The Children’s Health Insurance Program (CHIP) provides comprehensive benefits to children. Since states have flexibility to design their own program within Federal guidelines, benefits vary by state and by the type of CHIP program.
Medicaid Expansion Benefits
Medicaid Expansion CHIP programs provide the standard Medicaid benefit package, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, which includes all medically necessary services like mental health and dental services.
Separate CHIP Benefits Options
States can choose to provide benchmark coverage, benchmark-equivalent coverage, or Secretary-approved coverage:
- Benchmark coverage based on one of the following:
- The standard Blue Cross/Blue Shield preferred provider option service benefit plan offered to Federal employees
- State employee's coverage plan
- HMO plan that has the largest commercial, non-Medicaid enrollment within the state
- Benchmark-Equivalent coverage must be actuarially equivalent and include:
- Inpatient and outpatient hospital services
- Physician's services
- Surgical and medical services
- Laboratory and x-ray services
- Well-baby and well-child care, including immunizations
- Secretary-approved coverage: Any other health coverage deemed appropriate and acceptable by the Secretary of the U.S. Department of Health and Human Services.
Separate CHIP Dental Benefits
States that provide CHIP coverage to children through a Medicaid expansion program are required to provide the EPSDT benefit. Dental coverage in separate CHIP programs is required to include coverage for dental services “necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions.” For more information see CHIP Dental Care Goals and related Federal Policy Guidance.
States with a separate CHIP program may choose from two options for providing dental coverage: a package of dental benefits that meets the CHIP requirements, or a benchmark dental benefit package. The benchmark dental package must be substantially equal to the (1) the most popular federal employee dental plan for dependents, (2) the most popular plan selected for dependants in the state’s employee dental plan, or (3) dental coverage offered through the most popular commercial insurer in the state.
States are also required to post a listing of all participating Medicaid and CHIP dental providers and benefit packages on www.insurekidsnow.gov.