Kids' Health Insurance (CHIP) 2026: Who Qualifies & Apply

CHIP — the Children’s Health Insurance Program — provides free or low-cost health coverage for children and teens whose families earn too much for Medicaid but still need help paying for care. This guide covers who qualifies in 2026, how the income limits work (they are set by each state), what CHIP covers, and how to apply — any time of year.

What Is CHIP?

CHIP is a joint federal and state program that covers medical and dental care for uninsured children and teens up to age 19, according to USA.gov. It works alongside Medicaid: Medicaid covers the lowest-income families, and CHIP reaches higher up the income scale so that children in working families who earn a little too much for Medicaid can still get covered.

Like Medicaid, each state runs its own CHIP program within federal rules, so the exact income limits, benefits, and name of the program differ from state to state. But the promise is the same everywhere: comprehensive, affordable coverage for kids.

Who Qualifies for CHIP?

CHIP is for children and teens up to age 19 whose family income is too high for Medicaid but within their state’s CHIP limit. As USA.gov puts it, “If your income is too high for Medicaid, your child may still qualify for the Children’s Health Insurance Program (CHIP).”

Whether your child qualifies depends mainly on:

• Age — children and teens up to age 19
• Household income — measured against your state’s CHIP limit (explained below)
• Household size — larger families can qualify at higher incomes
• Being uninsured — CHIP is for children who do not have other health coverage

CHIP qualifications, as USA.gov notes, “are different in every state. In most cases, they depend on income.” Because states set their own cutoffs, the same income can qualify a child in one state and not in another.

CHIP Income Limits for 2026

There is no single national income limit for CHIP — each state sets its own. Federal law establishes a floor: Medicaid.gov and the CMS CHIP fact sheet explain that states may cover children up to the higher of 200% of the federal poverty level (FPL), or 50 percentage points above the state’s Medicaid income level — and many states have chosen to cover children at even higher income levels.

Applying that 200% baseline to the 2026 federal poverty guidelines gives these approximate yearly income figures for the 48 contiguous states and D.C.:

Household size	2026 federal poverty level	200% of poverty (CHIP baseline)
1	$15,960	about $31,920
2	$21,640	about $43,280
3	$27,320	about $54,640
4	$33,000	about $66,000
Each additional person	+$5,680	+$11,360

These 200% figures are calculated from the verified 2026 poverty guidelines and represent the federal baseline — your state may set its limit higher. Medicaid.gov states that Medicaid and CHIP eligibility levels vary by state and range from as low as 170% up to 400% of the federal poverty level. That spread is wide enough that guessing is pointless — fill out one application and let your state check your child against its own limit.

What CHIP Covers

CHIP provides comprehensive coverage for children. Benefits generally include:

• Routine check-ups (“well-baby” and “well-child” visits)
• Immunizations (vaccines)
• Doctor visits
• Prescriptions
• Dental and vision care
• Inpatient and outpatient hospital care
• Laboratory and X-ray services
• Emergency services
• Behavioral health services

HealthCare.gov states that CHIP benefits differ in each state, but that all states provide comprehensive coverage including the services above — and that states may provide more. Medicaid.gov confirms the core children’s benefits. Because each state designs its own CHIP benefits within federal rules, the exact extras and provider networks vary, so your state’s program can give you the full list of what is covered.

How Much CHIP Costs

CHIP is free or low-cost. Routine well-child doctor visits and dental visits are free. Some states charge a modest monthly premium or small copayment for other services, but there is a hard federal ceiling on the total. 42 CFR 457.560 says a state “may not impose premiums, enrollment fees, copayments, coinsurance, deductibles, or similar cost-sharing charges that, in the aggregate, exceed 5 percent of a family’s total income for the length of a child’s eligibility period.”

Note the wording: the cap runs across the whole eligibility period, not per visit and not per service. And the same regulation makes it the state’s job to tell you your number — the state “must inform the enrollee’s family in writing and orally if appropriate of their individual cumulative cost-sharing maximum amount at the time of enrollment and reenrollment.” If you were never told your cap, you can ask for it.

Three Rules That Are Often Reported Wrong

These come straight from the federal CHIP regulations, and they are the points where general summaries most often lag behind the rules.

1. A state can no longer make you go uninsured for a few months first. For years, many states required a waiting period after a family dropped employer coverage. That is now prohibited: 42 CFR 457.805(b) states that “a State may not, under this section, impose a waiting period before enrolling into CHIP an eligible individual who has been disenrolled from group health plan coverage, Medicaid, or another insurance affordability program.” If you are told you must wait 90 days, ask which rule that is based on.

