6 min read · Last updated June 22, 2026
- CHIP covers children whose families earn too much for Medicaid but cannot afford private insurance. It picks up right where Medicaid leaves off.
- Income limits vary by state. Many states cover children up to about 200 to 250 percent of the federal poverty level, which can be roughly $62,000 to $80,000 a year for a family of four.
- CHIP covers children up to age 19. Aging out happens at 19, not 18, but a birthday near a renewal can trigger a paperwork error.
- Once a child is enrolled, a federal rule that took effect in 2024 keeps most kids covered for a full 12 months even if household income rises mid-year.
In this article
- What CHIP actually is
- Who qualifies in 2026
- How one family splits between Medicaid and CHIP
- What CHIP covers and what it costs
- How to apply
- Common reasons children lose or get denied coverage
- Frequently asked questions
The Reyes family earns about $58,000 a year, and when they applied for Medicaid for their two kids, they were told they made too much. They assumed that meant no public coverage at all, and they went a year without insuring the children. They were wrong about the rule. Their kids qualified for CHIP the entire time, because CHIP is designed for exactly their situation: a working family that earns too much for Medicaid but cannot comfortably afford a private plan.
What CHIP actually is
CHIP stands for the Children’s Health Insurance Program. It is a joint federal and state program that covers children, and in some states pregnant women, in families that earn above the Medicaid limit. Like Medicaid, each state runs its own version with its own name and its own income rules.
For low-cost care, HRSA’s health center locator lets readers search federally supported clinics by location. For family coverage, HealthCare.gov explains Medicaid and CHIP coverage for children and families.
The simplest way to picture it: Medicaid covers the lowest incomes, and CHIP sits just above it. In many states the two programs are screened together, so one application checks your child for both. If your income is too high for Medicaid, the system should automatically check CHIP next.
Who qualifies in 2026
Three factors decide it: your child’s age, your household income, and your state.
Age. CHIP covers children up to age 19 in most states. A child is generally eligible through age 18 and ages out at 19. This is the rule parents most often get wrong, because they assume coverage stops at 18.
Income. This is where the state matters most. CHIP income limits are set as a percentage of the federal poverty level, and they vary widely. Many states cover children up to roughly 200 to 250 percent of the federal poverty level. At around 200 percent, that works out to roughly $62,000 to $66,000 a year for a family of four, depending on the year’s federal guidelines. Some states go higher. Because the limit scales with household size, a bigger family can earn more and still qualify.
State residency and status. Your child has to be a resident of the state where you apply, and a U.S. citizen or an eligible immigrant. Many states cover lawfully residing immigrant children without a waiting period. Do not assume immigration status disqualifies your child before you check your state’s rule.
What happens when your income rises mid-year? This used to throw families off coverage immediately. Not anymore. A federal rule that took effect in 2024 gives most children 12 months of continuous eligibility once they are enrolled in Medicaid or CHIP. In plain terms, your child generally keeps their coverage for a full year even if you get a raise, until the next renewal. That gives you time to plan rather than scramble.
How one family splits between Medicaid and CHIP
Families often assume one income number decides coverage for the whole household. It does not. Adults and children are tested against different income limits, so it is common for parents to land on a marketplace plan while their kids land on CHIP, off the same application.
Take a household of four, two parents and two children, earning $54,000 a year, about 164 percent of the 2026 federal poverty guideline for a family that size. Most expansion states cap adult Medicaid at 138 percent of poverty, $45,540 a year for a family of four in 2026, so this household’s income is too high for the parents to qualify for Medicaid. Many states set the CHIP ceiling for children closer to 200 percent of poverty, roughly $66,000 for a family of four, so the same $54,000 clears the bar for the kids. One application, two outcomes:
| Household member | Where they land | Why |
|---|---|---|
| Parent 1 | ACA marketplace, likely with a subsidy | Household income is above the 138% Medicaid expansion cutoff for adults |
| Parent 2 | ACA marketplace, likely with a subsidy | The same income test applies to both adults in the household |
| Child 1 | CHIP | Income falls under the higher CHIP ceiling many states set for children |
| Child 2 | CHIP | The same CHIP income test applies to every child in the household |
The handoff is automatic in most states. You file one Marketplace or state application, and the system checks each household member against the program that fits, instead of testing everyone against a single cutoff. If your state screens Medicaid and CHIP together, which most do, you do not file twice. If income changes later, only the person whose eligibility changed is affected. A raise that moves a parent off a subsidized marketplace plan does not automatically move a child off CHIP, and the reverse is also true.
