Frequently Asked Questions

What is the Children’s Health Insurance Program (CHIP)?

The Balanced Budget Act of 1997 created a new children’s health insurance program under Title XXI of the Social Security Act. Title XXI, also known as the State Children’s Health Insurance Program or CHIP, is specifically targeted to serve low-income, uninsured children.

What are the family income limits for the CHIP program?

CHIP provides health insurance coverage to children whose family income is up to 200% of Federal Poverty Level (FPL) -- (which amounts to $44,100 per year for a family of four in 2009).

Which children are eligible?

Under federal law, CHIP must provide health coverage to targeted uninsured children. Those children:

• Must be less than 19 years of age.
  
• Must have family income at or below 200% of Federal Poverty Level.
  
• Must not be covered by any other health insurance.
  
• Must not have been covered by a group health plan in the prior three months.
  
• May not be otherwise eligible for Medicaid.
  
• Must meet certain other non-financial criteria, such as state residency and citizenship.

How do I apply?

• Download and print CHIP Application

When completing the application, you must:

• Send proof of income received in the last 30 days along with the application (current pay stubs, award letters, etc.)
  
• Send proof of expenses for child support paid and child care paid while working.
• If you need further assistance, please call 1-800-305-3064.

Are American Indian Children eligible even if they have Indian Health Services (IHS) coverage?

Yes. The federal statute is very specific about the inclusion of American Indians and the IHS as providers. However, under the Medicaid option South Dakota can use 100 percent federal funds to purchase health care services from the IHS.

Why don’t these children currently have health insurance coverage?

Unfortunately, people in this income bracket typically do not have access to dependent health care coverage through their employers and cannot afford to purchase private health insurance for their children.

What happens if expenses for the program exceed the available funding? Does the State have to continue the program?

If the allocation is spent in its entirety, the state can access additional funding through the existing Medicaid program, however, the additional funding would require a slightly higher state match rate. The program is also optional. Therefore, if necessary, the CHIP plan can be amended and eligibility can be reduced to keep expenditures in check with the existing funding.