SCHIP stands for the State Children’s Health Insurance Program, a federally funded program Congress created in 1997 to cover children in families that earn too much to qualify for Medicaid but not enough to comfortably buy private insurance. In 2009, Congress dropped “State” from the name, and the program has gone by CHIP (Children’s Health Insurance Program) ever since. It’s the same program, still running, and roughly 7.2 million children were enrolled as of December 2025.
Where the Name Came From, and Why It Changed
Congress established the program as Title XXI of the Social Security Act through the Balanced Budget Act of 1997.1Centers for Disease Control and Prevention. Children’s Health Insurance Program For about a dozen years, everyone called it SCHIP. That changed when President Obama signed the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), which dropped “State” from the official name and repealed the requirement to use the SCHIP acronym.2Congress.gov. Children’s Health Insurance Program Reauthorization Act of 2009 If you’re reading an older article, policy brief, or government form that still says SCHIP, it’s referring to the program now called CHIP.
How the Program Actually Works
CHIP is not a single national plan. The federal government funds it and sets minimum standards, and each state designs its own version. That’s why names, income cutoffs, benefits, and costs all vary depending on where you live.
States pick one of three approaches. Some expand their existing Medicaid program to include CHIP-eligible children, so Medicaid rules largely apply. Others run a separate CHIP program that looks more like commercial insurance, with its own benefit package and cost-sharing rules. A third group combines both — typically a Medicaid expansion for younger or lower-income children and a separate program for everyone else.3Medicaid and CHIP Payment and Access Commission. Key CHIP Design Features
Who Qualifies
Eligibility comes down to a handful of requirements. The child must be under 19, uninsured, a resident of the state where the family applies, and a U.S. citizen or qualified noncitizen such as a lawful permanent resident.4Medicaid. CHIP Eligibility and Enrollment The child also cannot already be covered by a group health plan or other creditable insurance.
Family income is the main factor. Federal law sets a floor: states must cover children in families earning up to the higher of 200 percent of the federal poverty level (FPL) or 50 percentage points above the state’s 1997 Medicaid eligibility level.4Medicaid. CHIP Eligibility and Enrollment Most states go further. Current eligibility limits range from about 170 percent up to 400 percent of the FPL, so the cutoff depends heavily on your state.
For a sense of the dollar figures, the 2026 federal poverty level for a family of four in the 48 contiguous states is $33,000.5HHS ASPE. 2026 Poverty Guidelines Applied to common CHIP thresholds:
- 200% FPL: $66,000 per year
- 300% FPL: $99,000 per year
- 400% FPL: $132,000 per year
A family of four in New York, for example, can qualify with income up to 400 percent of the FPL, while other states set lower ceilings.6Medicaid and CHIP Payment and Access Commission. MACStats: Medicaid and CHIP Data Book Poverty guidelines are higher in Alaska and Hawaii, so the dollar cutoffs run higher there as well.5HHS ASPE. 2026 Poverty Guidelines
One boundary worth knowing: CHIP was built for children, but states can extend it to pregnant women too, covering prenatal care, delivery, and postpartum services for uninsured women whose income is above Medicaid limits.4Medicaid. CHIP Eligibility and Enrollment Whether that option exists depends on your state.
What CHIP Covers
No matter which program design a state uses, every CHIP plan must include a core set of benefits:7Medicaid.gov. CHIP Benefits
- Well-baby and well-child visits, including routine check-ups, developmental screenings, and immunizations
- Dental care — preventive, restorative, and emergency
- Behavioral health, including mental health treatment and substance use disorder services
- Vaccines
States with separate CHIP programs also have to cover benchmark-equivalent benefits, including inpatient and outpatient hospital care, surgical and medical services, and lab and X-ray work.7Medicaid.gov. CHIP Benefits Most states also include vision, prescription drugs, and emergency services. The overall coverage looks broadly comparable to what many employer plans offer for children.
What Families Pay
CHIP isn’t free for everyone. States running separate CHIP programs can charge modest premiums and copays, but federal rules limit the total. For families above 150 percent of the FPL, combined out-of-pocket costs cannot exceed 5 percent of annual income.8Medicaid. CHIP Cost Sharing For families under 150 percent, premiums are capped at the lower Medicaid levels.
A few protections apply everywhere. States cannot charge for well-baby or well-child visits. American Indian and Alaska Native children are exempt from all cost sharing. If a family falls behind on premiums, the state must give at least a 30-day grace period, and any lockout for nonpayment is capped at 90 days.8Medicaid. CHIP Cost Sharing
How to Apply
Two routes work. The most direct is to contact your state’s Medicaid or CHIP agency, which handles applications and determines eligibility.9Medicaid.gov. Where Can People Get Help With Medicaid and CHIP The other is to file through the Health Insurance Marketplace at HealthCare.gov. If it looks like anyone in your household qualifies for Medicaid or CHIP, the Marketplace forwards your information to the state, which then follows up about enrollment.10HealthCare.gov. Children’s Health Insurance Program Eligibility Requirements The Marketplace route has a bonus: if CHIP doesn’t work out, you’ll see whether you qualify for subsidized private coverage instead.
You can also call 1-800-318-2596 (TTY: 1-855-889-4325) to apply or find your state’s program. There’s no limited enrollment window. Families can apply any time of year.