Does my child qualify for CHIP if I don’t qualify for Medicaid?

Can my child be eligible for CHIP even if our family doesn’t meet Medicaid eligibility requirements?

Yes, your child may still be eligible for the Children’s Health Insurance Program (CHIP) in Utah, even if your family does not qualify for Medicaid. CHIP is specifically designed to cover children in families with moderate incomes—those who earn too much to qualify for Medicaid but still cannot afford private health insurance. Here’s how CHIP eligibility works and how it differs from Medicaid.

1. How CHIP and Medicaid Differ in Eligibility

CHIP and Medicaid have different income limits and eligibility requirements, which means that children in families who do not qualify for Medicaid may still qualify for CHIP.

A. Income Requirements for Medicaid

Medicaid eligibility in Utah is based on household income and is generally limited to families with lower incomes. For example, parents or guardians of children can qualify for Medicaid if their household income is up to 138% of the Federal Poverty Level (FPL).

B. Income Requirements for CHIP

If your family’s income is above the Medicaid eligibility threshold but below 200% of the Federal Poverty Level (FPL), your child may qualify for CHIP. CHIP offers healthcare coverage to children in families with moderate incomes that exceed Medicaid limits.

Here are the 2024 income limits for CHIP eligibility based on household size:

Household Size138% of FPL (Medicaid Limit)200% of FPL (CHIP Limit)1$20,120$29,1602$27,214$39,4403$34,307$49,7204$41,400$60,000

If your income falls between 138% and 200% of the FPL, your child may qualify for CHIP, even if your family does not qualify for Medicaid.

2. Other CHIP Eligibility Criteria

In addition to meeting income requirements, your child must meet other eligibility criteria to qualify for CHIP:

A. Age Requirement

• Your child must be under 19 years old to qualify for CHIP coverage.

B. Residency Requirement

• Your child must be a resident of Utah. You’ll need to provide proof of residency, such as a utility bill or lease agreement.

C. Citizenship or Immigration Status

• Your child must be a U.S. citizen or a qualified non-citizen (such as a lawful permanent resident). Proof of citizenship or immigration status is required when applying.

D. Uninsured Status

• Your child must be uninsured at the time of application to qualify for CHIP. If your child has access to affordable employer-sponsored health insurance, they will not be eligible for CHIP.

3. CHIP Coverage for Children

CHIP provides comprehensive healthcare coverage for children, similar to Medicaid. CHIP covers:

• Doctor visits: Routine checkups, preventive care, and vaccinations.

• Hospital services: Inpatient and outpatient care, including emergency room visits.

• Prescription medications: Coverage for necessary prescription drugs.

• Dental and vision care: Routine dental exams, cleanings, and vision exams, including eyeglasses.

• Mental health services: Counseling, therapy, and psychiatric care.

4. Premiums and Copayments Under CHIP

While Medicaid typically does not require premiums, families enrolled in CHIP may be required to pay small monthly premiums and copayments based on household income:

• Premiums: CHIP premiums are affordable and based on a sliding scale according to your income. These are generally much lower than private insurance premiums.

• Copayments: Families may have to pay small copays for services like doctor visits, prescriptions, and emergency care, but there are annual out-of-pocket limits to ensure costs remain manageable.

5. How to Apply for CHIP

If your family doesn’t meet Medicaid eligibility but you believe your child qualifies for CHIP, you can apply by following these steps:

• Apply online: Submit an application for CHIP at medicaid.utah.gov or healthcare.gov.

• Apply in person: Visit your local Department of Workforce Services (DWS) office to complete the application.

• Submit proof of income: You’ll need to provide documentation showing your household income, as well as proof of residency and citizenship.

6. Renewing CHIP Coverage

CHIP coverage must be renewed annually. When renewing, you will need to update your income and household information to ensure your child still qualifies for CHIP. If your income drops below the 138% FPL threshold, your child may transition to Medicaid.

Key Takeaways:

• CHIP provides healthcare coverage for children in families with moderate incomes that don’t qualify for Medicaid. To be eligible, your household income must be between 138% and 200% of the Federal Poverty Level (FPL).

• CHIP offers comprehensive coverage, including doctor visits, prescription drugs, dental and vision care, and mental health services.

• Families may need to pay small premiums and copayments, but costs are kept affordable.

For help determining if your child qualifies for CHIP or assistance with the application process, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.