Medicaid
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What is the Difference Between Medicaid and CHIP?

Learn the key differences between Medicaid and CHIP, two vital programs that offer affordable healthcare to low-income families, children, seniors, and disabled individuals.
Published on
June 27, 2024
Presented by Givers
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Family caregivers have life-saving responsibilities, including providing the best medical care for their loved ones. American healthcare costs have skyrocketed in the last few decades. Fortunately, the government offers programs to support seniors, people with disabilities, and struggling families. 

Two of the most extensive programs are Medicaid and the Children's Health Insurance Program (CHIP). Although these programs have some similarities, there are some differences you should know about when choosing the best health insurance. With your help, your loved one can get to a doctor, receive treatment, and stay healthy.

What is Medicaid?

Medicaid teams up the federal government with individual states for a comprehensive healthcare program. Medicaid acts as a safety net, providing free or low-cost medical coverage to low-income adults, children, pregnant women, aging adults, and people with disabilities.

Who qualifies for Medicaid?

Is your care recipient eligible for Medicaid? Each state sets its own rules within federal guidelines, but some common factors come into play:

  • Income level: This is a big one. In most states, your household income must fall below a certain percentage of the federal poverty line (FPL). Typically, this threshold is 133% for children, pregnant women, parents, and older or disabled individuals.
  • Household size: The number of people living in your home will affect eligibility.
  • Age: Children, pregnant women, seniors (usually 65+), and people with disabilities are high-priority groups for Medicaid.
  • Disability status: If you have a disability that affects your ability to work or live independently, you may qualify for Medicaid regardless of age.
  • Other criteria: States have flexibility in considering factors like citizenship status and family composition.

What does Medicaid cover?

Think of Medicaid as a comprehensive healthcare plan that covers a broad range of services, including:

  • Doctor visits: Routine checkups, specialist consultations, and treatment for various illnesses and injuries.
  • Hospital care: Coverage for inpatient stays, surgeries, and other necessary hospital services.
  • Medical supplies and equipment: Wheelchairs, crutches, diabetic testing supplies, and other tools needed to manage your health.
  • Home health services: Medicaid can cover in-home assistance for those who need help with daily living activities like bathing, dressing, or medication management.
  • Nursing home care: If a nursing home becomes necessary, Medicaid can help cover the costs associated with long-term care.

Remember, benefits and co-pays vary by state. Check with your state's Medicaid agency for the specifics of your coverage. Medicaid is not a one-size-fits-all program. Eligibility requirements and covered services can change, so staying informed will guarantee care without any coverage lapses.

Navigating healthcare options can be very stressful! However, if you or a loved one needs help, Medicaid will be a valuable resource. Explore eligibility and your loved one's options. Contact your local Office of the Aging or case manager to determine how your care recipient can benefit from Medicaid.

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What is CHIP?

CHIP provides affordable health insurance to children and, sometimes, pregnant women in families who make too much to qualify for Medicaid but cannot afford private insurance. In most states, children up to age 19 in families with incomes up to 200% of the federal poverty level can enroll in CHIP. Pregnant women in some states can also qualify for higher incomes.

CHIP provides comprehensive coverage, including routine checkups, immunizations, doctor visits, prescriptions, dental and vision care, hospitalization, and more. Low-cost premiums and co-pays are charged on a sliding scale based on income.

What is the difference between Medicaid and CHIP?

While Medicaid and CHIP both provide healthcare for qualifying low-income individuals, there are some significant distinctions:

Eligibility

Medicaid covers low-income children, parents, pregnant women, seniors, and disabled individuals. CHIP is specifically for uninsured children and sometimes pregnant women in families with moderate incomes too high for Medicaid.

Coverage scope

Medicaid provides exhaustive medical and long-term care benefits. CHIP only covers essential childhood health services, such as well-baby/child visits, immunizations, emergency care, and more. 

State policies

States set their income limits and eligibility criteria and cover benefits within federal Medicaid parameters. At the same time, CHIP is more standardized across states.

Cost Sharing

Medicaid has premiums and cost-sharing only for some higher-income beneficiaries. All CHIP enrollees pay annual enrollment fees and co-pays on a sliding income scale.

Age limits

Children qualify for Medicaid at any age. CHIP only covers children up to age 19.

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How to qualify for Medicaid or CHIP

For Medicaid, monthly household income must be below 133% of the federal poverty line in most states. For a family of 4, that's about $3,050 monthly in 2023. Children, pregnant women, aging adults, and disabled individuals often qualify at higher income levels.

For CHIP, incomes must be above the Medicaid limit but below 200% of the federal poverty line in most states. For a family of 4, that ranges from around $3,050 to $5,450 per month in 2023 in most places.

How do I apply?

Individuals can apply for Medicaid and CHIP coverage through their state's program websites, over the phone, via mail, or in person. Some can also apply through the healthcare.gov marketplace. 

Applicants must provide information such as proof of income, citizenship or immigration documents, household size, expenses, etc. State caseworkers review eligibility for each program. Family caregivers should work with their care recipient to collect the needed documents and information to qualify for these government programs.

Impact on families

Medicaid and CHIP provide life-saving health coverage to millions of low-income families across America each year who otherwise may not be able to afford care. 

It saves lives and improves health outcomes for people of all ages while easing some financial burden on family caregivers. 

Medicaid provides sweeping benefits for the most vulnerable populations, such as children, pregnant individuals, disabled care recipients, and aging adults, based on strict income criteria. CHIP bridges the gap for moderate-income families that don't qualify for Medicaid but still need affordable health coverage for their kids and sometimes pregnancy services.

Family caregivers help their loved ones get the high-quality healthcare they need. To do this well, family members need to know the best healthcare program their loved one can use based on their family's situation. Caregivers can provide the proper care and support to their loved ones. Take a proactive role in promoting the health and well-being of your loved ones with the help of Medicaid or CHIP.

Related article: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) >>

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