2. There is one exclusion that catches working families by surprise. If a parent works for a state or other public agency and the child is eligible for coverage under the state employee health plan, the child is excluded from CHIP — 42 CFR 457.310(c)(1) says this applies “even if the family declines to accept the coverage.” The regulation gives one narrow escape: the exclusion only bites if the employer’s contribution toward dependent coverage is more than nominal, defined as more than $10 per family per month above what it contributes for employee-only coverage.

3. Employer coverage your child cannot actually reach does not count. The same regulation says a child is not treated as covered under a group health plan “if the child does not have reasonable geographic access to care under that plan.” A family plan whose network is hours away is not the barrier it looks like on paper.

One more thing worth knowing: 42 CFR 457.342 now requires states to provide continuous eligibility for children in CHIP. A mid-year raise does not automatically knock your child off coverage.

How to Apply for CHIP

Applying is free, and there is no enrollment deadline — USA.gov says you can apply anytime. There are two ways to apply:

1. Apply through your state’s CHIP or Medicaid agency. This is the most direct route. USA.gov links to a state-by-state directory of where to apply for Medicaid and CHIP.
2. Apply through the Health Insurance Marketplace. Create an account at HealthCare.gov and fill out one application. If it looks like your child qualifies, your information is sent to your state agency, which contacts you about enrollment.

Either way, you fill out one application and your state checks your child for both Medicaid and CHIP — so you do not have to figure out in advance which program fits.

What to have ready. Applications generally ask for your child’s and household’s names and dates of birth, Social Security numbers, proof of income, and citizenship or immigration documents. Exact requirements vary by state, so your state agency will tell you what it needs.

After You Apply

Your state reviews the application and verifies your information. If your child qualifies, coverage can begin quickly, and there is no yearly window to worry about — you can apply the day you need it. CHIP coverage is renewed periodically, so watch for renewal notices from your state and respond on time to keep your child covered.

Getting one benefit often opens the door to others. If your child qualifies for CHIP, your household may also qualify for the Lifeline phone and internet discount — up to $9.25 off your monthly bill. If you are also stretching to cover food or energy costs, see our guides to food stamps (SNAP) and help paying heating and cooling bills (LIHEAP). And if the whole family may need coverage, start with our Medicaid guide — one application checks everyone.

How We Checked This

For this update we went past the plain-language government pages and read the CHIP regulations themselves, in 42 CFR part 457. Those regulations are the rule your state has to follow; the summary pages are descriptions of it, and they lag.

What the regulation says that the summaries mostly do not:

• The 200% figure is a definition, not a target. 42 CFR 457.310(b)(1) defines a “targeted low-income child” as one with household income “at or below 200 percent of the Federal poverty level for a family of the size involved,” or, in a state that had a Medicaid income level, one whose income “exceeds the Medicaid applicable income level for the age of such child, but not by more than 50 percentage points.” That is why states land at such different numbers — the second test is anchored to what each state’s Medicaid did in 1997.
• Waiting periods are prohibited, not merely uncommon. 42 CFR 457.805(b) is unambiguous: a state “may not… impose a waiting period before enrolling into CHIP an eligible individual who has been disenrolled from group health plan coverage, Medicaid, or another insurance affordability program.” A great deal of material written before 2024 still describes 90-day waiting periods as normal.
• The public-employee exclusion is real and is stated harshly. 42 CFR 457.310(c)(1) excludes a child eligible for a state health benefits plan through a family member’s public agency job “even if the family declines to accept the coverage” — with the $10-per-family-per-month “nominal contribution” test as the only opening. We have not seen this mentioned on any consumer page about CHIP.
• The 5% cost-sharing cap is per eligibility period, not per calendar year. 42 CFR 457.560 says “for the length of a child’s eligibility period in the State.” Plain-language pages usually say “for the year,” which is close enough for most families but is not what the rule says.

The 2026 poverty figures in the table above are unchanged from the last check, and the 200% column is arithmetic on them, not a state’s published limit.

Two limits on this check, stated plainly. medicaid.gov blocked our requests on this pass (an access-denied response), so its exact wording — including the “170% to 400%” range quoted above — was not re-opened today; the underlying 200%-or-50-points rule that sentence rests on was read directly in the regulation. And your state’s actual CHIP income limit is not a federal number — nothing here can tell you what it is. One application is still the only way to get a decision, and it costs nothing to file.

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Income figures shown are for 2026 in the 48 contiguous states and D.C.; the 200% figures are calculated from the official federal poverty guidelines, and your state’s exact CHIP limit and covered benefits may differ. Federal CHIP rules verified against 42 CFR part 457 on eCFR on August 28, 2026. This is general information, not legal or financial advice.