309.5 Children's Health Insurance Program (CHIP)

 

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 DHS who qualify for MA. Healthcare Handshake is the process through which the referrals to CHIP are made when a child no longer qualifies for MA, or to MA if the child is on CHIP and qualifies for MA.

 

Children must have no other health insurance to qualify for CHIP. 

 

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, inpatient and outpatient services, dental and orthodontia services, vision services and prescriptions.  

 

Free CHIP is available to children up to age 19 whose family income is 208%  or less of the Federal Poverty Income Guidelines (FPIG).  Low-cost CHIP is available to children up to age 19 whose family income is 208% to 314% of the FPIG.  Full-cost CHIP is available for families with income over 314% FPIG.

 

NOTE:  CHIP enrollees will not be required to apply for MA (spend-down) when hospitalized.

 

For more information on CHIP coverage, call one of the toll-free numbers found here.

CHIP contractor information is available underCAO Resources’ on the OIM webpage by clicking on the ‘CHIP Contractor Information.

 

Updated March 12, 2021, Replacing March 28, 2017