Childrens Health Insurance In Texas

Texas is home to the largest uninsured child population in the nation. Texas’ state-sponsored Children’s Health Insurance Program (CHIP) provides insurance coverage for uninsured children and unborn children. In addition, children from low-income families may also be eligible for the Children’s Medicaid program.

Eligibility

• The CHIP program covers Texas children age 18 or younger who are citizens of the U.S. The parents of qualified children do not have to be legal citizens of the U.S. Parents, step-parents, relatives and legal guardians can apply for CHIP as long as the child lives with them and they are responsible for the child’s care. Income eligibility requirements vary depending on the income of the family and the number of children in the family. In general, families that qualify for CHIP earn too much to be eligible for Medicaid and not enough to pay for private health insurance.

Coverage

• As of January 2009, the CHIP program provided insurance for 451,000 Texas children, according to the Houston Chronicle. The coverage provided for children under CHIP is very similar to the coverage provided by private insurance plans. Parents can select from a network of doctors. CHIP covers vaccines, regular checkups, doctor and dental visits, medical specialists, prescriptions and medical supplies, hospital visits and stays, mental health services, X-rays and lab tests, and eye exams and glasses.

Cost

• The CHIP program is costly to maintain. In the two years before 2009, the state’s cost for the children’s insurance program increased from $102 million to $267.5 million. Parents with children enrolled in CHIP do not pay monthly premiums. Instead, they pay a yearly enrollment fee of $50 plus co-pays to doctors and for prescription medications. The co-pays usually range from $3 to $10.

Pending Legislation

• The high cost of CHIP and the economic downturn has led to proposals for change. Many parents make more than the maximum allowed by the CHIP program but too little to afford private or employer-sponsored insurance. As a result, a new bill introduced in Congress will raise the current income limits if passed. The new legislation will increase the number of children covered by approximately 164,000. Other pending legislation will help offset the costs of the program by creating a sliding-scale payment system based on family income.

Waiting Period

• Children covered by private insurance before enrolling in the CHIP program are subject to a 90-day waiting period before coverage under CHIP begins. There are exceptions to the 90-day rule. Children may be covered immediately after being accepted into the program, regardless of previous coverage, if the loss of insurance was due to a parent losing his job due to a layoff or business closure. Other exceptions include employer-terminated insurance benefits, a change in the martial status of parents, insurance costs that exceed 10 percent of parents' income, a loss of COBRA insurance coverage or a loss of eligibility under the Texas Employment Retirement System. Children covered by CHIP in another state may be eligible for immediate benefits upon relocating to Texas. New children in the family, such as newborns, are also exempt from the 90-day waiting period.