Medicaid Children’s Health Insurance Program

Complete And Submit An Application

Self-service application options:

Online: Log on to Georgia Gateway at to apply for benefits. Available 24/7.

An application is considered filed when it has the name of the head of household, address, date and signature of the head of household or another household member and is received by DFCS.

Notice of Free Interpretation ServicesIf you have difficulty communicating with us because you do not speak English or have a disability, please notify a staff person. Free interpretation services, translated materials or other assistance is available upon request.

For additional support with requesting large print versions of DFCS applications, please visit .

DFCS Reasonable Modifications and Communication Assistance Request Form for Persons with Disabilities

Do you have a disability and need a reasonable modification or communication assistance to access DFCS services? to request a reasonable modification, communication assistance, extra help or to learn more about the rights of customers with disabilities.

Medicaid Benefit Renewal

All benefits recipients are required to undergo periodic review of continued program eligibility. A renewal form and any required accompanying verification can be submitted in Georgia Gateway or by using Form 508 the FOOD STAMP/MEDICAID/TANFRenewal Form.

Best Practices In Serving Ai/an Populations

To identify the best ways to conduct outreach and enrollment for Medicaid and CHIPRA among AI/AN children and families, CMS created a report on best practices in serving AI/AN populations. The study asked IHS, tribal, and urban CHIPRA grantees, state agencies, and Indian health programs who are not CHIPRA grantees about what practices had been successful for them. Findings in the report discuss barriers to access, enrollment strategies, tribal-state collaborations, and overall best practices.

Potential Cuts To Chip Funding

CHIP has struggled to maintain its funding too. Federal funding for the program was set to expire in September 2017. Congress approved a stop-gap measure in December 2017 to extend funding into March 2018. It was not until January 2018 that Congress passed a more long-term solution, a retroactive six-year extension through 2023.

That very same legislation also decreases the federal matching rate over time. Any enhanced FMAP rates for CHIP that were established by the Affordable Care Act would be reduced to the regular federal match rate by 2021. With less money put into the program, fewer children may be covered.

While block grants are currently used for the CHIP program, the CHIP program is significantly smaller in scale than Medicaid. Block grants limit how many children can be covered under the CHIP program. This explains why 15 states currently have waiting lists for CHIP.

In May 2018, the White House presented a rescission proposal that would cut $7 billion from CHIP. The proposal was not approved by Congress.

You May Like: Pediatric Dentist St Louis Medicaid

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.

Potential Cuts To Medicaid Funding

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.

Read Also: Medicaid Administrative Office Columbia Sc

South Dakota Medicaid For Youth Formerly In Foster Care

The Former Foster Care Medical Program provides extended medical coverage for youth age 18 to 26 that are leaving State foster care after their 18th birthday. Referrals for this program are normally generated by the Division of Child Protection Services staff. You may also call 877.999.5612 for further information.

Eligibility Requirements

• The youth must have been in foster care under the responsibility of the State of South Dakota on his/her 18th birthday.
• The youth must be a resident of South Dakota.
• There is no resource or income limit.
• Eligibility continues from the month the youth is no longer under the responsibility of the State until the end of the month in which the youth attains age 26 if s/he meets all other eligibility requirements.

Impacts To Medicaid And Chip

To comply with the continuous enrollment requirement in the FFCRA, state Medicaid agencies have not terminated ineligible individuals since early 2020. This helped prevent people with Medicaid and CHIP from losing health care coverage during the pandemic. Because of FFCRA and the effects of the pandemic, Medicaid and CHIP enrollment grew by more than 16 million, allowing record high levels of children and families to preserve access to health care nearly 87 million as of January 2022.

When the PHE expires, states will complete eligibility renewals for most individuals in Medicaid and CHIP for the first time since March 2020. Given that significant time may have elapsed since families were last required to renew, states may have outdated contact information for a substantial number of program enrollees. Almost 15 million enrollees, including children, young adults, and other vulnerable populations, could be at risk of losing Medicaid or CHIP coverage, though many may be eligible for other coverage options, including through the Health Insurance Marketplace.

Also Check: Does Medicaid Cover Tooth Replacement

Services Covered By Medicaid And Chip

• Regular checkups at the doctor and dentist
• Medicine and vaccines
• Access to medical specialists and mental health care
• Treatment of special health needs and pre-existing conditions

These services are provided by health plans. If your child gets Medicaid or CHIP, you will choose a plan from the ones available in your service area.

