Texas SCHIP Application Information

The CHIP was established in 1997 to address the issue of uninsured children. Texas Legislature established CHIP for Texas two years later and started enrolling children in 2000. The program has been enrolling children under the age of 18 ever since.

The CHIP program provides a kind of expansion of the Medicaid program to fill the gap between eligibility for Medicaid and private insurance. However, there are major differences between the two programs in policy.

  • Medicaid is an entitlement whereas CHIP is not
  • Federal funds available to states under CHIP have a cap because of not being an entitlement
  • CHIP allows greater flexibility for states to customize benefits package

Chip covers various medical expenses including office visits and prescription drugs. CHIP also provides a cover for dental care and eye exams. Here are details of what this program specifically covers:

  • General: Visits to medical specialists, mental health care, regular checkups
  • Dental: Visits, filling, and cleaning
  • Eye: Visits, exams, and glasses
  • Vaccines and prescription drugs
  • Special health needs
  • Exam and treatment of Pre-existing conditions
  • Lab tests
  • X-rays

CHIP also provides coverage for hospital care and other necessary services.

CHIP is a low-cost insurance plan for children. CHIP costs vary with each family since these costs are based on child's family income. Families will be paying $50 or less in enrollment fee, per year. Co-pays for doctor visits and prescription drugs are also low, typically ranging from $3-$5 for families with low income while these costs are between $20 and $35 for families with higher income.

Who can apply for CHIP?

It is important to note here that parents don't have to be U.S. citizen or bear certain immigration status in order to receive benefits for their child under CHIP. If the child is a legal permanent resident or a U.S. citizen then parent's citizenship or immigration status will not affect eligibility.

Not everyone can apply for CHIP. Adults can apply for an uninsured child if they have lived with the child for more than half time of his or her age. Parents, stepparents, grandparents, brothers and sisters, legal guardian, and even other relatives meeting this qualification can apply for insurance of child under CHIP.

A child meeting the age criteria but living on his/her own can also apply for this program. A pregnant woman can also apply for insurance of her unborn child under CHIP.

What happens when your child had a private health insurance previously?

If your child has just come off a private insurance program, you can still qualify for CHIP. If your child is approved for CHIP, you'll have to wait for 90 days before CHIP coverage begins.

However, this waiting period limitation does not apply to children whose parents have dropped private insurance because of a job loss. Similarly, if COBRA benefits have ended, you don't have to wait before the coverage begins. In case of a divorce between the parents, the 90-day period is automatically waived.

There are some other situations where 90-day period will be waived.:

  • Parent had dependent health coverage from employer but it has stopped
  • Previous health insurance cost was higher than 10% of family's income
  • Insurance from Texas Employees Retirement System has been lost
  • Children switching to CHIP from Medicaid, and vice versa, due to change in family income

Eligibility Requirements

Your child must fit the following criteria to receive benefits under CHIP.

  • Your child must be 18 years of age or younger
  • Your child must be a Texas resident
  • Your child must be a U.S. citizen or permanent resident

Birth Certificate

In order to apply for CHIP, you should ensure that you have your child's birth certificate. You will be required to send it to HHSC. You can also fax the certificate at 1-877-542-5951.

If you can't send the birth certificate for some reason, you can send copy of U.S. passport, certificate of naturalization, or hospital record of birth.

If your child was born in Texas, you will not have to send this certificate.

Income Eligibility

In order to qualify for benefits under CHIP, a child's family income should be less than 200% of federal poverty level.

You can see the full chart for incoem limits here:
www.chipmedicaid.org/Files/income_guildeines_chart.png

SCHIP Application Instructions

Apply Online

You can apply online for insurance of your child through the CHIP website. You'll need to create an account at www.chipmedicaid.org before your child can apply online. If you already have an account, just enter your login details and your child can start the procedure.

Before you apply for health insurance of your child under this program, you'll have to check if your child qualifies to receive benefit under CHIP. You can see if your child will qualify or not at this link:
www.chipmedicaid.org/en/Can-I-Get-It

If your child qualifies for benefits under CHIP, you will have to fill out an application. You can apply online through this link:
www.texkid.org/CISS

After you have successfully applied for CHIP you will receive a confirmation email. Typically, confirmation email can take up to 45 days. You can track your case during this period by providing your case number and password on the website. You'll soon receive an email with welcome packet.

You can then pick a plan and choose your child's primary healthcare doctor. You'll be able to pick a dentist and a main (general) doctor.

After picking your doctor's, you'll have to fill out enrollment/transfer forms. You'll start by picking a medical and a dental plan. Sign the forms and return them before the due date. In case you are required to pay a fee for enrollment, your packet will include a coupon for payment. It's easy to pay the fee since you can either pay online or pay by check.

For further help and assistance, you can utilize official helpline at 1-877-543-7669. Phone lines remain open from Monday to Friday, 8 a.m. to 8 p.m. If you need someone in person to help you with things, you can find someone near you at this link:
www.chipmedicaid.org/en/Get-Help