CHIP Health Insurance: What It Is, Eligibility, Benefits, Income Limits & How to Apply

CHIP Health Insurance is a federal and state program to help children who are not eligible for Medicaid due to higher income limits. It is an alternative for all those who cannot afford to purchase expensive private insurance plans. 

CHIP differs from Medicaid in income limits and benefit coverage. Medicaid reports that almost 7,249,206 children participated in CHIP and 69.54 million in Medicaid in 2025. However, you have to pay premiums or copayments for CHIP. The CHIP premium is not more than 5% but it varies for every state.

This guide covers everything about the CHIP health program in detail. We will discuss the income limits for different states, qualification and the application process.

What is the CHIP Health Program?

CHIP represents the Children’s Health Insurance Program. This was also known as the State Children’s Health Insurance Program (SCHIP) in the beginning. CHIP helps children to access healthcare services free or at low cost. 

CHIP was passed as a federal law under the Balanced Budget Act of 1997. It is also a part of the Social Security Act of 1935, topic 21. The U.S. Department of Health and Human Sciences Administers CHIP. Both Medicaid and CHIP get different amounts of funds. The federal government contributes 56% of the Medicaid costs and 71% of CHIP costs. Medicaid is a no-cap (no limit) and CHIP has a cap. It means if the funds end for Medicaid then the government provides  more. But they don’t match funds for states in the case of CHIP.

Check the FMAP for CHIP.

CHIP Health Insurance Eligibility​

Here is the basic criteria you need to meet to qualify for CHIP:

• Children from 0 to 18 years of age
• A U.S. Citizen
• An immigrant with a green card
• Resident of the specific state
• Pregnant women
• Unborn child
• Income more than Medicaid state limit 
• Cannot afford a private insurance plan

There are three ways to be eligible for CHIP:

1. Express lane eligibility
2. Continuous eligibility
3. Presumptive eligibility

Express Lane Eligibility

Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 allows states to use data from other programs to enroll the children in CHIP. This is called the express lane eligibility (ELE) process. So you qualify for CHIP if you are already getting:

• SNAP (food stamps)
• School lunch or breakfast programs
• WIC (nutrition program for women & children)
• TANF (cash assistance)

Continuous Eligibility

Continuous eligibility allows CHIP qualified children to keep the coverage for continues 12 months. It means you don’t have to report any income changes once you qualify for a year. For example, you get CHIP in June and your income raises in August. So you can enjoy the benefits until December. CE is valid only for children under 19 years of age.

Presumptive Eligibility

Presumptive eligibility (PE) is for Children and women who need immediate benefits. The government allows hospital care providers under the Affordable Care Act to verify the case and offer CHIP benefits. These healthcare providers are known as Qualified Entities (QE). This eligibility is for those who reach hospital in critical condition and have not applied for CHIP yet.

Check the PE in your state here.

Income Guidelines for CHIP 2026

You need to meet your state’s minimum income limits to qualify for CHIP. These income limits range from o 200%–300% of the Federal Poverty Level (FPL) and sometimes even more. The income depends on the MAGI. MAGI usually counts:

• Wages and salaries
• Earned income
• Social Security (most types)
• Unemployment benefits
• Taxable interest and dividends

It usually does not count things like:

• SSI (Supplemental Security Income)
• Certain veteran benefits
• Child support received
  (depending on federal rules)

CHIP Income limits 

Here are CHIP income limits in Alabama, Florida and Alaska that is effective in 2026:

Income Limits for CHIP in Texas 2026

You are eligible for CHIP if your family income is below 200% on the poverty line. The CHIP income limit for families of 1 is $2,622 per month and $31,464 per year in Texas. Here are maximum income limits and enrollment fee for CHIP in Texas 2026:

There is no premium in Texas but enrollment fee. You have to pay an annual fee according to your income level. Plus, you also have to copay if your income is too high such as:

CHIP Co-Pays by Income Level:

CHIP Income Limits PA 2026

Chip income limit is different for every age group in Pennsylvania. This is a free and low cost CHIP health insurance according to your income. For example, Free CHIP is for families under 228% FPL. And Low Cost CHIP is for families up to 346% FPL in PA.

Here are the maximum income limits to get FREE CHIP benefits in PA:

They don’t have to copay and pay premiums at all. However, here are the people who can get low cost CHIP benefits in Pennsylvania:

You can check the low cost for specific age groups at PA Income guidelines.

Children’s Health Plus Limits in 2026

CHIP is called Children’s Health Plus in New York. So here are the maximum free and low cost limits that is effective in 2026:

2026 CHIP Income Limits in California 

The CHIP program is known as Medi-Cal in California. It has an income limit of 266% on the FDL. But this limit differs in a few counties. San Francisco, San Mateo, and Santa Clara have income limits between 266% and 322% FPL. This is due to County CHIP also known as (C-CHIP).

Here are the income limits of CHIP for 2026 in California:

What are the CHIP Health Benefits?

Here are the benefits of CHIP for Children and pregnant women:

• Daily appointments
• Immunizations
• Doctor visits and X-rays
• Drug prescriptions
• Inpatient and outpatient hospital care
• Blood tests
• Emergency services
• Checkup of pregnant women

But CHIP may not offer:

• All medical services
• Unlimited autism  services
• Full coverage of every therapy 
• Automatic coverage of services 

The CHIP program name and benefits vary in every state.

The CHIP Program Name by State

The CHIP Program name differs in every state. Look below to find what it is called in your state:

Visit the Healthcare website to find the CHIP program name in your state if it’s not mentioned above.

How to Apply for CHIP Health Coverage 

There are three ways to apply for CHIP health insurance:

1. Visit the healthcare.gov website to apply for CHIP. They transfer your application to your state agency if you qualify.
2. You can apply at your state agency website. Enter your state name and the webste provide you with your website and contact details of your local agency.
3. Apply via phone call at Call 1-800-318-2596 (TTY: 1-855-889-4325)

You have to create an account on the Healthcare website first. They ask you to select your state, add a PIN ansd also 3 questions. You have to select apply now after that and just fill out the application. You need:

• Social Security Numbers (SSN)
• Immigration documents
• Employer and income information 
• Taxable income 
• Policy numbers for any current health insurance plan

You may have to wait for 30, 60 or even 90 days, depending upon your state. Make sure to submit clear and original documents to avoid any delays in your coverage process. 

Conclusion

The CHIP health insurance program is for Children and pregnant women who are not eligible for Medicaid. It allows them to access limited healthcare services compared to Medicaid. CHIP has different names and income limits in every state.

Plus, these limits change every year so you may stand a chance now. The CHIP application process is super simple. You just have to visit the Healthcare.gov website, create an account and apply. They transfer your application to your state agency if you qualify. Otherwise you can also apply at your state agency from the link mentioned above.

FAQs

What is the difference between Chip and Medicaid?

CHIP and medicaid both are both federal programs but with different target audiences. Medicaid is for unemployed (low-income) and disabled people of all ages. Whereas CHIP is for those who have income higher than Medicaid and lower than to purchase a private insurance plan.

Is Chip Medicaid?

No, CHIP and Medicaid are both different programs.

How can I track my CHIP application?

You can track your CHIP application from your online portal under “Check Application Status” or “View Case Details”.