Questions?

Filling out the application

Can my children get CHIP/Children's Medicaid?

How to challenge the decision

Don't qualify for CHIP or Children's Medicaid?

Questions about CHIP coverage

Questions about Children's Medicaid coverage

Reporting Changes

Information for providers

Other

Filling out the application

Citizenship

Q: Do I need to send a copy of my child's birth certificate with the application?

A: If your child was born in Texas, you do not need to send a copy of the child's birth certificate. We can find a copy of the certificate in our system. If the child was born in another state or another country, you will need to send a copy of the child's birth certificate along with the other documents of proof we have asked for.

You can send documents like copies of birth certificates to:

HHSC
P.O. Box 14200
Midland, TX 79711-4200

Or, you can fax copies to: 1-877-542-5951.

If you need to send your finished CHIP/Children's Medicaid application, make sure to include all proof of recent income and expenses and any other documents we've asked for in the application.

Q: Can I send you something other than my child's birth certificate to prove that he is a U.S. citizen?

A: You do not need to send us anything to prove citizenship if your child was born in Texas. We can look up Texas birth certificates in our system. If your child was not born in Texas, you must send us a copy of one of the following along with the application:

  • Front and back of Permanent Resident Card (I-551).
  • Arrival/Departure Form (I-94) from the U.S. Bureau of Citizenship and Immigration Service (BCIS).
  • U.S. birth certificate.
  • U.S. passport.

Q: My child is not a U.S. citizen but is a legal permanent resident. Can we apply for CHIP/Children's Medicaid for him?

A: Yes. You will need to send us a copy of one of the following along with the application:

  • Front and back of Permanent Resident Card (I-551).
  • Arrival/Departure Form (I-94) from the U.S. Bureau of Citizenship and Immigration Service (BCIS).

Income

Q: My brother-in-law and father-in-law live with us. They are both adults and they both work. Do we list them on the application?

A: No, you do not need to list them, nor do you need to list their income. You only need to list the parents, stepparents and children age 18 and younger and their incomes on the CHIP/Children's Medicaid application.

Q: My 16 year-old's friend is living with us. Should we include him on the application as a member of our household?

A: No, you should not list on the application the names of children living with you who are not yours.

Q: When we're filling out the application, do we put gross income or net income?

A: The application asks for your family's gross income, money you are paid before taxes and deductions.

Q: Do I need to include child support as part of my monthly income?

A: Yes, child support payments you receive are counted as income when we determine whether your children can get CHIP or Children's Medicaid. You need to send us proof of that income, such as a copy of the child support check or a copy of the court order, when you send us the application.

Q: I get food stamps and TANF. Do I report that on my application? What documents of proof do I send?

A: Food stamps (SNAP food benefits) are not considered income and you should not enter that as income on your CHIP/Children's Medicaid application. TANF is considered income. You can send us a copy of the letter that shows the amount of TANF benefits and the length of time you will be collecting TANF.

Q: My husband and I own our own small business. How do we give you proof of our income?

A: If you are self-employed your proof can be a copy of your most recent IRS tax return including Schedule C or the Schedule C-EZ. If you send us the Schedule C-EZ also send documents that prove the business deductions you claimed on that form so we can use that information when we look at expenses we can deduct when we are figuring your income.

Q: I was wondering if the income guidelines included overtime.My husband gets some overtime, but not all the time.

A: If the paycheck stub you send us as proof of income shows overtime, we will use that in our calculations to find out if your children qualify for CHIP or Children's Medicaid. Please send us a recent paycheck stub that shows how much you usually make.

Expenses

Q: We pay for child care. Will you deduct these expenses from our income?

A: Yes. You need to send us proof of these expenses, such as a copy of cancelled check or a signed & dated statement from the child care center that shows how much you pay each week or month. Send these copies with your finished CHIP/Children's Medicaid application. We can deduct up to $200 a month in child care expenses for a child age 1 year old and younger and up to $175 a month in child care expenses for a child age 2 and older.

Q: I pay alimony and child support to my first wife. How do I show proof of these expenses?

A: You can send us a copy of the divorce decree or the court order that shows the amounts of these payments or you can send us copies of cancelled checks.

Assets

Q: How much money can a family have in the bank, an IRA account, etc. and still qualify for CHIP or Children's Medicaid?

A: If your income is below 150 percent of the federal poverty level (income of less than$33,075for a family of four) we will not look at your assets when wedetermine whether your children are eligible for CHIP orChildren's Medicaid. If your income is above150 percent of the federal poverty level, the asset limit (cars, bank accounts, cash, etc.) is $10,000. Your main car is not counted as an asset for this purpose. Neither are certain financial accounts such as retirement accounts and college savings plans recognized by the Internal Revenue Service.

