What is the program?
The Children’s Health Insurance Program (CHIP) is available statewide and provides free or low cost insurance for uninsured children who do not qualify for MA. It is administered by private health insurance companies that are licensed and regulated by the Pennsylvania Insurance Department (PID) and have contracts with the commonwealth to offer CHIP coverage. The CAOs will refer children who no longer qualify for MA to CHIP and CHIP will refer children to DPW who qualify for MA.
NOTE: MA and CHIP applications will go through a Master Client Index (MCI) interface with the SSA. The interface will match an individual based on demographic information and return a positive response if the individual is a U.S. citizen. The interface may fail if there is a mismatch or if the SSA has no record of the individual’s citizenship information. If the SSA match is successful for both citizenship and identity, there is no further action required by the CAO. If the SSA match is unsuccessful, the CAO will need to reach out to the individual to obtain identity and citizenship verification. In a situation where the SSN match is unsuccessful, an SSN is not acceptable verification of identity.
CHIP provides preventative and primary care services, outpatient services, and prescriptions. CHIP pays for up to 90 days of inpatient services a year.
Who qualifies?
Free CHIP is available to children up to age 19 whose family income is 200% or less of the Federal Poverty Income Guidelines (FPIG). Low-cost CHIP is available to children up to age 19 whose family income is 200% to 235% of the FPIG.
NOTE: CHIP recipients will not be required to apply for MA (spend-down) when hospitalized.
Where can I receive more information?
For more information on CHIP coverage, call one of the following toll-free numbers:
Southeastern PA: 1-800-464-KIDS.
Northeastern PA: 1-800-KIDS-199.
Central PA: 1-800-KIDS-101.
Western PA: 1-800-KIDS-105.
Philadelphia area: 1-800-464-KIDS or 1-800-822-CHIP.
For CHIP contractor information, go to ‘CAO Resources’ on the OIM webpage and click on the ‘CHIP Contractor Information.’
Updated February 14, 2012, Replacing February 8, 2002