CHIP in Ohio
The Children’s Health Insurance Program (CHIP) is a bridge program that resolves the challenge of providing the Medicaid eligibility children need in order to receive adequate healthcare when their families fall just above the income-eligibility cut-off for Medicaid, but not far enough above to afford care independently. In Ohio, the CHIP program is also often referred to as Healthy Start or SCHIP. The Children’s Health Insurance Program (CHIP) meets a critical public health need by delivering reliable, quality healthcare services for little or no cost to income-qualified patients. In addition to asking, “What is CHIP Medicaid?,” potential enrollees (or their parents/guardians) are often most concerned with and confused by two closely related questions: “Is CHIP considered Medicaid?” and, “What is covered by CHIP Medicaid?” Simply put, CHIP is considered a form of Medicaid, and it covers a wide variety of services intended to ensure consistent and appropriate care in both routine and emergency situations for qualifying applicants. To learn more about CHIP in Ohio, continue on to the sections below.
Who does CHIP cover in Ohio?
The services covered by CHIP Medicaid are designed for – and intended to meet – the needs of two income-eligible constituencies: pregnant women (without regard to age) and children and adults younger than 19 years of age. The Children’s Health Insurance Program (CHIP), also called Healthy Start in Ohio, sees these populations as necessarily linked, as early and appropriate prenatal care positively impacts most aspects of childhood health.
Accordingly, CHIP Medicaid covers nearly all costs associated with pregnancy, prenatal care and birth for income-qualified pregnant women of any age. Additionally, Children’s Health Insurance Program (CHIP) recognizes that Healthy Start Ohio participants often face a complex set of disadvantages and socioeconomic strains that reduce their access to care, even when it is provided at little or no direct cost. Supplemental support features are therefore included in CHIP Medicaid coverage to reduce barriers to care and to ensure that participants are able to fully engage with and utilize the resources and opportunities available to them to protect their health. CHIP services covered for eligible pregnant women include:
- Transportation assistance to and from Healthy Start-funded appointments.
- Access to trained CHIP Medicaid staff to help applicants complete program-specific activities or requirements.
Children born to women covered under the Children’s Health Insurance Program (CHIP) will automatically be eligible for Medicaid for children coverage until the age of 19, so long as the family remains income-qualified for participation. Learn more about CHIP coverage in Ohio by downloading our comprehensive guide.
CHIP Medicaid for Children in Ohio
Under Healthy Start, Medicaid for children provides comprehensive primary, emergency and supplemental care for qualifying children. Families enrolled in the Children’s Health Insurance Program (CHIP) select qualified and participating health care providers, schedule appointments and receive services, just like other patients. Providers then bill Healthy Start directly for the care provided. In some cases, participants may be required to pay marginal fees or small copays. These are typically capped at a specific percentage of annual income, and are prohibited for certain types of appointments or services.
Medicaid for children promotes and encourages patients to routinely access and take advantage of preventative and primary care services. To this end, the program covers a predetermined number of standard well-child visits with a primary care family physician or pediatrician, as well as optometrists and other specialty providers. Coverage for age-appropriate immunizations is required under CHIP. Healthy Start covers the costs of authorized medical equipment, healthcare tools and accessories where they are deemed necessary and prescribed by qualified, participating providers. Similarly, Medicaid for children pays some or all of the costs of appropriately prescribed medications. Occasionally, patients pay small copays for their prescription medications. Ohio residents approved for coverage under CHIP Medicaid also have access to several mental and behavioral health services.
Under the Children’s Health Insurance Program (CHIP), specific attention is paid to dental care in deference to the national awareness that oral health is a persistent problem area for many children and, when not properly addressed, routinely leads to impaired academic performance and other socially detrimental outcomes. Accordingly, Healthy Start CHIP coverage requires dental referrals for all enrolled children in compliance with a state-adopted schedule. These visits are supplemented with additional visits on an as-need basis.
Furthermore, the Children’s Health Insurance Program (CHIP) provides qualifying pregnant women and children with emergency healthcare services, in addition to regular preventative and primary care. This includes, but is not limited to, visits to the Emergency Room, hospitalization and surgical care. Some surgeries require advance authorization by a patient's physician. Learn more about the services covered by Ohio CHIP by downloading our complimentary guide.
Eligibility for the Children’s Health Insurance Program (CHIP) in Ohio
There are three categories of residents eligible for Healthy Start coverage in Ohio. Pregnant women of any age qualify if they – or their families – have an income 200 percent or less of the Federal Poverty Level. Children below the age of 19 who do not have health insurance qualify to learn how to apply for CHIP if they belong to families drawing incomes of 206 percent or less of the Federal Poverty Level. And, children below the age of 19 who are covered by health insurance can still qualify for Healthy Start coverage if they belong to families earning annual incomes of 156 percent or less of the Federal Poverty Level.
How to Apply for CHIP in Ohio
Healthy Start does not restrict the enrollment period of Medicaid for children under the Children’s Health Insurance Program (CHIP). Qualifying residents can apply at any time, and will receive benefits as soon as they are approved. If you qualify for CHIP and Medicaid enrollment, you can apply online via the Federal Health Insurance Marketplace, if you have access to a computer with working internet. If not, you can apply for CHIP in person at the Ohio Department of Medicaid. Download our informative guide to read more information about applying for CHIP in Ohio.