For more information on your particular situation, please call the CHIP/Children's Medicaid Hotline at1-877-KIDS-NOW (1-877-543-7669).

Q: The application asks us about our cars. We use our cars for work. What are the rules on this?

A: For most households, the main car or truck is not counted as an asset. Other cars and trucks may be exempted (not counted) if they are used primarily for making money.

Help with the application

Q: Is there someone who can help me fill out the application?

A: There are a couple of ways you can get help with the application.

HHSC works with social service groups in many parts of Texas. These groups help families fill out applications for programs like CHIP, Medicaid, food stamps, Temporary Assistance for Needy Families and other services. You can find the group in your area. There's a search feature on our “How to Apply” web page under the heading, “Need Free Help?” Using this search feature you can type in your county and the name of the group that serves your county will appear along with the name of a staff person and a contact phone number.

You can also call the CHIP/Children's Medicaid hotline toll-free at 1-877-KIDS-NOW (1-877-543-7669) and ask what health plan she is enrolled in. That hotline is open Monday through Friday from 8 a.m. to 8 p.m., except federal holidays.

After you send in the application

Q: I got a letter telling me my application has missing information. How do I get you the information that is missing?

A: If the missing information is something you can tell us over the phone, call the CHIP/Children's Medicaid Hotline. That toll-free number is 1-877-KIDS-NOW (1-877-543-7669). The hotline is open from 8 a.m. to 8 p.m. Monday through Friday, except federal holidays. Here's a chart that shows what kind of information we can take over the phone.

If you need to send us documents of proof such as a copy of a recent paycheck stub or a birth certificate, you can mail or fax us those documents. The mailing address is:

HHSC
P.O. Box 14200
Midland, TX 79711-4200

Or you can fax it to 1-877-542-5951.

Whether you mail or fax the documents, make sure to write your name on each document you send.

Q: I sent in my CHIP/Children's Medicaid application, but I haven't heard anything yet. Did you get my application?

A: The best source for the most current information on the status of your children's application is the CHIP/Children's Medicaid Hotline. That toll-free number is 1-877-KIDS-NOW (1-877-543-7669). The hotline is open from 8 a.m. to 8 p.m. Monday through Friday, except federal holidays.

If you are renewing Medicaid coverage, you will need to call or visit your local HHSC benefits office. You can find the nearest office by dialing 2-1-1 or search our office locations online.

Q: How long does it take for you to find out of my children can get CHIP or Children's Medicaid?

A: Our staff has up to 45 days to work on your application. Once we have finished work on your application, we will send you a letter letting you know if your children qualify or not. If they do qualify, our letter will tell you which program – CHIP or Children's Medicaid – they qualify for. That letter will include instructions on what your next steps will be to get your children signed-up for a CHIP or Medicaid health plan.

If you'd like to get an update on where we are with your application, please call 1-877-KIDS-NOW (1-877-543-7669).

CHIP enrollment fee

Q: How do I pay my CHIP enrollment fee?

A: You can pay your CHIP enrollment fee by mail with a check or through a website with a credit card.

The website for paying with a credit card is Texas Online. Look for the CHIP Enrollment Fee Payment page. You will be charged an additional $2 to pay with a credit card through this system.

Or, you can mail a check for the enrollment fee to:

HHSC
P.O. Box 660287
Dallas, TX 75266-9792

Q: I paid my CHIP enrollment fee last week but now my wife got a job and she can add the kids to her insurance. How can we get our enrollment fee back?

A: You can call the CHIP/Children's Medicaid Hotline and tell the customer care representative you need a refund on your CHIP enrollment fee. That toll-free number is 1-877-KIDS-NOW (1-877-543-7669). The hotline is open from 8 a.m. to 8 p.m. Monday through Friday, except federal holidays.

Can my children get CHIP/Children's Medicaid?

Q: The screening tool on this website tells me my kids might qualify for CHIP. Does that mean you'll approve my application?

A: The only way we can tell if your children can get CHIP or Children's Medicaid is by looking at the information you give us on the application. You have to apply to be approved.

There are social service groups in Texas that help families fill out applications for programs like CHIP, Medicaid, food stamps, Temporary Assistance for Needy Families and other assistance. There is a search feature on this website where you can find a group in your county that can help you. Look on the “How to Apply” page for the search window under the heading, “Need Free Help?”