South Dakota Medicaid For Individuals In Adult Foster Care Facilities

Individuals in adult foster care homes that meet all eligibility criteria may qualify for South Dakota Medicaid.

Eligibility Requirements

• A person must be 65 years or older. If under age 65, a person must be blind or disabled.
• A person must be a resident of South Dakota and meet certain citizenship requirements of the United States.
• Medical needs of the individual are such that they require a level of care that must be provided in an adult foster care home.
• The applicants monthly income minus allowable deductions must be less than the current state reimbursement rate to an adult foster care home.
• The resource limit is $2,000. Resources include items such as checking and savings accounts and certificates of deposit.

You May Like: Indiana State Medicaid Phone Number

Strategies To Reach Families And Individuals

We ask for your assistance with sharing key messages to prepare people you serve to renew their coverage. Families and individuals should:

• Update their contact information with their state Medicaid program or CHIP,
• Check their mail for a renewal form and complete and submit the form in a timely manner.

1The federal government issued the first PHE in January 2020, amid deteriorating public health conditions. Enabled by the PHE and subsequent Congressional action, HHS made swift and significant changes to how its programs operate to ensure the continuous delivery of services and the financial viability of entities providing these services. A PHE is for 90 days and must be continuously renewed. The current PHE is set to expire on July 15th. The possibility exists for HHS to renew the PHE again, and the Administration has committed to providing a 60-day notice of the expiration. Until that time, the waivers and flexibilities will remain in place, and current program requirements will remain the same.

Income Guidelines For Childrens Medicaid

Your income is the money you get paid before taxes are taken out. Find your family size on the table below. If your monthly income is the same or less, your child might get Childrens Medicaid.

*A family of one might be a child who does not live with a parent or other relative.

Read Also: Does Medicaid Cover Therapy Sessions

New Chip Contracts Take Effect Nov 1 2019

CHIP is currently administered by two coordinated care organizations . New CHIP contracts with Molina Healthcare and UnitedHealthcare Community Plan will take effect Nov. 1, 2019. CHIP beneficiaries currently enrolled with the outgoing CHIP CCO, Magnolia Health Plan, will receive a letter giving them the opportunity to choose between Molina Healthcare and UnitedHealthcare Community Plan. If a CHIP beneficiary does not respond, they will be assigned to Molina Healthcare.

All CHIP beneficiaries can select which plan they want during annual open enrollment which will be held in October through December.

As always, DOM encourages providers to enroll in all Mississippi Medicaid programs and wants providers to be aware that Molina Healthcare will be providing CHIP services come Nov. 1, 2019.

South Dakota Medicaid For Individuals In Assisted Living Facilities Nursing Facilities Or Homes

Individuals in assisted living centers, Nursing Facilities or Homes who meet all eligibility criteria may qualify for South Dakota Medicaid.

Eligibility Requirements

• A person must be 65 years or older. If under age 65, a person must be blind or disabled.
• A person must be a resident of South Dakota and meet certain citizenship requirements of the United States.
• Medical needs of the individual are such that they require a level of care provided in a nursing home.
• The monthly income limit is 300 percent of the SSI Standard Benefit Amount.
• The resource limit is $2,000. Resources include items such as checking and savings accounts and certificates of deposit.

Don’t Miss: What States Does Medicaid Cover Abortions

South Dakota Medicaid For Certain Newborns

South Dakota children born to women eligible for South Dakota Medicaid are also eligible for South Dakota Medicaid.

Eligibility Requirements

• The child must be born to a woman eligible for and receiving South Dakota Medicaid on the date of the childs birth.
• There is no resource or income limit.
• Coverage continues from the month of birth until the end of the month in which the child turns one year of age as long as the child continues to live in South Dakota.

Quadriplegics Who Would Require Nursing Home Care If Not For Special Services Performed In Their Home

Individuals with quadriplegia living independently in their own homes may be eligible for South Dakota Medicaid. Individuals who are eligible are entitled to full South Dakota Medicaid coverage.

Eligibility Requirements

• A person must be age 18 or older and have quadriplegia.
• The income limit can be up to $2,523 month.
• The resource limit is $2,000. Resources include items such as checking and savings accounts and certificates of deposit.

Don’t Miss: Get My Medicaid Id Number

Medicaid Vs Chip: An Overview

Medicaid and Childrens Health Insurance Program both play a critical role in ensuring that children in lower-income families have sufficient health care coverage. Although they are both federal programs largely implemented through the states with joint financing, the two programs differ in many respects.

