max