If you want to fill out an application on your own, call 1-877-KIDS-NOW (1-877-543-7669) toll-free and start an application over the phone. That hotline is open from 8 a.m. to 8 p.m. Monday through Friday, except federal holidays.

Q: I'm divorced. The court says I am supposed to provide health insurance for my kids but I don't have a job. Can I apply for CHIP for my children?

A: The only people who can apply for CHIP/Children's Medicaid on behalf of a child are those who actually live with the child and provide for the child. If you have joint custody of the child you could apply on behalf of the child. To learn more, talk with a CHIP/Children's Medicaid customer care representative by callingthe CHIP/Children's Medicaid call center toll-free at 1-877-KIDS-NOW (1-877-543-7669) Monday through Friday, 8 a.m. to 8 p.m., except federal holidays.

Q: My children are 19 and 21 years old but they are full time students. Can they still get CHIP coverage?

A: CHIP covers children age 18 and younger. You might want to see what's available through www.texashealthoptions.com. This is a site sponsored by the Texas Department of Insurance, and it has information for people looking for affordable health insurance.

Q: My husband was recently laid-off from his job and is now getting unemployment benefits. Can I apply for CHIP while he is on unemployment and if so, how do I send proof of that income along with the application?

A: You can send us a copy of the letter the Texas Workforce Commission sent your husband telling him he would receive unemployment benefits. If he does not have that letter but you have online access to your debit card account, you can print out a statement showing the amount deposited and how often it is deposited.

Q: My children have health insurance but the premiums and co-payments are really high. Can I sign them up for CHIP?

A: CHIP is designed for children who do not have access to other health insurance. Your children may qualify if their current health insurance coverage costs more than 10 percent of the family's gross income.

To learn more, call the CHIP/Children's Medicaid Hotline. That toll-free number is 1-877-KIDS-NOW (1-877-543-7669). The hotline is open from 8 a.m. to 8 p.m. Monday through Friday, except federal holidays.

Q: My wife works as a teacher so we're not sure whether our kids would qualify for the CHIP program or SKIP. Which should we apply for?

A: The programs use the same application. We will review your application to see if your children qualify for either program. If we find that your children qualify but they should be in the State Kids Insurance Program (SKIP), we will send the file to the Texas Employee Retirement System, which administers SKIP.

Q: I'm 7 months pregnant. Can I apply for CHIP now so that when my baby is born he'll be covered?

A: We cannot process an application for an unborn child unless you are applying for CHIP perinatal services, which provides coverage during your pregnancy and once your baby is born. If you have health insurance that already covers your pregnancy, you will not be eligible for CHIP perinatal coverage.

You can apply for coverage for your baby immediately after your child's birth, and you can start working on your application now. Call 1-877-KIDS-NOW (1-877-543-7669) toll-free and ask them to send you an application. That hotline is open from 8 a.m. to 8 p.m. Monday through Friday, except federal holidays.

You can also get an application on our website. Go to the “How to Apply” page of this website. There, you can choose to fill out an application using your computer keyboard and download the application with your information on it.

How to challenge the decision

Q: I applied for CHIP, but you denied my application. I think you were wrong in your decision. Is there a way I can appeal?

A: If you have a question about our decision, you can ask us to take another look at your application. Send us a letter telling us the reason you think we made a mistake. That letter needs to reach us within 30 days from the date of the letter we sent you telling you your children couldn't get CHIP. Your letter asking us to look at your application again must be in writing and signed– it cannot be made over the phone. Please send your letter to:

CHIP
PO Box 14400
Midland, TX 79711-9904

Or, you can fax your letter to 1-877-542-5951.

Don't qualify for CHIP or Children's Medicaid?

Q: My children do not qualify for CHIP or Medicaid, but my children need to see a doctor. What can I do?

A: You can dial 2-1-1 and find out if there are any resources in your town that can help you. 2-1-1 has a long list of local services – free and low-cost – for people in need. You can also search the 2-1-1 database of services by going to www.211Texas.org. Click on “Search for services.”

Q: I've looked at the CHIP income guidelines and I know our income is too high to qualify for the program. Do you know what other options we have for getting low-cost health insurance for our kids?

A: You can get information about private health insurance you can purchase at the Texas Department of Insurance website, www.texashealthoptions.com. You also can call 1-800-252-3439 and ask about other insurance options that might be available to you.

Another source for information is 2-1-1 Texas. When you dial 2-1-1, ask about low-cost health insurance programs available for children. You can also do your own search of the 2-1-1 database by going to www.211Texas.org. Click on “Search for services.”

