Child Health Plus Vs Medicaid


What If I Need Immediate Care


You may qualify for a program called Presumptive Eligibility . PE is a way for children and pregnant women to receive care right away without having to wait to see if you are eligible. To apply, you must visit a PE Site and they will do a quick review. If found eligible you will get enrolled for up to 60 days while you wait to see if you qualify. Find a PE Site in your area.

Community Organizations That Can Help You Enroll

  • All Counties & All New York City BoroughsCommunity Service Society of New York888-614-5400
  • Westchester County Department of Health914-995-6350
  • Bronx, Kings, New York, QueensCoalition for Asian American Children and Families 212-809-4675
  • Bronx, Kings, New York, QueensNADAP, Inc.
  • Bronx, Kings, New York, Queens, Richmond-Hispanic Federation
  • Bronx, Kings, New York, Queens, RichmondPublic Health Solutions
  • Morris Heights Health Center, Inc.718-483-1260
  • Bronx, Kings, New York, Queens, RichmondSingle Stop USA
  • Yeled V’Yalda Early Childhood Center, Inc.718-686-2188
  • Joseph P. Addabbo Family Health Center718-945-7150 ext. 1102
  • The Lesbian, Gay, Bisexual & Transgender Community Center646-556-9300 ext. 271
  • Gay Men’s Health Crisis, Inc.-212-367-1029 ext. 1029
  • New York
  • Charles B Wang Community Health Center, Inc. 718-886-7355
  • Community Health Center of Richmond, Inc.718-924-2254 ext. 7417
  • Jewish Community Center of Staten Island718-981-1400

See If Your Children Qualify And Apply For Chip

Each state program has its own rules about who qualifies for CHIP. You can apply right now, any time of year, and find out if you qualify. If you apply for Medicaid coverage to your state agency, youll also find out if your children qualify for CHIP. If they qualify, you won’t have to buy an insurance plan to cover them.

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Ways To Apply For Chip:

  • Fill out an application through the Health Insurance Marketplace®. If it looks like anyone in your household qualifies for Medicaid or CHIP, well send your information to your state agency. Theyll contact you about enrollment. When you submit your Marketplace application, youll also find out if you qualify for an individual insurance plan with savings based on your income instead. Create an account or log in to an existing account to get started.

FYI: Apply any time

You can apply for and enroll in Medicaid or CHIP any time of year. Theres no limited enrollment period for either Medicaid or CHIP. If you qualify, your coverage can start immediately.

How The Process Works

What Is Medicare and How to Get It

Patients do not need to apply to join OHIP+, nor do they need to pay any upfront costs. Those eligible for OHIP+ only need to give pharmacists their health card number and a valid prescription for an eligible medication. The pharmacist may ask the patient or their parent/guardian if they are covered by a private plan.

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How Much Does Child Health Plus Cost

The table below shows costs. Monthly premiums depend on income and family size . There is no cost for low income families. Families with higher incomes pay a sliding scale premium as low as $9 and as high as $60 per child, per month. The chart below shows how much per month a family will pay based on their income. The premium is capped at the monthly cost for three children. For example, if a family with four children qualifies for CHP at $9 per month, per child, their monthly premium will only be $27 to cover all four children.

There are no annual deductibles and no co-pays for services in Child Health Plus plans.

Family Contributions

Childrens Health Insurance Program

Through Mississippi Health Benefits there are two health insurance options that cover children, the Childrens Health Insurance Program and Medicaid.

The income limits are based on Modified Adjusted Gross Income or MAGI limits. The limits are referred to as MAGI because the programs using MAGI limits are based primarily on IRS rules for counting income and determining household composition.

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Expiration And 2018 Reauthorization For 6 Additional Years

CHIP expired on September 30, 2017. At the time, most states had sufficient funds to keep the program running for a period of months.

On September 18, 2017, Senators Orrin Hatch and Ron Wyden introduced the Keeping Kids Insurance Dependable and Secure Act , which would fund CHIP until 2022. On November 3, 2017, the House of Representatives passed the CHAMPION Act, which also would fund CHIP until 2022.

On January 22, 2018, President Trump signed legislation that reauthorized CHIP for six years. Bill H.195 passed the House by a vote of 266-150 and passed the Senate a vote of 81-18. Fifteen Senate Democrats and 144 House Democrats voted against the bill because they objected to ending a three-day government shutdown without legally enshrining the DACA program for certain undocumented immigrants.

On February 9, 2018, Congress passed the Bipartisan Budget Act of 2018, which reauthorized CHIP for an additional four years. The bill was passed by vote of 7128 in the Senate and by a vote of 240186 in the House of Representatives. President Trump signed the bill into law that same day, allowing for CHIP’s extension through 2027.

Out Of Pocket Prescription Reimbursement



If you paid for a prescription while covered by CHP+, but before you enrolled in your health plan, you may ask the pharmacy for a refund.

