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Child Health Plus (CHP) FAQ

For children under the age of 19 who require health insurance, Child Health Plus (CHP) provides all-inclusive coverage. For kids who don't qualify for Medicaid due to family income or immigrant status, CHP may be an option. Please see the FAQ (frequently asked questions) resources below to determine if CHP is the best choice for you and your child.

 

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Frequently Asked Questions for New York State's Child Health Plus (CHP) Program

How do I get insurance coverage for my children?

In New York State, if you are employed, your employer may offer health care insurance for your children. 

If not, you can qualify for coverage under Children's Medicaid or Child Health Plus. For more information, see below or call New York State at this toll-free number: 800-698-4KIDS (1-800-698-4543), and ask about Child Health Plus and Children's Medicaid. 

You can also call Fidelis Care directly at 1-888-343-3547.

What is Child Health Plus?
New York State has a health insurance plan for kids, called Child Health Plus, for families who make too much money to qualify for Children’s Medicaid

What is “CHP” insurance?
CHP (aka "CHIP") is an abbreviation for Child Health Plus.
What is the difference between Medicaid and Child Health Plus?
Medicaid is a program for families who have a very limited income. Eligibility depends on how many kids you have. A family with one child is eligible for Medicaid if their monthly income is $1,745 or less. With four children, that’s $3,562 per month. Families with children under one year old, and with babies on the way, are eligible at higher income levels.
How are kids in foster care covered in NY?
In New York State, children in the care and custody of a Local Social Services (LDSS) Commissioner or the Commissioner of the New York State Office of Children and Family Services – including kids in foster care – are eligible for Medicaid.
Are my children eligible for Child Health Plus?

To be eligible for Child Health Plus, children must be under the age of 19 and be residents of New York State if they don't already have health insurance and are not eligible for coverage under the public employees' state health benefits plan.

Do I have to pay a premium for coverage under Child Health Plus?

To see whether you would have to pay a premium for coverage, consult the Child Health Plus eligibility table below:

2022 Child Health Plus (CHP) Income Levels

 

Monthly Income by Family Size**

Each Additional Person, Add:

Family Contributions   

1

   2

   3

   4

5

6

7

8

FREE Insurance

 

$1,811

 

$2,441

 

$3,070

 

$3,699

 

$4,329

 

$4,958

 

$5,587

 

$6,217

 

$630

 

$9 Per Child Per Month 

(Maximum of $27 per family)

 

 

$2,515

 

$3,388

 

$4,261

 

$5,134

 

$6,007

 

$6,881

 

$7,754

 

$8,627

 

$874

 

$15 Per Child Per Month

(Maximum of $45 per family)

 

 

$2,832

 

$3,815

 

$4,798

 

$5,782

 

$6,765

 

$7,748

 

$8,732

 

$9,715

 

$984

 

$30 Per Child Per Month

(Maximum of $90 per family)

 

 

 

$3,398

 

$4,578

 

$5,758

 

$6,938

 

$8,118

 

$9,298

 

$10,478

 

$11,658

 

$1,180

 

$45 Per Child Per Month

(Maximum of $135 per family)

 

 

 

$3,964

 

$5,341

 

$6,718

 

$8,094

 

$9,471

 

$10,848

 

$12,224

 

$13,601

 

$1,377

 

$60 Per Child Per Month

(Maximum of $180 per family)

 

 

 

$4,530

 

$6,104

 

$7,677

 

$9,250

 

$10,824

 

$12,397

 

$13,970

 

$15,544

 

$1,574

 

Full Premium Per Child Per Month

 

 

Over

$4,530

 

Over

$6,104

 

Over

$7,677

 

Over

$9,250

 

Over

$10,824

 

Over

$12,397

 

Over

$13,970

 

Over

$15,544

 

Over

$1,574

 

 

If I have to pay a premium, how much does Child Health Plus cost?

For CHP, there is no monthly premium for families whose income is less than 2.2 times the poverty level. 

  • That's about $1065 a week for a three-person family, about $1283 a week for a family of four. 
  • Families with somewhat higher incomes pay a monthly premium of $15, $30, $45, or $60 per child per month, depending on their income and family size. 
  • For larger families, the monthly fee is capped at three children.
  • If the family's income is more than four times the poverty level, they pay the full monthly premium charged by the health plan. 
  • There are no co-payments for services under Child Health Plus, so you don't have to pay anything when your child receives care through these plans.
How do I sign up for Child Health Plus?

