Medicaid Decoded

Joint federal-state health coverage for people with low incomes, in plain English

Medicaid and CHIP for children

An empty playground
An empty playground Photo: Wikimedia Commons.
A school building in Clarksburg, Maryland
A school building in Clarksburg, Maryland Photo: Wikimedia Commons.
Two sets of wooden toy building blocks
Two sets of wooden toy building blocks Photo: Wikimedia Commons.

Children get the broadest, most generous version of Medicaid, and where family income is too high for Medicaid, the Children's Health Insurance Program (CHIP) usually picks up. Together the two programs cover tens of millions of children, and the rules for children are deliberately more forgiving than the rules for adults: higher income limits, no cost sharing traps, and a full year of continuous coverage.

Medicaid for children, then CHIP above it

Every state covers children through Medicaid up to at least a minimum federal floor, and nearly every state covers children up to at least 200 percent of the federal poverty level through Medicaid or CHIP combined. Above the state's Medicaid limit, CHIP covers children in families that earn too much for Medicaid but cannot afford private coverage. CHIP was signed into law in 1997, and it is run by states under federal rules similar to Medicaid's, sometimes as an expansion of the state Medicaid program and sometimes as a separate program with its own name and card.

Whether your child lands in Medicaid or CHIP is your state's determination, not your choice, and it does not matter much to you in practice: both provide comprehensive coverage, and the application is the same. What matters is that you apply. A child who qualifies for neither because the family's income is higher still may qualify for marketplace coverage, and the application transfer described in the how to apply guide handles that automatically.

12 months of continuous eligibility

Since January 1, 2024, federal law requires states to provide 12 months of continuous eligibility for children under 19 in both Medicaid and CHIP. Once a child is found eligible, the child keeps coverage for the full 12 months even if family income rises, household composition changes, or other circumstances shift during the year. The exceptions are narrow: the family asks for coverage to end, the child moves out of state, the agency discovers the original determination was made in error, or the child turns 19. This protection exists precisely so that a parent's new job or a temporary pay rise does not interrupt a child's checkups, prescriptions, or treatment mid-year.

EPSDT: why children's coverage is broader

Children under 21 in Medicaid receive EPSDT, the Early and Periodic Screening, Diagnostic, and Treatment benefit explained in the benefits guide. In practice this means regular checkups on a schedule, vision and hearing screening, dental care, and any medically necessary treatment for a condition found by screening, even if that treatment is not covered for adults in the same state. CHIP programs must also cover a comprehensive set of children's services, including dental care. If a plan denies a service for your child, ask whether EPSDT (for Medicaid) or the CHIP benefit package requires it, and appeal if the answer is not convincing.

Costs for children: minimal by design

Children in Medicaid pay no premiums and no cost sharing for covered services. Children in CHIP may be subject to premiums or copayments in some states, but federal rules cap total family cost sharing and, as noted in the costs guide, unpaid CHIP premiums cannot cut short a child's 12 months of continuous eligibility. If cost is the reason you have not applied for your child, the cost of applying is nothing and the cost of coverage is, for Medicaid children, nothing.

Apply for your child even if you assume you earn too much. The child limits are higher than the adult limits in every state, and CHIP extends them further. Families who would never qualify themselves are routinely surprised to find their children qualify, and a single application checks both programs.

Sources: Medicaid.gov, Program History; Medicaid.gov, Continuous Eligibility; Medicaid.gov, CHIP eligibility and enrollment; Social Security Act, Titles XIX and XXI; Consolidated Appropriations Act, 2023, section 5112.

General information only. This page explains Medicaid in plain English. It is not legal, financial, or medical advice, and it cannot decide whether you qualify. Only your state Medicaid agency can decide a claim. Rules, income limits, and covered services vary by state and change over time, so always confirm the current position with your state Medicaid agency before you act on it. Contact: hello [at] tapetoolhq.com.