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The Importance of Child Health Insurance for Low-income Families

Child health insurance for low-income families

Children can get a wide range of benefits through the Child Health Insurance for Low-income Families (CHIP). Benefits vary according on the state and the type of Child Health Insurance for Low-income Families program because states have the freedom to create their own programs under federal restrictions. States may opt for a distinct CHIP program, a Medicaid expansion program, or a hybrid of the two. will provide some information for you in this article.

What is State Children’s Health Insurance Program?

Child health insurance for low-income families
Child health insurance for low-income families

Children who live in households who make too much money to be eligible for Medicaid can receive affordable Child health insurance for low-income families through the Children’s Health Insurance Program (CHIP), a joint effort between the federal and state governments. Pregnant women are covered by CHIP in some states. Each state has a CHIP program and collaborates closely with its own Medicaid system. Each state offers a different set of CHIP advantages. However, all states offer full coverage, including regular checkups, vaccinations, doctor visits, and prescription drugs.

Who is eligible for State Children’s Health Insurance Program?

Applicants must reside in the state in which they submit their application and satisfy all of the requirements in order to be eligible for this benefit program.

18 years of age or younger; primary caregiver for a child(ren) 18 years of age or younger; citizen, national, or legally admitted non-citizen of the United States; and uninsured (and not Medicaid-eligible).
Children’s eligibility requirements for benefits may occasionally be higher. You might be required to pay small premiums and cost-sharing for specific services, depending on your income level. For specifics, consult the program information for your state.

Benefits of Children’s Health Insurance Program

Child health insurance for low-income families
Child health insurance for low-income families

The same Medicaid benefit package is offered to children under the Medicaid state plans and/or section 1115 demonstration programs of each state under the Medicaid Expansion CHIP programs. States that have a Medicaid Expansion CHIP are required to offer the Early and Periodic Screening, Diagnostic and Treatment Services, or EPSDT benefit, to children and adolescents. According to section 1905(r) of the Social Security Act, EPSDT offers a wide range of preventative, diagnostic, and treatment services for low-income newborns, kids, and teenagers under 21. The goal of the EPSDT benefit is to guarantee that children receive early identification and care, thereby preventing or diagnosing and treating health issues as soon as possible.

States may opt to offer benchmark coverage, benchmark-equivalent coverage, or Secretary-approved coverage under a separate CHIP.

Benchmark coverage is Child health insurance for low-income families that is roughly equivalent to the insurance provided under one of the following benefit plans:

Plan for a health maintenance organization (HMO). Child health insurance for low-income families that is provided by an HMO, as that term is used in the Public Health Service Act, and has the state’s largest insured commercial, non-Medicaid enrollment.

Benchmark-equivalent coverage has an overall actuarial value that is at least as good as the protection provided by one of the benchmark packages. Benchmark-equivalent health benefits coverage must include the following kinds of services in addition to providing coverage for all CHIP coverage types:

hospital inpatient and outpatient services
medical and surgical treatments provided by doctors
services for laboratories and X-rays
Depending on the particular benchmark package the state uses, there can be additional coverage requirements.

U.S. Health and Human Services is the insurer with Secretary approval. A health benefit plan that has been approved by the Secretary is one that the Secretary considers offers adequate coverage for the population of low-income children who are targeted for the program. Coverage that is identical to the coverage offered by the Medicaid state plan may be included in Secretary-approved coverage, but it is not required to be.

Mandatory Separate CHIP Benefits

Child health insurance for low-income families
Child health insurance for low-income families

All states are required to offer well-baby and well-child care, dental coverage, behavioral health care, and vaccinations regardless of the kind of separate CHIP coverage they choose.

Well-Baby & Well-Child Visits

Well-baby and well-child visits are required, and states are free to choose the frequency schedule that specifies when those visits should take place. While some states choose to adopt a state-specific periodicity schedule, many states follow the American Academy of Pediatrics’ Bright Futures recommendation.

Dental Benefits

Dental care must be provided “necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions,” as stated in 2103(a)(5) of the Social Security Act, as part of different CHIP programs. A Secretary-approved dental benefit package that satisfies the CHIP dental criteria, or a benchmark dental benefit package, are the two alternatives available to states that have a distinct CHIP program for dental care. One of the following must be substantially equivalent to the benchmark dental package:

  • The most common dependent dental plan for federal employees
  • The most popular plan in the state’s employee dental plan chosen for dependents
  • The state’s most well-known commercial insurer provides dental Child health insurance for low-income families.

View our Medicaid Dental Care website and our Dental Coverage in CHIP letter to State Health Officials for additional information on providing for children’s oral health.

Behavioral Health Benefits

The Mental Health Parity and Addiction Equity Act (MHPAEA, Pub.L. 110-343) prohibits some discriminatory practices that restrict insurance coverage for behavioral health treatment and services, making it simpler for Americans with mental health and substance use disorders to get the care they require. MHPAEA mandates that restrictions on coverage for mental health and substance use problems be no worse than those that are typically present for medical/surgical diseases. Medicaid and CHIP programs must abide by federal laws requiring parity between mental health and substance use disorders. This stipulation is applicable to:

  • Coinsurance, out-of-pocket maximums, and copays.
  • Limitations on the use of services, such as caps on the number of covered outpatient visits or inpatient days.
  • The use of non-quantitative treatment restrictions, like care management systems, and standards for determining medical need.


CHIP must provide coverage for age-appropriate vaccinations. Vaccinations for children enrolled in CHIP-eligible states must be purchased with CHIP federal and state matching funds exclusively. In contrast, the immunizations for Children (VFC) program under section 317 of the Public Health Service Act covers the cost of immunizations for children who are Medicaid-eligible (including Medicaid expansion CHIP) and uninsured. Vaccines for kids with separate CHIP coverage cannot be purchased with VFC funding.

In order to purchase vaccines for kids participating in various CHIP programs, states have two options:

  • Utilize the contract and distribution system provided by the Centers for Disease Control and Prevention (CDC) to purchase vaccines.
  • Purchase vaccines from the commercial market.

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