Child Health Plus is a New York State program that is administered by a range of health insurance companies, including Fidelis Care. 

  • Complete the Contact Form to speak with a qualified Health Representative
  • Contact Fidelis Care directly to sign up, at 1-888-343-3547.
    • Our representatives are happy to answer your questions and walk you through the process.
What is the full premium for Child Health Plus in NY?
It depends on the insurance company that is administering Child Health Plus for your child. Reach out to Fidelis Care for specifics, at 1-888-343-3547.
Where will I take my child for care under Child Health Plus?

After your child is enrolled in Child Health Plus, you will be given a list of providers near you. The provider may be a single doctor, group practice of several doctors, or community health center. If it is a group practice, you will be asked to choose a doctor for your child.

What services are covered under Child Health Plus?
  • Well-child care.
  • Immunizations.
  • Treatment for illness or injury.
  • Inpatient hospital medical or surgical care.
  • Short-term physical therapy; occupational therapy.
  • Radiation therapy.
  • Therapeutic outpatient services (chemotherapy, hemodialysis).
  • Inpatient and outpatient treatment for alcoholism and substance abuse, and mental health.
  • Prescription and non-prescription drugs if ordered by a physician.
  • Emergency care.
  • Emergency ground transportation.
  • Emergency, preventative and routine dental care. Limited orthodontic services are available for children with a severe medical condition such as cleft lip or cleft palate.
  • Preventive and routine vision care (including eyeglasses).
  • Speech and hearing services (with limits).
  • Durable medical equipment.
  • Hospice services.
Does Child Health Plus cover daycare costs?
No, regular daycare for healthy children is not covered by Child Health Plus.
Are services covered for fragile children under Child Health Plus?
Children and youth with special health care needs may be eligible for certain services, programs, and waivers.

  • A few examples of such conditions include cerebral palsy, muscular dystrophy, asthma, sickle cell anemia, diabetes, heart conditions, depression, developmental disability, conduct disorder, and autism. 
  • For more information, contact Fidelis Care at 1-888-343-3547.
Can a Child stay on CHPlus if they get Married?

Yes.  If a child marries, they may continue to be covered by their parents' health insurance until they turn 26. If preferred, the child may also be included in a spouse's work-based insurance plan.  According to the Affordable Care Act (ACA), all children under the age of 26 must be covered under family insurance.  Marriage will not alter these rulings.

 

 

"Special Circumstance" Questions for Child-Related Health Insurance

Who Pays for Child Health Insurance after a Divorce?

A court in New York must decide who is responsible forpaying the child's health insurance payments and uninsured medical bills, aswell as who is responsible for providing the child with health insurancebenefits. For more on HealthInsurance Coverage of Minor Child of Divorced Parents

How is Health Insurance Calculated in Child Support in NYS?
In New York State, the non-custodial parent's basic percentage contribution to the custodial parent does not include child support.
  • The parent with the insurance is responsible for paying the premium directly, but the other parent will reimburse that parent for a portion of that amount on whatever terms they choose.
  • According to their income, the parents contribute to their health insurance.
  • Moreover, health insurance for the child is typically deemed reasonable if it costs less than 5% of the parent's gross income, with the 5% representing the price difference between the individual plan for the parent only and the plan's price when the child is included.

For more information, please visit, Income Withholding for Dependent Health Insurance (Medical Support) - NYSDOH

What is the NYS Child Care Assistance Program?
The NYS CCAP offers eligible families financial assistance with all or part of the expense of child care. The CCAP is managed by each Local Social Services District (LSSD) with money and assistance from the Office of Children and Family Services (OCFS).

How Can I Apply?
If you want to apply for the Child Care Assistance Program (CCAP), get in touch with the local LSSD that oversees it and ask for an application.  In addition, you can look up your local social services district in our contact list to get the phone number for your local agency.

Eligibility Requirements for NYS CCAP 
Families may be eligible based on their income, the need for child care, the kid's age, or special requirements.

Income Requirements for NYS CCAP 

Here are the highest incomes a family can make and still be eligible, per NYS DOCCS. Although this information may be useful, families should contact local LSSD to see if they are eligible. Income is simply one consideration for eligibility for child care assistance in the state of New York. Depending on their unique needs, other families might also be eligible.