Contact the pharmacy where you got the prescription. Give them your receipt, State ID number, BIN , and PCN . If you dont know your State ID number or need help, call the pharmacy liaison. Call them at 303-866-3588.

You have 120 days from the date the prescription was filled to ask the pharmacy for a refund. Refunds are not promised.

There may be times when you are charged for the full cost of a prescription medication. This may be if you do not have your ID card when you go to pharmacy that is in our network. Or if you fill a prescription at pharmacy that is not in our network.

If you pay the full cost for a covered prescription medication, please follow these steps:

  • Ask for an itemized receipt. This will show that you paid for the medication.
  • Please also give us your name and address.
  • Mail the itemized receipt and this form for reimbursement to:

Colorado Access

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Children’s Health Insurance Program

The Children’s Health Insurance Program formerly known as the State Children’s Health Insurance Program is a program administered by the United States Department of Health and Human Services that provides matching funds to states for health insurance to families with children. The program was designed to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid. The program was passed into law as part of the Balanced Budget Act of 1997, and the statutory authority for CHIP is under title XXI of the Social Security Act.

CHIP was formulated in the aftermath of the failure of President Bill Clinton‘s comprehensive health care reform proposal. Legislation to create CHIP was co-sponsored by Democratic Senator Ted Kennedy and Republican Senator Orrin Hatch, and received strong support from First Lady Hillary Clinton. Despite opposition from some conservatives, SCHIP was included in the Balanced Budget Act of 1997, which President Clinton signed into law in August 1997. At the time of its creation, SCHIP represented the largest expansion of taxpayer-funded health insurance coverage for children in the U.S. since the establishment of Medicaid in 1965. The Children’s Health Insurance Reauthorization Act of 2009 extended CHIP and expanded the program to cover an additional 4 million children and pregnant women, and the Bipartisan Budget Act of 2018 extended CHIP’s authorization through 2027.

Who Is Eligible For Child Health Plus

Children may qualify for CHP if:

  • They are under age 19
  • They are New York State residents
  • They are not eligible for Medicaid or covered by other health insurance
  • They are not eligible for or enrolled in a health plan through a state health benefits program

*All children are eligible regardless of immigration status

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How Chip Works For Children

CHIP was created as part of the Balanced Budget Act of 1997 to build on Medicaid coverage for low-income children. States are able to utilize federal funds for CHIP to expand their Medicaid program or create a standalone program, or a combination of both. The primary goal of CHIP is to expand the reach of government-funded health care coverage to more low-income children. As part of CHIP, the states have simplified the enrollment process, making it easier for children to obtain coverage. Although CHIP covers more children, its coverage options are more limited than Medicaid. CHIP doesnt offer coverage for EPSDT services.

What Benefits Can You Get For Your Children


If your child is enrolled in Children’s Medicaid, you may be required to enroll in a managed care plan, or you may bring your child to any provider who accepts Children’s Medicaid. If your child is enrolled in Child Health Plus, you will be given a list of providers near you. The provider may be a single doctor, group practice of several doctors, or community health center. If it is a group practice, you will be asked to choose a doctor for your child. Either way, you will be getting the personal health care that your child deserves!

  • Well-child care
  • Diagnosis and treatment of illness and injury
  • X-ray and lab tests
  • Prescription and non-prescription drugs if ordered
  • Inpatient hospital medical or surgical care
  • Short-term therapeutic outpatient services
  • Inpatient and outpatient treatment for alcoholism and substance abuse, and mental health
  • Dental care
  • Emergency ambulance transportation to a hospital
  • Hospice

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Ontario Works Ontario Disability Support Program Long

Children and youth 24 years and under who are eligible for the Ontario Drug Benefit program because they are enrolled in Ontario Works, the Ontario Disability Support Program, receive Home Care, or are residents of a Long-Term Care Home, Homes for Special Care, or Community Homes for Opportunity, will maintain their benefits through the ODB program with no co-pay and no deductible regardless of whether they have a private plan.

What If I Need Immediate Care For My Pregnancy

If you are pregnant, you may qualify for a program called Presumptive Eligibility . PE is a way for pregnant women to receive prenatal care right away without having to wait to see if you are eligible. To apply, you must visit a PE Site and they will do a quick review. If found eligible you will get enrolled for up to 60 days while you wait to see if you qualify. Find a PE Site in your area.

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Child Health Plus Overview

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This article was authored by the Health Law Unit of the Legal Aid Society.

American Disabilities Act Notice

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In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

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If Youre 24 Years Old Or Under

If you need a covered medication and you are not covered by a private plan:

  • Visit your doctor or nurse practitioner and get your prescription.
  • Take your health card OR health card number to any pharmacy in Ontario you dont need a separate or special card. Your pharmacist may ask if you are covered by a private plan.
  • If you do not have a private plan, the pharmacy will fill your prescription at no charge .
  • What Does It Cost

    CHP+ costs vary depending on your household size and income. CHP+ members may have to pay an annual enrollment fee. This fee is due within 30 days of your CHP+ approval. If the enrollment fee is not paid within the 30 days allowed then the family will be denied and will need to re-apply. Some CHP+ clients may also have to pay co-pays to their health care provider at the time of service. Prenatal women, American Indians and Alaskan Natives do not have to pay annual enrollment fees or co-pays.

