What is SCHIP?

SCHIP stands for State Children's Health Insurance Program. The SCHIP program was designed to provide health insurance to children whose families who can not afford a private health plan, but do not qualify for Medicaid.

Since 1997, the SCHIP program has provided millions of children health coverage. In 2006, there were an estimated 6.6 million children with SCHIP insurance.


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How SCHIP Works

Even though the SCHIP was created by the federal government, individual state governments operate their own programs.

How each SCHIP program works depends on the state. To provide SCHIP benefits for children, states can choose to expand Medicaid coverage, create an entirely separate SCHIP program, or combine the two options.

But no matter which route a state chooses to provide children's health insurance coverage, federal law requires states to provide a minimum set of benefits.

So which medical services does SCHIP cover?

  • Preventive care (including doctor's visits and vaccinations)
  • Hospitalization
  • Emergency room visits

While all states must meet these minimum benefits, many offer additional coverage for children in need.

Eligibility for SCHIP

The federal SCHIP law states that anyone earning up to 200% of the federal poverty level is eligible for coverage. That equals about $36,200 a year for a family of four.

The exact the eligibility limits are determined on a state-to-state basis. Some states also offer SCHIP coverage for low-income pregnant women and for the parents of covered children.

Many states are starting to push the federal government to allow expanding the SCHIP program to children in higher-income families. But before states can expand coverage, they must comply with newly created federal rules.

One new rule requires states to prove it has covered 95% of children up to 200% of the poverty level before expanding coverage. Also, the number of SCHIP-eligible children covered by private health plans cannot drop by more than 2% in five years.

Currently, these rules are being disputed.

Enrolling For SCHIP Coverage

Most states require parents to mail in an application to enroll their child or children in SCHIP coverage.

In general, children must re-apply for SCHIP coverage every 12 months to ensure they're still eligible.

If you think your child or children might be eligible for SCHIP coverage, contact your state's children's health insurance administrator or your state's department of health and human services.

Want to learn more? Visit our Health Insurance Info Center.