Differences Between CHIP and Medicaid

The team at food-stamps.org knows that citizens across America work hard to provide for their families but sometimes require government medical assistance. Private health insurance is often expensive or inaccessible due to financial restraints or living situations, but federal and state medical coverage plans offer low-cost ways to provide for adults and children alike. The Children’s Health Insurance Program (CHIP) and Medicaid plans strive to cover vulnerable Americans and provide them with basic coverage. These programs, funded by both the federal and state governments, both have federal requirements but differ in their coverage and eligibility qualifications. Although very similar programs, CHIP is specifically for children (although some states extend coverage to pregnant women), whereas Medicaid provides for adults and children. It is important for families to see which plan works best for them, and they can do so by reviewing the information below.

What is Medicaid?

Medicaid is a federal government insurance program fulfilled on the state level. Due to this state implementation, eligibility and coverage are varied, and prospective customers should check with their state of residence for state-specific requirements. Nevertheless, Medicaid programs share commonalities that are applicable to all situations. States determine any potential premiums and out-of-pocket costs (copayments, deductibles, etc.), although certain groups and services are exempt from such costs.

Learn About Medicaid Requirements

Federal law guarantees coverage for certain groups, like eligible pregnant women, children below 133 percent of the federal poverty line or eligible persons with disabilities. At the state level, states may choose to expand Medicaid coverage for low-income adult residents with an income at or below 133 percent of the federal poverty line. Without extended state coverage, eligibility can be determined based on a variety of factors, including age, income and disability. The team at food-stamps.org encourages families to apply if they are unsure about their eligibility, as the state Medicaid agency will inform the household about its eligibility and provide information on the Health Insurance Marketplace to help guide families through non-Medicaid options, if applicable. If Medicaid is not an option, families may wish to see if Children’s Health Insurance Program (CHIP) benefits can be obtained through the Marketplace.

Note: There are three types of eligibility that may be applicable to Medicaid applicants, depending on the state: presumptive eligibility, continuous eligibility and Express Lane Eligibility. Presumptive and Express Lane eligibility help expedite the applications of Medicaid-eligible children. Meanwhile, continuous eligibility helps ensure that eligible children receive health care for up to 12 months, even if an income change will disrupt health care assistance.

Learn About Medicaid Benefits and the Application

Due to the program’s state-level fulfillment, some benefits, like prescription drug coverage, chiropractor visits and hospice, are optional and vary in availability across the country. However, federal guidelines mandate essential, comprehensive service coverage, which includes inpatient and outpatient hospital services, physician services and X-ray and laboratory services.

Medicaid applications can be submitted in a number of ways, for the applicant’s convenience. The most convenient method is to submit an application online through the state Medicaid or health department website. Application submissions through fax, phone or email are acceptable as well, for customers who prefer personalized customer service. The team at food-stamps.org encourages applicants to contact their local Medicaid office to confirm application receipt.

CHIP Overview

The Children’s Health Insurance Program (CHIP) is another option for families looking to procure health care for children up to 19 years of age in their household. CHIP provides a resource for those children whose household income disqualified them from receiving Medicaid services. Like Medicaid, the federal government mandates the basic framework for CHIP, but state agencies set their own optional benefits and organizational structure. CHIP operates as an extension of the existing Medicaid program, and like Medicaid, states may choose to implement presumptive, Express Lane or continuous coverage for CHIP applicants.

Learn About CHIP Requirements

The team at food-stamps.org encourages families to check with their local state agency about the CHIP program and the eligibility of the children in the household. Low-income pregnant women should check with their state CHIP or Medicaid office to inquire about potential CHIP benefits for pregnancy care and information about future CHIP coverage for their unborn child.

A recent addition to CHIP from the Affordable Care Act allows the children of state employees to benefit from CHIP enrollment, if the employee’s benefits do not provide adequate coverage for the children. The team at food-stamps.org urges state employees to inquire about CHIP eligibility in such instances.

Find Out About CHIP Benefits and the Application

As CHIP functions as an extension of Medicaid, the coverage provides the same benefits as the basic Medicaid plan, including pediatric services, early screening services and required vaccination coverage. Out-of-pocket expenses must also follow Medicaid regulations, although children’s wellness visits are exempt out-of-pocket payments.

Like Medicaid, CHIP applications are found online and in-person at Medicaid/CHIP offices. Waiting periods and waiting period exemptions for CHIP vary from state to state, although many states have eliminated the waiting time, and waiting times (in the states that do have them) are required by law to be no longer than 90 days.