CHIP vs. Medicaid for Children: What Is the Difference and Which Will Your Child Get?
If your child qualifies for coverage, the state decides whether it is Medicaid or the Children's Health Insurance Program (CHIP) based on your income. You apply once; the agency sorts it out. But the two programs are not identical, and the difference can matter for cost and provider networks.
How income decides
Children below the state's Medicaid limit (at least 138% of FPL for all ages, higher in many states) get Medicaid. Children above that limit but below the CHIP limit, which ranges from about 175% in North Dakota to over 400% in New York, get CHIP. Many states run CHIP as an expansion of Medicaid so families never notice the difference.
Key differences
| Medicaid | Separate CHIP | |
|---|---|---|
| Premiums | None | Some states charge modest monthly premiums (often $10–$50) |
| Copays | None for children | Small copays allowed, capped at 5% of family income |
| Benefits | Full EPSDT benefit: every medically necessary service | Benchmark package; usually comprehensive but can be narrower |
| Waiting period | None | A few states impose up to 90 days after dropping private insurance |
| Retroactive coverage | Up to 3 months | Usually none |
Continuous eligibility
Since 2024, every state must keep children enrolled for 12 months regardless of income changes. Some states have extended this to multiple years for young children.
Children with disabilities
A child receiving SSI qualifies for Medicaid automatically in most states. Children with significant disabilities whose parents earn too much may qualify through a Katie Beckett or TEFRA option that ignores parental income; ask the agency.
What to do next
- Find the children's limit on your state page; compare family income for the child's age band.
- Apply through the state portal or HealthCare.gov; one application covers both programs.
- If assigned CHIP with a premium you cannot afford, ask about hardship waivers.