Medicaid vs. CHIP: Key Differences in Children’s Healthcare Coverage

Core Insights - Medicaid and CHIP are essential federal programs aimed at providing healthcare coverage for children in low-income families, with distinct structures and coverage options [2][3][9]. Medicaid Overview - Medicaid was established in 1965 to provide health coverage for families with dependent children living below the federal poverty line (FPL), initially covering children up to 133% of FPL, later expanded to 138% under the Affordable Care Act (ACA) [5][8]. - Medicaid mandates coverage for a wide range of services, including check-ups, hospital visits, and dental care, and also covers adults [6][13]. CHIP Overview - CHIP was created in 1997 to extend Medicaid coverage to low-income children who do not qualify for Medicaid but cannot afford private insurance [9][11]. - The program simplifies the enrollment process and covers more children, although its coverage options are more limited compared to Medicaid [10][11]. Key Differences - Medicaid has over 76 million enrollees, while CHIP has around 6 million, indicating Medicaid's larger scope [13]. - Medicaid provides coverage for adults, while CHIP is exclusively for children [13]. - The federal matching funds for CHIP are higher (71%) compared to Medicaid (56%), but CHIP has capped matching funds, unlike Medicaid [15]. Coverage Requirements - Medicaid has comprehensive coverage requirements, including Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services, while CHIP has more flexibility in its coverage design [16]. - States can impose premiums and cost-sharing under CHIP, but Medicaid does not allow this for mandatory coverage [17]. Application Process - Eligibility for Medicaid and CHIP can be determined using an income calculator on healthcare.gov, and applications can be submitted through the Health Insurance Marketplace or state Medicaid agencies [19][20][21]. - Teenagers up to age 19 are eligible for coverage, but application is still required regardless of age [22]. Coverage Details - Both programs provide comprehensive coverage for children, including routine check-ups, prescriptions, and emergency services, though specific benefits may vary by state [24].