CHIP

The Children’s Health Insurance Program (CHIP) is an insurance program that is jointly financed by federal and state dollars and is administered by each state. CHIP provides health care coverage to uninsured children up to age 19 whose family income is too high for Medicaid, but less than state-specific income eligibility limits. The child must also not have access to other insurance, such as through a parent’s employer. The federal government provides a higher match rate for CHIP compared to Medicaid. For fiscal year 2023, the average CHIP match rate among states is 69%, compared to the average Medicaid match rate of 56%. The maximum eligibility level that states can set and still receive the higher federal matching rate that CHIP provides is 300 percent of the federal poverty level (FPL). In 2019, the median allowed income for CHIP eligibility was 255% FPL.

Within broad federal guidelines, each state determines the design of its program, eligibility groups, benefit packages, reimbursement rates, and administrative and operating procedures. Federal law allows states to choose from three different program designs for their CHIP programs:

1. Separate CHIP – States design their programs within the statutes of the CHIP program.
2. Medicaid Expansion CHIP – States cover CHIP-eligible children through their Medicaid program.
3. Combination CHIP – States use elements of the separate CHIP and Medicaid expansion models.

If a state chooses to operate CHIP as an expansion of Medicaid, the program will follow the same federal guidelines as Medicaid; whereas if CHIP is implemented separately, states have more flexibility in determining the program’s structure. Medicaid expansion CHIP programs generally offer robust benefits, as enrollees are entitled to EPSDT coverage and the same cost-sharing limits as those in Medicaid.¹ Most states choose to use a combination of Medicaid expansion and separate CHIP programs to cover eligible children.

To learn more about CHIP eligibility and benefits, read the Catalyst Center’s resource, Medicaid and CHIP: A Tutorial on Coverage for Children and Youth with Special Health Care Needs (CYSHCN).

¹ MACPAC. Key CHIP Design Features. https://www.macpac.gov/subtopic/key-design-features/

 

State	CHIP Program Design
Alabama	Combination
Alaska	Medicaid Expansion
Arizona	Combination
Arkansas	Combination
California	Combination
Colorado	Combination
Connecticut	Separate CHIP
Delaware	Combination
District of Columbia	Medicaid Expansion
Florida	Combination
Georgia	Combination
Hawaii	Medicaid Expansion
Idaho	Combination
Illinois	Combination
Indiana	Combination
Iowa	Combination
Kansas	Combination
Kentucky	Combination
Louisiana	Combination
Maine	Combination
Maryland	Medicaid Expansion
Massachusetts	Combination
Michigan	Combination
Minnesota	Combination
Mississippi	Combination
State	CHIP Program Design
Missouri	Combination
Montana	Combination
Nebraska	Combination
Nevada	Combination
New Hampshire	Medicaid Expansion
New Jersey	Combination
New Mexico	Medicaid Expansion
New York	Combination
North Carolina	Combination
North Dakota	Medicaid Expansion
Ohio	Medicaid Expansion
Oklahoma	Combination
Oregon	Combination
Pennsylvania	Combination
Rhode Island	Combination
South Carolina	Medicaid Expansion
South Dakota	Combination
Tennessee	Combination
Texas	Combination
Utah	Combination
Vermont	Medicaid Expansion
Virginia	Combination
Washington	Separate CHIP
West Virginia	Combination
Wisconsin	Combination
Wyoming	Combination