In early 2017, Alicia Batista, of Raleigh, North Carolina quit her job as an elementary school teacher. After giving birth to her second son, working a full-time job no longer made financial sense. After paying for daycare, taxes, and her commute, the job would yield just a few hundred extra dollars each month. But leaving the job left the family in a health-care quandary.
Alicia’s husband, Alex Batista, received free health insurance through his work. Unfortunately, adding the family to his plan cost more than $600 per month. That was over 20 percent of his take-home pay at the time. Buying a health insurance plan through the health exchanges would have cost even more — between $636 and $900 for Alicia and her boys.
The Batistas were caught in the “Obamacare family glitch.” In other words, because Alex could purchase insurance through work, the family couldn't receive health insurance credits to offset the price of a marketplace plan.
Alicia also met with a local Disability and Social Services (DSS) agent to determine if the family qualified for Medicaid. Alicia herself didn’t qualify because the family earned well above the ceiling. However, her boys were “possibly” eligible for Medicaid for Children, or CHIP. Alicia would need to submit income and tax documents for the agent to evaluate the family's situation.
CHIP Insurance Eligibility
In North Carolina, children of families who earn less than 215 percent of the federal poverty line qualify for free health insurance through Medicaid. Four a family of four, the eligibility cutoff for children to get Medicaid is $52,890 in North Carolina. Income eligibility for children varies by state, but all states offer CHIP to children whose family income is less than 190 percent of the poverty line, regardless of other insurance availability.
Due to Alicia’s earnings as an elementary-school teacher earlier in the year, the family wasn’t sure whether they would earn less than the cutoff.
Even if the children did qualify, Alicia would still have to buy her own insurance policy through the health care exchange.
Ultimately, the family chose to buy the expensive workplace plan. A few months later, Alex found a better-paying job that covered health care for the family.
If the family’s income situation remained the same for 2018, the Batistas would save several hundred dollars per month by getting CHIP health insurance for the kids and a full-price marketplace plan for Alicia. It’s a hassle to have three different insurance plans for a family of four, but in most cases, the financial costs outweigh the hassle.
How to Get CHIP Insurance for Your Kids
The Kaiser Family Foundation, a nonpartisan health insurance resource offers three income eligibility charts to help you determine your Medicaid or CHIP insurance eligibility — one for pregnant women, one for healthy adults who aren’t pregnant, and one for children.
If you’re a legal immigrant, you’ll also need to meet other eligibility requirements.
Your child (or children) may qualify for Medicaid if they have a disability. In most states, if your child qualifies for Supplemental Security Income, they automatically qualify for Medicaid. Of course, dealing with the Medicaid bureaucracy taxes families more than you might expect, but it’s financially worthwhile.
If you aren't eligible for Medicaid yourself, find out if your children qualify for Medicaid or CHIP insurance. If you think they qualify for CHIP based on your income, you can apply at any time through HealthCare.gov. Once a state agency determines that your kids qualify, their insurance starts immediately.
If you meet with a DSS agent, it’s best to go into the meeting prepared. Bring any existing insurance documents that you have, as well as evidence of income. Income evidence includes a tax return from the previous year, current pay stubs, and statements regarding other forms of income (such as disability payments or child support payments). These will make it easier for the agent assigned to your case to determine your kid’s CHIP insurance eligibility.