Income limits for eligibility by family size.
Family Size Annual Income Limit*see table footnote Monthly Income Limit
1 $40,770.00 $3,397.50
2 $54,930.00 $4,577.50
3 $69,090.00 $5,757.50
4 $83,250.00 $6,937.50
5 $97,410.00 $8,117.50
6 $111,570.00 $9,297.50
7 $125,730.00 $10,477.50
8 $139,890.00 $11,657.50
Who are Consider "Allowed Caregivers" for Fragile Children?

In early 2021, the online Medicaid Provider Directory for Private Duty Nurses for Medically Fragile Children was made public by the New York State Department of Health.

With the use of the new online tool, family members and caregivers can find nurses in their region who have experience and training in providing care to children and young adults up to age 23 who have medically fragile conditions.

Filters for the Directory include name, license type, and county. It includes a list of private duty nurses and nursing organizations that provide Medicaid participants up to the age of 23 who need ongoing skilled nursing care at home. Children who are medically fragile run the risk of being hospitalized or institutionalized, but they can still be cared for at home with the right home care services. Currently, Medicaid-covered private duty nursing services are provided to 650+ medically fragile children.

Registered nurses (RNs) and licensed practical nurses (LPNs), among other independent providers, who have agreed, subject to their availability, to serve medically fragile children enrolled in fee-for-service Medicaid are eligible providers for the Directory. These providers include Licensed Home Care Services Agencies (LHCSAs) and independent providers.  Participants in the Directory who accept patients will be reimbursed for Medicaid at a higher rate.

  • You can see the Directory and learn more about the Private Duty Nursing Program for Medically Fragile Children here.
What is the Average Cost of Adding a Child to a Health Insurance Plan in NY?
The average monthly cost for a couple in their 40s is $954, which is double what it would be for an individual in that age bracket. But adding children isn't quite as straightforward. A family of five would pay around $1,782 per month, and a 40-year-old couple with one child under 14 would pay about $1,230.
This national average relates to private health insurance purchased under the Affordable Care Act, also known as ObamacareHealth ,'s Insurance Marketplace.
Many Americans are eligible for subsidies, which lower the cost of purchasing health insurance through the Marketplace. If your job provides health benefits or you qualify for government insurance programs like Medicaid or Medicare, which provide all-inclusive plans like MMC, you may also be able to find less expensive solutions.
Are a Child’s Braces Covered by insurance in NY?
Nationally, orthodontic treatment is not covered by most health plans in the country for those above the age of 18, but many do at least partially cover those under 18. New York State, however, is an exception to the rule.
If a child's condition complies with the requirements of the NYS Medicaid Orthodontic Program, they are entitled to free braces (free orthodontics) regardless of whether they are insured by New York State Medicaid or have a Medicaid component to any of the insurance plans listed below.
Examining the details of your plan is a smart idea if your child is getting close to the age for braces. You want to choose the right strategy because not all are created equal.

2023 Child Health Plus (CHP) Income Levels

 

Monthly Income by Family Size**

Each Additional Person, Add:

Family Contributions   

1

   2

   3

   4

5

6

7

8

 

FREE Insurance

 

 

$2,698

 

 

$3,649

 

 

$4,600

 

 

$5,550

 

 

$6,501

 

 

$7,452

 

 

$8,403

 

 

$9,354

 

 

$951

 

$15 Per Child Per Month

(Maximum of $45 per family)

 

 

$3,038

 

$4,109

 

$5,180

 

$6,250

 

$7,321

 

$8,392

 

$9,463

 

$10,534

 

$1,071

 

$30 Per Child Per Month

(Maximum of $90 per family)

 

 

 

$3,645

 

$4,930

 

$6,215

 

$7,500

 

$8,785

 

$10,070

 

$11,355

 

$12,640

 

$1,285

 

$45 Per Child Per Month

(Maximum of $135 per family)

 

 

 

$4,253

 

$5,752

 

$7,251

 

$8,750

 

$10,250

 

$11,749

 

$13,248

 

$14,747

 

$1,500

 

$60 Per Child Per Month

(Maximum of $180 per family)

 

 

 

$4,860

 

$6,574

 

$8,287

 

$10,000

 

$11,714

 

$13,427

 

$15,140

 

$16,854

 

$1,714

 

Full Premium Per Child Per Month

 

 

Over

$4,860

 

Over

$6,574

 

Over

$8,287

 

Over

$10,000

 

Over

$11,714

 

Over

$13,427

 

Over

$15,140

 

Over

$16,854

 

Over

$1,714

 

 

 

 

 

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