CHIP (the Children’s Health Insurance Program) is not Medicaid, but the two are closely related. CHIP is a separate federal program created under a different section of law to cover children in families that earn too much to qualify for Medicaid but still need affordable coverage. That said, the line between them gets blurry because some states actually run their CHIP program as an extension of Medicaid, while others operate it as a completely independent program.
How CHIP and Medicaid Are Connected
Both CHIP and Medicaid are jointly funded by the federal government and individual states, and both provide health coverage to low-income populations. They share application systems, and in most states you apply for both through a single portal. If your child doesn’t qualify for Medicaid based on your family’s income, the application is automatically screened for CHIP eligibility. You don’t need to submit two separate applications.
The key difference is who they serve. Medicaid covers a broad population including adults, seniors, and people with disabilities, in addition to children. CHIP is designed specifically for children (and in some states, pregnant women) whose families fall into a gap: too much income for Medicaid, but not enough to comfortably afford private insurance. About 7.2 million people are enrolled in CHIP, compared to roughly 68 million in Medicaid.
The Three Ways States Run CHIP
This is where things get confusing, and why many people aren’t sure whether CHIP counts as Medicaid. States have three options for how they structure their CHIP program:
- Medicaid-expansion CHIP: The state expands its existing Medicaid program to cover CHIP-eligible children. Federal Medicaid rules generally apply, and from a parent’s perspective, the experience looks and feels like Medicaid.
- Separate CHIP: The state creates a standalone program with its own rules, branding, and benefit design. These programs often resemble commercial insurance more than Medicaid. States can charge premiums, impose waiting periods, and market the program under its own name.
- Combination: Some states use both approaches. For example, younger or lower-income children might be covered through a Medicaid expansion, while older or slightly higher-income children are enrolled in a separate CHIP program.
So depending on where you live, your child’s CHIP coverage might technically be administered through the Medicaid system, or it might be a distinct program with a different name entirely. This is a big reason for the confusion.
Income Limits: Where Medicaid Ends and CHIP Begins
Medicaid eligibility for children varies by state, but CHIP is designed to pick up where Medicaid leaves off. Federal law sets the CHIP ceiling at the higher of 200% of the federal poverty level or 50 percentage points above the state’s Medicaid income limit. In practice, state CHIP eligibility ranges from about 170% to 400% of the federal poverty level.
For a family of four in 2024, 200% of the federal poverty level is roughly $62,400. If your household income falls below your state’s Medicaid threshold for children, your child qualifies for Medicaid. If it’s above that threshold but below the CHIP limit, your child qualifies for CHIP. The exact cutoffs depend entirely on where you live.
Differences in Benefits and Costs
Children on Medicaid receive a comprehensive benefit package called EPSDT, which covers preventive care, immunizations, dental services, vision and hearing screening, mental health care, and specialty services. If a doctor determines a service is medically necessary, the state must cover it, even if it’s not part of the standard benefit package. Medicaid for children is also free in most cases, with little to no cost sharing.
CHIP benefits are still robust and must include dental and vision coverage, but states have more flexibility in designing the benefit package. Separate CHIP programs can look more like a commercial insurance plan. States can also charge families for CHIP coverage. For families earning above 150% of the federal poverty level, total out-of-pocket costs (premiums, copays, and deductibles combined) are capped at 5% of family income. For families below that threshold, premiums can’t exceed what Medicaid would charge.
Enrollment and Waiting Periods
You can apply for both programs simultaneously through your state’s Medicaid agency or through HealthCare.gov. If your Marketplace application suggests someone in your household qualifies for Medicaid or CHIP, your information is forwarded to your state agency automatically. If you’re denied Medicaid or CHIP, the system routes you back toward Marketplace plans with potential subsidies.
One practical difference: nine states still require a waiting period before CHIP coverage kicks in. Arizona, Arkansas, Indiana, Louisiana, South Dakota, Texas, and Utah impose a 90-day wait. Florida requires two months, and Iowa requires one month. These waiting periods typically apply after a child drops private insurance, to prevent families from switching to CHIP purely to save money. Medicaid, by contrast, generally does not have waiting periods for children.
Why the Distinction Matters
Whether your child is on Medicaid or CHIP can affect which providers accept the coverage, what your family pays out of pocket, and how comprehensive the benefits are. If your state runs a Medicaid-expansion CHIP, your child gets the full Medicaid benefit package with its stronger protections. If your state runs a separate CHIP program, the coverage is still good but may come with premiums and a slightly different provider network.
When filling out forms that ask about insurance status, CHIP is generally listed separately from Medicaid. Schools, tax documents, and other agencies may treat them as distinct programs. If you’re unsure which program your child is enrolled in, your state’s Medicaid or CHIP agency can clarify, and the answer may matter for things like provider selection and expected costs.