CHIP 2026: Children’s Health Insurance Program — Income Limits & How to Apply

Last Updated: July 2026

There’s a real coverage gap that catches many working families off guard: you earn too much for Medicaid, but health insurance through work or the private market feels impossibly expensive for your kids. CHIP exists exactly for this situation — and the income limits are far more generous than most parents assume.

What CHIP Actually Is

The Children’s Health Insurance Program (CHIP) provides free or low-cost health coverage to children in families whose income is too high for Medicaid but too low to comfortably afford private insurance. It’s a joint federal-state program, similar in structure to Medicaid, covering roughly 7 to 8 million children nationwide. Each state runs its own CHIP program — some fold it directly into their Medicaid system, while others operate it as a separate program with its own name (Texas Children’s Health Plan, WVCHIP in West Virginia, and similar state-branded versions elsewhere).

Who Qualifies?

Basic requirements:

• Under age 19
• A U.S. citizen or qualified immigrant (with some states extending coverage to lawfully present children within their first 5 years of status)
• Uninsured — not already covered by Medicaid, a group health plan, or other creditable insurance
• A resident of the state where you’re applying
• Household income within your state’s CHIP range

Important exclusions: Children who are inmates of a public institution or who already have health coverage through a family member’s public-agency employment generally cannot enroll in CHIP.

Income Limits: More Generous Than You’d Think

This is the detail that surprises most families. CHIP eligibility is based on Modified Adjusted Gross Income (MAGI) as a percentage of the Federal Poverty Level — and the federal minimum is considerably higher than Medicaid’s threshold.

• Federal minimum: 200% FPL
• National median: approximately 255% FPL
• Some states go up to: 317% FPL or even 400% FPL for children

FPL Percentage	Approximate Annual Limit (Family of 3)	Approximate Annual Limit (Family of 4)
200% (federal floor)	~$54,640	~$66,000
255% (national median)	~$69,666	~$84,150
317% (higher-limit states)	~$86,604	~$104,610

Add approximately $5,680 per additional household member. Your state’s exact cutoff may vary depending on specific income-counting rules and deductions.

Practical takeaway: A family of four earning around $80,000/year — which would disqualify them from Medicaid in most states — can very plausibly still qualify for CHIP, depending on their specific state’s threshold. For a comparison against Medicaid’s lower 138% FPL threshold, see our Medicaid eligibility guide, and for the exact Federal Poverty Level figures this is based on, see our income limits guide.

Younger children often qualify at even higher income levels than older kids in some states, since many states set more generous thresholds for children under 6.

Is CHIP Really Free?

Often yes, but not always. Many states charge a small monthly premium once household income crosses a certain threshold — commonly $20, $30, or $50 per month per household, not per child. Co-pays for specific services may also apply, though these are typically modest compared to private insurance.

Important consequence of missed payments: If a family doesn’t pay their CHIP premium for two consecutive months, coverage can be terminated, and the child may be locked out of re-enrolling for 90 days unless they qualify for Medicaid instead or pay the outstanding balance.

What CHIP Actually Covers

CHIP benefits vary somewhat by state but generally include comprehensive coverage:

• Doctor visits and preventive care (checkups, immunizations)
• Prescription medications
• Dental and vision care
• Emergency services and hospitalization
• Mental health and substance use disorder treatment

Some states also extend CHIP to cover prenatal, delivery, and postpartum care for pregnant women whose income exceeds Medicaid’s threshold but qualifies for CHIP. Infants born to CHIP or Medicaid-eligible pregnant women are automatically enrolled for their first year of life, without a separate application.

CHIP vs. Marketplace Insurance: Which Is Better?

If your child qualifies for CHIP, they generally cannot simultaneously receive subsidized Marketplace coverage. Enrolling in a Marketplace plan instead of accepting CHIP typically means losing access to premium tax credits for that child, since CHIP is almost always the more affordable option when available.

If your income is above your state’s CHIP limit, Marketplace plans with premium tax credits may still be surprisingly affordable — it’s worth comparing both options rather than assuming private insurance is your only choice.

How to Apply: Step by Step

Step 1 — Apply anytime. Unlike Marketplace insurance, there’s no open enrollment period for CHIP or Medicaid — you can apply any time of year, and if approved, coverage can start immediately.

Step 2 — Apply through one of two paths:

• HealthCare.gov — Complete a single Marketplace application; if it looks like your child qualifies for CHIP or Medicaid, your information is automatically routed to your state agency
• Directly through your state’s Medicaid/CHIP agency — Often faster if you already know you’ll qualify for CHIP specifically rather than Medicaid

Step 3 — Gather documentation: proof of income (pay stubs or tax return), Social Security numbers for household members, proof of state residency, and immigration status documentation if applicable.

Step 4 — Wait for a determination. Since CHIP and Medicaid share an application system in most states, you’ll find out which program your child qualifies for (or both, if you have multiple children with different needs) through the same process.

Step 5 — Renew as required, typically annually — respond promptly to any renewal notice to avoid a coverage gap.

Special Situation: Immigrant Families

Federal law generally requires qualified immigrant children to wait 5 years after obtaining legal status before enrolling in Medicaid or CHIP, unless their state has opted out of this waiting period (many states have). Separately, some states run specific programs for children who don’t qualify for traditional CHIP due to citizenship status — Utah’s “State CHIP,” for example, extends coverage to non-citizen children of working families, though note that state-specific programs like this can have limited funding and enrollment windows that close once capacity is reached.

Important reassurance: Applying for CHIP is not considered under the “public charge” rule and does not affect a family’s immigration status or path to citizenship.

Frequently Asked Questions

What’s the actual difference between CHIP and Medicaid for kids? Both are income-based children’s health coverage, but CHIP serves a higher income bracket than Medicaid — generally families who earn too much for Medicaid but still need help affording insurance.

Does my child’s CHIP eligibility affect my own Medicaid eligibility as a parent? No — a child’s CHIP enrollment doesn’t automatically qualify adults in the household for Medicaid or CHIP, since CHIP exclusively covers children (and pregnant women in some states).

Is there really no enrollment period, as there is with Marketplace insurance? Correct — you can apply for CHIP or Medicaid any time of year, unlike ACA Marketplace plans which generally require open enrollment or a qualifying life event.

What happens if I miss a CHIP premium payment? After two consecutive months of missed coverage, coverage typically ends, and re-enrollment may be blocked for 90 days unless the balance is paid or the child qualifies for Medicaid instead.

Can newborns get automatic coverage? Yes — infants born to Medicaid or CHIP-eligible pregnant women are automatically enrolled for their first year without a separate application in most states.

Does applying for CHIP affect immigration status? No. CHIP enrollment is not considered under the public charge rule and does not affect immigration proceedings or eligibility for citizenship.

How do I find my exact state’s income limit? Limits vary significantly — check your state’s Medicaid/CHIP agency website directly, or use HealthCare.gov’s screening tool, since national averages won’t reflect your specific state’s threshold.

Final Thoughts

CHIP fills a real and often-overlooked gap for working families — its income limits (typically 200-317% FPL, depending on your state) are considerably more generous than Medicaid’s, meaning many families who assume they earn “too much” for assistance actually qualify. Since there’s no enrollment period restriction and applying costs nothing, it’s worth checking your eligibility any time your child is uninsured, rather than assuming private insurance is your only option.

This article is for informational purposes only and is not affiliated with CMS, Medicaid, CHIP, or any state agency. Income limits, premiums, and program rules vary significantly by state and change periodically — always verify current details directly through your state’s Medicaid/CHIP agency or at healthcare.gov.