CHIP In California

U.S. Congress established the Children’s Health Insurance Program (CHIP) in 1997 to provide health care coverage to children who meet the eligibility requirements. CHIP and Medicaid enrollment eligibility is mainly dependent on the household income of applicants. In California, Medicaid for children is still available to households that earn more than the income threshold for standard Medicaid, but less than the state standards. For comprehensive information on Children’s Health Insurance Program in California, download our comprehensive guide. Select details about CHIP eligibility, covered services and the application process is available below.

What is CHIP Medicaid in California?

Many residents ask, “Is CHIP considered Medicaid insurance in California?” when looking into the details of the program. Although CHIP is essentially Medicaid for children, the financial qualifications and services provided are different from those of standard Medicaid or Medi-Cal. When considering Medicaid eligibility children must meet the definite requirements of CHIP, as these are different from standard Medicaid for low-income adults and families. When households apply for Medicaid in California, they may receive a denial notification with a suggestion, based on factors in the application, to register children for CHIP instead. This means that children may qualify for CHIP even though the parents may not be eligible for Medicaid.

Eligibility requirements for CHIP Medicaid are specific to age and household income. To meet the Medicaid eligibility for children, the minor must be younger than 19 years of age and a U.S. citizen, national, permanent resident or legal alien of the country. Applicants must not be currently covered by a health insurance plan, including Medicaid. While CHIP is considered Medicaid for youths, the financial thresholds are different from the basic program. While there is a statewide income threshold for qualifying petitioners, some counties of California, like San Francisco for example, have higher thresholds for household incomes. Petitioners will need to find out the income requirements for CHIP in the area where they are applying.

What is covered by CHIP Medicaid in California?

CHIP Medicaid for children provides comprehensive coverage on a number of core health care services. Medical services covered by CHIP Medicaid include routine check-ups, doctor visits, immunizations, inpatient and outpatient hospital care, prescriptions, emergency services as well as laboratory and x-ray services. The Children’s Health Insurance Program (CHIP) also covers certain core dental services. What is covered by CHIP Medicaid dental services includes:

  • Preventative services like cleaning, sealants, fluoride treatments and space maintainers.
  • Diagnostic services such as dental examinations, full or partial mouth x-rays.
  • Treatment services including fillings with both amalgam and tooth-colored composite, porcelain, metal and stainless steel crowns, root canals, gum therapy, dentures, retainers, braces and oral surgery.

Depending on the amount of household income, CHIP participants may be required to pay a low premium and/or cost sharing for some of the health services. While the costs and coverage of Medicaid will vary, routine doctor and dental visits are free. Other health services may require a reasonable copayment. If CHIP participants receive a bill for services not covered by CHIP, they can make file an appeal.

How to Apply for CHIP in California

In California, residents can apply for CHIP and Medicaid enrollment year-round, as the programs are not contingent on open enrollment periods. The application for the Children’s Health Insurance Program is the same one as for Covered California and Medi-Cal. When residents apply for CHIP in California, the state may recommended enrollment into:

  • Medi-Cal.
  • Covered California health care insurance.
  • Medi-Cal Access Program for pregnant women.
  • County Children’s Health Initiative Program.

California residents can apply for CHIP Medicaid online, over the phone, by mail or in person at enrollment centers. Applicants can locate an enrollment center based on region, enroller type, spoken languages and times open. Several people can apply for Medicaid and CHIP for a child, including parents, foster parents, grandparents, guardians or any other authorized legal representative. Teenagers living alone may be eligible for CHIP and can apply on their own behalf.

Finding a California Health Care Provider That Accepts CHIP

When it comes to finding a physician or dentist who accepts Medicaid for children, there are a number of things parents and guardians can do. As soon caregivers enrolled children into the Children’s Health Insurance Program, they must let the children’s health care provider know straight away. If the family practitioner does not accept CHIP Medicaid, the child may still be permitted to use that physician for a short time until another provider who accepts CHIP is located.

When the state enrolls participants into CHIP, the agency will send a notification letter with a member service number. This information will also be on the insurance card. Guardians can also talk to local health agencies to find a pediatrician or specialist who accepts the insurance. After identifying a participating service provider, enrollees must furnish the Medicaid eligibility information when making the appointment as well as at each doctor’s visit.

CHIP beneficiaries can make an appointment as soon as they receive confirmation of enrollment. To make an appointment or fill a prescription, the office or pharmacy simply needs the eligibility letter as proof of enrollment. Find out more about CHIP benefits and covered services in our downloadable California guide here.


What Are the Available Health Services in California?

Low-cost, and even free health benefits are available to a large number of California residents, with some being offered to low-income applicants and others being offered to elderly or disabled individuals. However, before you can access these health services, you need to submit the appropriate application and prove that you meet the necessary qualifications. To learn all about the different health benefits you can receive in California and the application procedures that you must undergo to obtain these benefits, download our free comprehensive guide.


Who Is Eligible to Obtain California Health Benefits?

California’s health programs have various eligibility requirements that applicants must meet in order to successfully enroll. Income, age and other factors are all taken into consideration in the eligibility verification process. Find out which health benefits you qualify for here.