CHIP English Application PDF

CHIP Spanish Application PDF

The Children’s Health Insurance Program (CHIP) is a subsidized form of healthcare targeted at families who have modest incomes but still do not qualify for Medicaid assistance. It offers health services at reduced rates, with exact prices varying according to family size and household income.

Benefits


Like Children’s Medicaid, CHIP subsidizes the costs of many different health services, including:

  • Pre-existing conditions
  • Doctor’s office visits (i.e. check-ups, well-baby)
  • Dental check-ups/braces
  • Eye exams/glasses
  • Immunizations
  • Physical, speech and occupational therapies
  • Transplants
  • Hospital Care and surgery
  • Specialist Care
  • Labs and X-rays
  • Prescription drugs
  • Mental health services and substance abuse treatment
  • Emergency services

Costs


Unlike Children’s Medicaid, which is a free federal program, CHIP is a cost-sharing program based on a sliding scale of family size and household income. Families pay no more than $50/yr with some families paying nothing at all. Several costs are associated with enrolling in CHIP:

  • Renewal required every 12 months
  • Yearly enrollment fee
  • Co-pays (from $3-$10) for certain services (doctor’s office, emergency room, prescription drugs).

Eligibility


Age Requirement

Child must be aged 0-18.

A Social Security number must be provided for each child.

US Citizen

Child must be US citizen, legal permanent resident, or refugees. The immigration status of the parents does not matter.

Proof of US citizenship (ie: U.S. passport, Certificate of Naturalization, U.S. birth certificate, hospital record of birth, or Medicare card)  and, if applicable, proof of immigration status (ie: resident card (I-551), arrival/departure form (I-94), or papers from the U.S. Citizenship and Immigration Services), must be provided.

 
If the child was born in Texas, proof of US citizenship does not need to be provided as Texas birth certificates can be looked up by the CHIP system for your case.
 
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Texas Resident

Child must be a Texas resident and living with their parents, friends/relatives, or on their own.
 
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Income Requirement

Household income must be between 100-200% of the Federal Poverty Line. Use the CHIP/Children’s Medicaid Income Checker to easily determine if a child qualifies.

Proof of each household member’s income (at least one pay stub from the past 60 days, self-employment records, or a signed statement from the employer) must be provided. The statements must be dated and show the employer’s name, address, phone number, and signature.

Miscellaneous

Any eligibility questions can be answered at the CHIP/Children’s Medicaid page (subpage “Can I Get It?”): English or Spanish
 
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Applying


Application Form

The CHIP application (the same application as Children’s Medicaid’s) is an 8 page form with included instruction pages. There are various methods of filling out and sending in the application form. In addition, CHIP requires additional documents that need to be mailed or faxed in. It may take up to 45 days for CHIP to process your application.

 
It is very important to answer EVERY question on the application. If something does not applying to you, write N/A.
 
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  • Apply by mail or by fax using a printable paper CHIP/Children’s Medicaid application (EnglishSpanish), or by picking one up from any HEB pharmacy. Mail the completed application and additional documents to CHIP or fax it to 1-877-542-5951.
  • Apply online through the CHIP/Children’s Medicaid website (Internet Explorer 8 works best). You can change the text size and language (English, Spanish) by clicking the buttons in the upper right-hand corner of the page. Applying online allows the applicant to not only apply and check on the status of their case, but to pick their healthcare plans and providers, renew their benefits, and update their contact information.
  • Apply over the phone by calling 2-1-1 OR toll-free 1-877-447-2839 (Monday-Friday 8am-8pm Central Time). The CHIP representative will fill out your application over the phone then mail it back to you for you to sign. Mail the completed application and additional documents to CHIP or fax it to 1-877-447-2839.
        CHIP Mailing address: HHSC, PO Box 14200, Midland, TX, 79711-4200
        CHIP Fax number: 1-877-447-2839
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Other Documents

In addition to a completed CHIP application, applicants are required to send in all relevant documents from the 3 main areas listed below. Copies (front and back) should be both mailed in and retained. Include all documents relevant to your case.
 
A full description of each needed document can be found on page 2 of the CHIP application.
  • Proof showing facts about people applying for benefits: Social Security number, US citizenship, and immigration status
  • Proof showing money coming into the home (income): Proof of money from jobs, child support received, loans/gifts (someone paying the bills for you), Social Security or pension benefits, veterans’ benefits, workers’ compensation, or unemployment
  • Proof showing costs to take care of others (expenses): Child support paid, Child care or other costs you pay to take care of others, alimony paid.

Application Status

  • By phone: Call 1-877-447-2839
  • Online: Your Texas Benefits
    • If you already have an account, log in with either your user name and password OR your CHIP case number and password.
    • If you sent in your application by mail or fax, a temporary username and password were sent by letter or email. Log in using this provided information and change your username and password.

Get help with the application process

  • Visit the CHIP/Children’s Medicaid “Get Help” subpage to get answers to commonly asked questions about the application
  • Visit the CHIP/Children’s Medicaid “Get Help” subpage and search “Harris County” to find the nearest qualified person who can walk you through the CHIP application process.
  • Call toll-free 1-877-447-2839 for any questions related to the application or additional documents.

CHIP Perinatal


CHIP Perinatal coverage provides prenatal care for the unborn children of low-income women who do not qualify for Medicaid, either due to income level or immigration status. Once born, the child will receive CHIP benefits for the duration of the 12-month coverage period. CHIP Perinatal only covers cost of care related to the health of the child, not the mother.

 
The application for CHIP Perinatal is the same as the one used for CHIP/Children’s Medicaid. See the section “Applying” above for more details.
 
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FAQ


Q: Does the parent have to be a legal immigrant in order to apply to CHIP for their children?
A: No. As long as documents are provided for the child, the immigration status of the parents does not matter.
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Q: What is the difference between CHIP and Medicaid?
A: A family’s total income determines whether their children are eligible for CHIP (100-200% FPL) or Medicaid (<100% FPL).
 
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Useful Links


CHIP/Children’s Medicaid homepage:
http://www.chipmedicaid.org/

Comprehensive list of FAQs about CHIP:

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CHIP Perinatal:
 
More information and FAQs about CHIP Perinatal:
http://www.hhsc.state.tx.us/chip/perinatal/