Children's Health Insurance Program or CHIP is a joint effort of federal and state governments to provide health coverage to children who cannot qualify for Medicaid because the parents' income is too high. Each state can make regulations for eligibility, but the federal government provides guidelines. The CHIP program has been available since 1997, but the Children's Health Insurance Program Reauthorization Act of 2009 expanded it to cover more children.
Poverty Guidelines
The federal government releases figures for poverty level or poverty guidelines in the United States each year and states use these figures to calculate eligibility for CHIP, since CHIP eligibility is low-income based. The government bases calculations for poverty guidelines on the number of members in the family.
The 48 contiguous states have one set of figures for poverty levels and the other two states have another. Poverty level for a family of four in the 48 states was $22,050 in 2010. This provides a working figure for CHIP income limits.
Federal Guidelines for CHIP Programs
The federal government gives the states latitude in developing the CHIP programs, but offers guidance and oversight. Federal guidelines mandate Medicaid coverage for certain groups of low-income individuals in return for federal funds, and federal poverty guidelines define some of these groups.
The federal government also has a Medicaid/CHIP quality strategy to partner with the states for best practices, technical assistance and improvement efforts. The federal government encourages building a new health information infrastructure with electronic health records and linking medical records nationwide.
State Guidelines
Generally, the states choose between 160 percent and 400 percent of the federal poverty level for CHIP income limits. A state allowing 400 percent of federal poverty level would permit insuring children in a family of four making $88,200 a year. The low states at 160 percent of the federal poverty level would insure children in a family of four making $35,280.
New York chooses to qualify children for CHIP insurance at the 400 percent level, and New Jersey insures to 350 percent of the federal poverty guidelines. Many states insure at 300 percent, including Washington, Oregon, Wisconsin, Alabama, Maryland, District of Columbia, Iowa, Missouri, Vermont, Massachusetts, Connecticut, New Hampshire and Pennsylvania.
States insuring children for CHIP benefits at 200 to 300 percent of poverty level are California, Montana, Colorado, New Mexico, Kansas, Minnesota, Indiana, Tennessee, Louisiana, West Virginia, Delaware, Rhode Island, Nevada, Utah, Arizona, Texas, South Dakota, Arkansas, Mississippi, Michigan, Ohio, Georgia, Florida, South Carolina, North Carolina, Virginia, Nebraska, Wyoming, Illinois, Kentucky and Maine.
States insuring at a level between 160 percent and 199 percent of federal poverty guidelines are Idaho, North Dakota and Oklahoma.
Other Requirements and Benefits
Children must be under the age of 18 in most states to receive CHIP benefits and some states have a 90-day waiting period for some children. States usually require that the parent and child be residents of the state. Enrollment is about $50 a year and office visits and prescriptions are $3 to $10 depending on the family income and the state.
