To qualify for CHIP (the Children’s Health Insurance Program), a child must be under 19, uninsured, a resident of the state where they’re applying, and part of a household that earns too much for Medicaid but falls within the state’s CHIP income range. That income range varies significantly by state, from about 142% to 400% of the federal poverty level. Here’s what each requirement looks like in practice.
Income Limits by State
CHIP is designed for families who earn too much to qualify for Medicaid but not enough to comfortably afford private insurance. Eligibility is based on your household’s Modified Adjusted Gross Income (MAGI), which is essentially your adjusted gross income from your tax return plus a few additions like tax-exempt interest.
The income cutoff depends entirely on where you live. For reference, the federal poverty level for a family of three is $27,320. States set their own thresholds as a percentage of that number, and the differences are dramatic:
- Highest thresholds: New York and Connecticut cover children in families earning up to 324% of the federal poverty level (roughly $88,500 for a family of three). New Jersey’s cutoff is 317%.
- Lowest thresholds: Kansas sets eligibility at 142% of the poverty level (about $38,800 for a family of three). Wyoming is at 144%, and several states including Arizona, Arkansas, Ohio, and South Carolina cap eligibility at 147%.
This means a family that doesn’t qualify in one state could easily qualify in another. You can check your state’s specific threshold through your state Medicaid agency or HealthCare.gov.
Medicaid Screening Comes First
You don’t apply for CHIP separately from Medicaid. When you submit an application, your child is first evaluated for Medicaid eligibility. If your household income is too high for Medicaid but still within your state’s CHIP range, the application is routed to CHIP instead. This happens automatically, so you don’t need to figure out which program to apply for.
A child who already has health insurance through a parent’s employer or another group plan generally won’t qualify. CHIP is specifically for children who are uninsured.
Age, Residency, and Citizenship Requirements
The child must be under 19 years old and a resident of the state where they’re applying. U.S. citizens qualify straightforwardly, but immigration status adds some complexity for non-citizen families.
Children who are “qualified non-citizens” can be eligible for CHIP. This category includes lawful permanent residents (green card holders), refugees, asylees, victims of trafficking, and several other immigration statuses. There is normally a five-year waiting period after receiving qualified status before Medicaid or CHIP coverage kicks in, but many states have chosen to waive that waiting period for children. Refugees and asylees are exempt from the five-year wait regardless of state.
If your child is in the five-year waiting period and your state hasn’t waived it, they may still be eligible for coverage through the Health Insurance Marketplace.
Who Doesn’t Qualify
A few groups are excluded from CHIP even if they meet the income and age requirements:
- Children with existing coverage: If a child is already covered under a parent’s employer-sponsored plan or other creditable health insurance, they generally can’t enroll in CHIP.
- Children eligible for a state employee health plan: If a family member works for a public agency that offers health benefits, the child typically must use that coverage instead.
- Incarcerated youth and patients in institutions for mental diseases: These children are excluded under federal rules, though some exceptions exist.
What CHIP Costs
CHIP is not always free, but it’s designed to be affordable. Some states charge small monthly premiums or copays, while others provide coverage at no cost. The federal cap is 5% of your family’s annual income, so total out-of-pocket costs for the year can never exceed that amount. For a family of three earning $35,000, that means no more than $1,750 per year for all premiums and cost-sharing combined.
How to Apply
Unlike marketplace insurance, CHIP has no limited enrollment window. You can apply any time of year. There are two main ways to start:
- Through HealthCare.gov: Create an account and fill out a health insurance application. If anyone in your household appears to qualify for CHIP, your information is forwarded to your state agency, which will contact you about enrollment.
- Directly through your state: Every state runs its own CHIP program (often under a state-specific name like PeachCare in Georgia or Hoosier Healthwise in Indiana). You can find your state’s program and apply through it directly.
The application asks for basic household information: how many people live in your home, your income, and your children’s ages and insurance status. Most states process applications within a few weeks, though timelines vary. If your child is found eligible for Medicaid instead of CHIP during the screening process, coverage through Medicaid is typically retroactive to the date of application.