What CHIP covers and what it costs
CHIP is comprehensive coverage, not a discount card. Every state CHIP plan covers a core set of benefits:
- Routine checkups and immunizations.
- Doctor visits and specialist care.
- Hospital care, both inpatient and outpatient.
- Lab tests and X-rays.
- Prescriptions.
- Dental and vision care.
- Emergency services.
Cost-sharing is deliberately low. Some states charge a modest monthly premium or small copays, and some charge nothing. Federal rules cap total family cost-sharing at 5 percent of your household income. In plain terms: across a year, what your family pays in CHIP premiums and copays combined cannot exceed 5 percent of what you earn. Routine checkups and immunizations are generally free with no copay.
For a plain-language overview of how the program works day to day, see our guide on the Children’s Health Insurance Program and what parents need to know.
How to apply
There is no open enrollment window for CHIP. You can apply any time of year. There are two doors:
- HealthCare.gov. Fill out a single Marketplace application. If anyone in your household appears eligible for Medicaid or CHIP, your information is sent to your state agency.
- Your state Medicaid and CHIP agency. You can apply directly online, by phone, by mail, or in person.
Have these ready:
- Social Security numbers or document numbers for household members applying.
- Proof of income, such as recent pay stubs or a tax return.
- Proof of state residency.
- Immigration or citizenship documentation for the children applying.
Most states process CHIP applications within 45 days. If your child has an urgent medical need, say so, because some states expedite.
Common reasons children lose or get denied coverage
The family assumed they earned too much. This is the Reyes family mistake, and it is the most common one. Being over the Medicaid limit does not mean being over the CHIP limit. Apply and let the system check both. If your income changed recently, our explainer on how Medicaid expansion affects your coverage options can help you see where you fall.
Renewal paperwork was missed. The biggest cause of lost coverage is procedural, not financial. A renewal notice goes to an old address, the form is not returned in time, and the child is dropped even though they still qualify. Keep your address current with the agency and respond to every renewal letter the day it arrives.
A birthday near renewal triggered a drop. A child who turns 18 may be flagged incorrectly by a system that confuses 18 with aging out. Coverage runs through age 18. If your child is dropped right after a birthday, call and ask for a review.
Income proof did not match. If your documented income does not line up with what you reported, the application stalls. Submit current, consistent pay stubs or a recent tax return for every working adult.
Frequently asked questions
Do I qualify if I earn too much for Medicaid? Quite possibly. CHIP is built for families above the Medicaid limit. Many states cover children up to about 200 to 250 percent of the federal poverty level, so apply and let the system check both programs for you.
What documents do I need to apply for CHIP? Social Security or document numbers for the applying members, proof of income such as pay stubs or a tax return, proof of state residency, and citizenship or immigration documentation for the children.
Does CHIP cost anything? It depends on your state and income. Some states charge a small monthly premium or copays, and some charge nothing. Federal rules cap total family cost-sharing at 5 percent of household income, and routine checkups are generally free.
What happens if my income goes up after my child is enrolled? A federal rule from 2024 gives most children 12 months of continuous eligibility. Your child generally keeps coverage for a full year even if your income rises, until the next renewal.
Until what age does CHIP cover my child? CHIP covers children up to age 19 in most states. Coverage runs through age 18, and a child ages out at 19. A birthday near a renewal can trigger a paperwork error, so confirm with your state if coverage drops.
Leave a Comment