Prior to the passage of the Affordable Care Act (ACA), or Obamacare, it was estimated that nearly 30 million Americans were living without health insurance. These individuals had no access to affordable preventive, emergency, or other medical care and had to pay out of pocket or go into debt for services and prescriptions.
These uninsured Americans, generally speaking, were part of a number of underserved groups, including low-income individuals and families, women, the elderly, and the disabled, just for example. Some were unable to obtain affordable adequate insurance (or any insurance at all) due to preexisting conditions.
Also included among those who commonly went uninsured were children. With the passage of Obamacare, however, these underserved groups gained the ability to procure affordable insurance coverage, regardless of economic status, age, or medical condition/history. For children unable to obtain their own health insurance coverage, the CHIP program was implemented.
What is CHIP?
CHIP stands for the Children’s Health Insurance Program. It is offered through Obamacare, either through state exchanges or the federal healthcare marketplace (working in conjunction with states that have yet to establish independent exchanges) as part of the Medicaid system, although there are also separate CHIP programs.
CHIP is funded by both the federal government and individual states, so the level of benefits may vary from one state to another, depending on how much any given state has elected to contribute to Medicaid and CHIP programs. The program is administered by individual states, not the federal government.
The goal of CHIP is to provide low-cost coverage for children. In some cases, children may be eligible for benefits through the Medicaid program, but if parents make too much money to qualify for Medicaid, CHIP can offer assistance by providing low-cost health coverage to ensure that children have access to necessary health care. In some states, CHIP may also provide coverage for pregnant women and even parents.
Because CHIP benefits are generally considered an extension of Medicaid services, it’s no surprise that the major benefits offered by the program include EPSDT, or Early and Periodic Screening, Diagnostic, and Treatment services, just like Medicaid. This category includes all medically necessary services, extending to dental care and even mental health services.
States have several options for providing coverage through the CHIP program, but they must meet set standards for including vaccinations and well-baby and well-child care, as well as physician, hospital, medical, surgical, x-ray, and laboratory services, among other benchmarks.
How to Qualify
Before you can receive low-cost CHIP coverage for your children, you must first fill out an application, either online through the health insurance marketplace or through your state Medicaid agency. If you qualify for Medicaid, you will have all the coverage you need for your children.
If your household earnings are high enough that you are ineligible for Medicaid, however, you may still qualify for the low-cost coverage provided by CHIP. It will depend on your income and the rules of your state. However, you can apply at any time, so if you think you may be eligible for Medicaid or CHIP coverage for your family or your children, do not hesitate to apply.