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    How Long Does Chp+ Coverage Last

    • For children, CHP+ coverage begins the date the application is received at the CHP+ office, an Application Assistance Site, or a county office. Coverage lasts at least 12 months.
    • For pregnant women, CHP+ Prenatal Care Program coverage begins the date the application is received at the CHP+ office, an Application Assistance Site, or a county office. Coverage will last for at least 60 days after your pregnancy ends.

    Potential Cuts To Medicaid Funding

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    The Trump administration attempted to repeal the Affordable Care Act and replace it with the American Health Care Act, subsequently known as the Better Care Reconciliation Act in 2017. This legislation did not pass but it would have ended Medicaid expansion and would have also changed how Medicaid was funded. According to the Congressional Budget Office, the BRCA would have cut $756 billion from Medicaid over a decade and 15 million people on Medicaid would have lost coverage as a result.

    The BCRA did offer tax credits for individuals and families. In this way, it can be argued that attempts were made to decrease the cost of health care to Americans. Specifically, the BCRA would have replaced the ACA-income-based tax credits with a flat tax credit adjusted for age. In some cases, the subsidies would be greater under the BCRA than the ACA, but these subsidies were capped at $14,000 per year regardless of family size. Also, anyone who was eligible for an employer-sponsored health plan, Medicare, Medicaid or CHIP, or TriCare, would not have been eligible for those tax credits.

    Attempts are still underway to repeal the Affordable Care Act. With the individual mandate deemed unconstitutional in 2017, a federal court judge in Texas ruled in 2018 that the Affordable Care Act as a whole is unconstitutional. That ruling is under appeal and may eventually make its way to the Supreme Court. Until then, the Affordable Care Act remains in effect.

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    Key Differences Between Medicaid And Chip

    With more than 75 million enrollees, Medicaid is larger in size and scope than CHIP. Working together, the two programs are coordinated to provide coverage to all low-income children up to 300% of the FPL threshold. Although the ACA has established minimum requirements across all health care programs, there are still some key differences in the way the Medicaid for children and CHIP are administered on a state level.

    Westchester County Waives Beach Fees

    If you and your family continue to struggle with paying rent, face possible eviction, and/or cannot cover your heat and utilities bills due to issues related to the COVID-19 pandemic or other circumstances, Westchester County Social Services may be able to assist.

      Family Health Plus provides coverage to adults who do not have health insurance but have income too high for Medicaid. Parents and childless adults aged 19 through 64 are eligible if they live in New York State, have no health insurance and meet income and resource guidelines. There is no cost to apply for Family Health Plus and no deductibles once you are enrolled. Once enrolled you may be asked to co-pay part of the costs of some medical care services. Health care is provided through managed care plans. Family Health Plus will do its best to help participants continue to see their current doctor.

      Services covered by Family Health Plus

      • physician services
      • inpatient and outpatient hospital care
      • prescription drugs and smoking cessation products
      • X-rays and lab tests
      • vision, speech, and hearing services
      • rehabilitative services
      • durable medical equipment
      • inpatient hospital medical or surgical care
      • emergency room and emergency ambulance
      • drug, alcohol, and mental health treatment
      • diabetic supplies and equipment

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      Who Administers The Program

      Within federal guidelines, each state determines the design of its individual CHP program, including benefit package, payment levels for coverage , who qualifies, and administrative procedures.

      On the federal level, the overall responsibility for the administration of the Child Health Plus program lies with the Centers for Medicare & Medicaid Services , an agency of the Department of Health and Human Services.

      In New York State, CHP is administered by the NYS Department of Health, Division of Planning, Policy and Resource Development.

      Federal Funding For Chip

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      Federal funding for CHIP, on the other hand, has pre-set limits. Each state is given an allotment every year as a block grant. The dollar amount is fixed regardless of the number of people covered by the program.

      The 50 states and the District of Columbia have a choice to use their block grants in one of three ways:

      • As a combination Medicaid-CHIP program
      • As part of the state’s Medicaid expansion
      • As a separate CHIP program

      To encourage states to participate in CHIP, the federal government offers a higher matching rate than it does for Medicaid. This is referred to as the enhanced Federal Matching Assistance Percentages . The minimum for Medicaid matching in 2020 is 50 percent but all states are 65% or higher. Again, states with higher economic needs get reimbursed at an even higher rate.

      Those states using combination programs or Medicaid expansion have the same program requirements as traditional Medicaid. States with separate CHIP programs, however, have more wiggle room. If need be, they can put children on waiting lists or establish enrollment caps to rein in CHIP costs. Many of those states will also charge premiums and copayments to their beneficiaries.

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