Medicaid and CHIP Health Insurance

Many Americans find it difficult to understand their health insurance options. This article is meant to provide information to you regarding your options. Assistance is available for health insurance to those who qualify.

Medicaid

Medicaid is a federal and state health care program that provides health care coverage to low-income people. Medicaid can provide free or low-cost health coverage. This program focuses on children, pregnant women, parents, the disabled and the elderly. Millions of Americans get Medicaid benefits at some point in their lives. About 75 percent of people enrolled in Medicaid are children, the elderly and the disabled. Medicaid is given out by your state. The federal government provides at least half of the funding. Some states have expanded coverage of Medicaid to cover all people below a certain income level.

There are several ways to apply for Medicaid. You can fill out an application for insurance through the Health Insurance Marketplace. If it looks like anyone in your household qualifies, the government will send your information to your state agency and they will contact you about enrolling. You can also apply directly through your state Medicaid agency. Some Medicaid programs pay for your care directly. Some programs use private insurance companies to provide you with coverage.

Since Medicaid options are based upon your state, coverage can be different depending on where you live. Typically states look at household income, household size, if someone in your household is pregnant or caring for young children, disability, age, and other key factors. The only way to find out what you qualify for is to reach out to your state’s Medicaid agency or fill out an application through the Health Insurance Marketplace. If you already have Medicaid but you would like more benefits, you can fill out the application on the Health Insurance Marketplace to see if you qualify for more coverage. If you currently have limited Medicaid coverage you do not want to check the box to say you have Medicaid. You will need to click “None of the above” instead.
Medicaid and CHIP program names can be different state to state. This can be very confusing when you’re searching for help. To see what your state programs are named, you can visit healthcare.gov/medicaid-chip-program-names/

Children’s Health Insurance Program (CHIP)

The Children’s Health Insurance Program provides health coverage to eligible children. This can be through Medicaid or separate individual CHIP programs. CHIP, much like Medicaid, is given out by each state. Also like Medicaid CHIP is funded by both state governments and by the federal government. .
CHIP can provide children with the same benefits of Medicaid including Early and Periodic Screening, Diagnostic and Treatment services which can include services like mental health and dental services. There are three main options with CHIP depending on what state you live in:

Benchmark Coverage
Benchmark Coverage can come in three varieties. Standard Blue Cross/Blue Shield preferred provider option service which is offered to federal employees, your state’s employee’s coverage plan, or an HMO plan that has the largest commercial, non-Medicaid enrollment in your state.

Benchmark-Equivalent Coverage
This coverage must match the Benchmark Coverage and include inpatient and outpatient hospital services, physician’s services, surgical and medical services, laboratory and x-ray services, and well-baby and well-child care, including immunizations.

Secretary-Approved Coverage
This category covers any coverage which is found to be appropriate and acceptable by the Secretary of the U.S. Department of Health and Human Services.
There are also possible additional coverage options based upon your state. These can include things like separate dental benefits and special coverage for vaccinations. Much like Medicaid, these programs can be named different things based upon your state. To find out what services are offered where you live, you can go to healthcare.gov/medicaid-chip-program-names/

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