Children's Health Insurance Program (CHIP)

The Children’s Health Insurance Program (CHIP) is a joint state and federal government program that provides low cost healthcare coverage for children in families who can’t afford private insurance but earn too much to qualify for Medicaid.

All U.S. states provide CHIP coverage but the rules and services covered under the plan may differ from state to state. Coverage in all states includes:

Routine check ups
Immunizations
Doctor visits
Prescriptions
Dental and vision care
Hospital care (inpatient and outpatient)
Lab and x ray services
Emergency services

In some states, CHIP also provides coverage for pregnant women.

Premiums and copayments for CHIP coverage tend to be low, but those costs vary by state. Some participants’ coverage may even be free.

Does CHIP Cover Addiction Treatment?

Yes CHIP covers some addiction treatment and mental health services, but the level of coverage varies by state. Under the 2010 Affordable Care Act (ACA) most insurance plans — including CHIP — must cover certain essential health benefits. Mental health and substance use treatment are considered essential health benefits required by the ACA.

Furthermore the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) requires Medicaid to cover substance use treatment and medication-assisted treatment. As a Medicaid program, CHIP also covers these services.

Because the specific benefits available vary by state you should consult a state case manager to determine the resources available for youth addiction treatment coverage under your child’s CHIP coverage.

How to Qualify for the Children's Health Insurance Program (CHIP)

You can apply for CHIP through your state Medicaid agency or Health Insurance Marketplace. The income requirements for the program differ depending on the state you are in but usually range between 170% to 400% of the federal poverty level.

To qualify for the program your child must be uninsured and ineligible for Medicaid coverage as well as under age 19 and a resident of the state where you are applying. They must also be a U.S. citizen or a legal immigrant.

There is no specific enrollment period for CHIP. You can apply for coverage at any time throughout the year.

What Inpatient Addiction Treatment Does CHIP Cover?

As part of the requirements of the ACA there will be at least some inpatient addiction coverage with CHIP. However it will need to be deemed medically necessary. Your child’s doctor can do an ASAM Criteria assessment to evaluate your child’s needs and determine the level of care that is necessary.

Having a treatment plan from your child’s doctor can help ensure that their addiction treatment is covered and can help with preauthorization if it’s required.

Inpatient addiction treatment often includes medical detox followed by inpatient residential care. These crucial steps in addiction treatment can help your child wean themselves off drugs or alcohol in a safe environment with round the clock supervision. Depending on the CHIP program in your state there may be limitations on the number of inpatient days covered.

What Outpatient Rehab Does CHIP Cover?

The number of outpatient visits covered for your child through CHIP also may vary based on the state in which you live. Outpatient rehab programs include partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs) as well as general outpatient programs.

PHPs are a more intensive type of outpatient rehab where your child spends 4 to 8 hours a day receiving treatment at a facility. IOPs are a step down from PHPs and the child receives 9-20 hours of treatment spread over three to five days a week.

General outpatient programs can include individual, family, or group counseling sessions once or twice weekly. The ultimate goal of outpatient rehab is to help your child develop and maintain new habits so they can establish long term recovery and avoid relapse.

Does CHIP Cover Methadone & Suboxone (MAT)?

Yes CHIP is required to cover medication assisted treatment (MAT) for substance use disorders. This is part of the SUPPORT Act that requires Medicaid to offer this coverage. The healthcare laws also require Medicaid to offer the same coverage for mental health and substance use disorders as they do for medical and surgical conditions.

MAT is often used in detox because it helps alleviate withdrawal symptoms and reduce cravings as a young person gets rid of drugs and alcohol in their system. It may also be used longer term to manage cravings so your child can stay stable in treatment and avoid relapse and potential overdose concerns.

Does the Children's Health Insurance Program (CHIP) Cover Other Mental Healthcare?

Yes CHIP also covers mental health care. However that coverage may differ from state to state so it is essential to consult a case manager in your state for more information. Generally your child will be able to get counseling and crisis support for diagnoses like depression or anxiety or other disorders.

Substance use disorders often coincide with underlying mental health concerns as well. When this happens it’s known as co occurring disorders or a dual diagnosis. In this case your child’s mental health and addiction will need to be treated together to ensure your child’s recovery.

How Long Will CHIP Cover Rehab?

The medical necessity of your child’s rehab treatment plays a big part in how long CHIP will provide coverage. Typically inpatient residential treatment programs are covered from 30 to 90 days. It is usually recommended that IOPs run for about 90 days and general outpatient programs can last up to 12 weeks or more.

The more willing your child is to embrace the treatment process the better their chances are for long term recovery success.

Can I Travel Out of State For Treatment With CHIP?

No you can’t travel out of state for treatment with CHIP. Because the program is tied to your state’s Medicaid program you must receive treatment in the state you live in. CHIP coverage levels varies by state.

There may be exceptions if your child requires emergency medical care while traveling out of state or if they need specialized treatment that isn’t available in your state. However these exceptions are very rare and require prior authorization from your state’s CHIP program.