Dont Miss: At What Age Am I Eligible For Medicaid

Chip Medicaid Kept Children Insured

Data released today show the number of U.S. children without health insurance declined for the first time in at least four years in 2021, aided by government policies that helped maintain their access to medical care.

Just under 4 million children or 5% of all U.S. children went without health insurance in 2021, according to new data from the U.S. Census Bureau, a 0.6 percentage-point drop from 2020. The figure represents 475,000 children who gained or retained insurance in 2021, largely due to increased public coverage through Medicaid or the Childrens Health Insurance Program, which took over as job losses and other economic issues decreased childrens private coverage.

Insuring our nations 73 million children and keeping them insured offers one of the best investments we can make in their health and well-being, said First Focus on Children President Bruce Lesley. We are pleased to see this decline in the number of children who go without insurance and Congress must move quickly to cement these gains. Congress also must make permanent the Childrens Health Insurance Program. CHIP, which insures 10 million children each year, is the only federal health insurance program that requires constant renewal. When Congress allows it to expire as they did in 2017 they endanger the health care of the next generation.

You May Like: Are Breast Pumps Covered By Medicaid

How To Apply For Health Insurance Financial Aid

Applying for most health insurance financial aid starts with the Marketplace. Although some states run their own marketplaces, the federal website will redirect users to those marketplaces when appropriate. Medicare beneficiaries in need of assistance should contact their state’s Medicaid office.

To apply for assistance, you may need to provide documentation supporting your claims, including confirmation of immigration status, citizenship, social security number, household income, and American Indian or Alaskan Native status.

If you’re at risk of taking on medical debt even with insurance, individual hospitals have financial assistance or charity care programs to defray unexpectedly high bills. Many hospitals use charity care applications to determine if a patient qualifies for one or more of the government programs above, and otherslike Ohio Healthoffer interest-free loans to patients who do not qualify for other discounts.

How To Apply For Financial Assistance To Pay For Health Insurance

In 2021, employers paid 73% of the average $22,221 in annual premiums for health insurance for a family of four, but that still left $5,969 for the employee to pay. Costs for the independently insured can be even more daunting.

No wonder so many Americans rely on some form of financial assistance to meet their healthcare needs. As of June 2022, 82.3 million people were enrolled in Medicaid. And, according to the Kaiser Family Foundation, nearly 9.1 million people received financial assistance for Marketplace health plans in 2020.

Health insurance is expensive, but also essential, which is why it is important to know what types of financial assistance exist to help pay premiums and lower out-of-pocket costs.

Also Check: What Does Medicaid Cover In Michigan

Considerations For Chip Reauthorization

CHIP reauthorization will be considered within the broader context of coverage and changes from the ACA. CHIP is funded through FY 2015, so Congress will soon need to consider CHIP reauthorization. Since CHIP was reauthorized in 2009, the ACA has altered the health care landscape by expanding Medicaid eligibility for children to 138% FPL and establishing tax credits and new options for coverage under the new health insurance Marketplaces.

If CHIP is not reauthorized, some children will face barriers to coverage. If Congress does not reauthorize CHIP, Medicaid expansion CHIP programs will be subject to the maintenance of eligibility requirements through FY 2019 and children in separate CHIP programs could transition to Marketplace coverage, if the Secretary of HHS certifies that this coverage is at least comparable to CHIP in terms of benefits and cost-sharing. However, some children will not be eligible for tax credits because a parent may have access to affordable employer coverage however, the affordability test for employer coverage is based on a calculation of the individual coverage relative to a workers wages . This situation is referred to as the family glitch and could leave more children uninsured.

Read Also: Does Medicaid Cover Home Birth In Texas

Medicaid Eligibility For Children

Children raised in families earning 138 percent or less of the federal poverty level per year are eligible for Medicaid. The FPL is calculated by the U.S. Department of Health and Human Services every year and is based on the number of people in a family with consideration also given to location. After all, some states are much more expensive to live in than others, like Hawaii.

Before the Affordable Care Act , i.e., Obamacare, was passed in 2010, children became eligible for Medicaid based on both their age and family income. Generally speaking, the older a child got, the less likely he was to get Medicaid coverage for the same family income. Oddly enough, this meant that only some children within the same family might be covered in any given year. The new legislation made the income eligibility standard the same for children 0 to 19 years of age.

Some states still have different eligibility requirements for different ages groups, but the standard value is now set for at least 138 percent of the FPL for all children. Before the ACA, the eligibility threshold was set at only 100 percent for children between 6 and 19 years old.

Recommended Reading: Can I Get Medicaid For Pregnancy If I Have Insurance