Questions about CHIP coverage

Q: I need to get new health plan cards for my children. Who do I call to get those?

A: For information about health plan identification cards, please call your children's CHIP health plan.

If you don't know your children's health plan, you can call the CHIP/Children's Medicaid hotline toll-free at 1-877-KIDS-NOW (1-877-543-7669) and ask what health plan your children are enrolled in. That hotline is open Monday through Friday from 8 a.m. to 8 p.m., except federal holidays.

Another option is to search for your children's health plan by visiting the Find a CHIP Health Plan page of this website.

Q: I need to see if my child is still has CHIP. I recently tried to take him to the doctor, but the assistant told me my child was no longer covered. I did not receive any information about renewing his plan or the coverage ending.

A: Call the CHIP/Children's Medicaid Hotline. That toll-free number is 1-877-KIDS-NOW (1-877-543-7669). The hotline is open from 8 a.m. to 8 p.m. Monday through Friday, except federal holidays.

Q: Would CHIP cover braces for my kids' teeth?

A: Orthodontics (braces) are not covered by the CHIP program. Many other dental services are covered. For a complete list, please visit the Children's Health Insurance Program Dental Benefits page. You can also call the CHIP Dental hotline toll-free Monday through Friday from 8 a.m. to 7 p.m. at 1-866-561-5892.

Q: I want to change my son's doctor. How can I do that?

A: You can change primary care providers by calling your son's CHIP health plan.

If you don't know your child's health plan, you can call the CHIP/Children's Medicaid hotline toll-free at 1-877-KIDS-NOW (1-877-543-7669) and ask what health plan your child is enrolled in. That hotline is open Monday through Friday from 8 a.m. to 8 p.m., except federal holidays.

Another option is to search for your child's health plan by visiting the Find a CHIP Health Plan page of this website.

Q: I want to change my child's CHIP health plan. How can I do that?

A: The only times you are able to change your child's CHIP health plan are:

  • Within the first 90 days from the time your child's CHIP coverage started.
  • When you renew your child's CHIP coverage.
  • If you move out of your CHIP service area.

Q: I need dental insurance for my children. I noticed that CHIP has dental insurance, but also includes medical, which we do not need. Is there a way to get just the dental portion?

A: No. CHIP does not offer dental coverage as a separate plan.

Q: How can I find out when my son's CHIP is up for renewal?

A: If we have your current address we will send you a CHIP renewal packet three months before your son's coverage is scheduled to end.

In the meantime, if you would like to find out when his coverage is scheduled to end, call the CHIP/Children's Medicaid Hotline. That toll-free number is 1-877-KIDS-NOW (1-877-543-7669). The hotline is open from 8 a.m. to 8 p.m. Monday through Friday, except federal holidays.

Q: Can you help me find an optometrist that takes CHIP?

A: CHIP services are delivered through private health plans under contract with the Texas Health and Human Services Commission. For questions about finding an optometrist or any other specialist in your area that is part of your child's CHIP health plan, you will need to call the CHIP health plan.

If you don't know your child's CHIP health plan, you can call the CHIP/Children's Medicaid hotline toll-free at 1-877-KIDS-NOW (1-877-543-7669) and ask what health plan your child is enrolled in. That hotline is open Monday through Friday from 8 a.m. to 8 p.m., except federal holidays.

Another option is to search for your child's health plan by visiting the Find a CHIP Health Plan page of this website.

Q: I am due to have a baby in early June.I was wondering what coverage CHIP offers to meet the needs of my unborn child.

A: CHIP perinatal coverage is designed to provide prenatal benefits for your unborn baby and full CHIP coverage for its first few months of life. You can learn more by calling the CHIP/Children's Medicaid call center, which is open from 8 a.m. to 8 p.m. Monday through Friday, except federal holidays. That toll-free number is 1-877-543-7669 (1-877-KIDS-NOW). There's also more information on CHIP perinatal coverage on the HHSC website.

Questions about Children's Medicaid coverage

Q: I have a question about my children's Medicaid services. Who do I call?

A: If your children have Medicaid and you have questions about services, call your child's STAR, PCCM, or STAR+PLUS health plan. There's a list of the Medicaid health plans in the middle of the page on the “Quick Answers” page of the HHSC website.

Q: I have a question about my child's Medicaid case. Who do I call?

A: You can get information about your child's Medicaid case by calling or visiting your local HHSC benefits office. You can find the nearest office by dialing 2-1-1 or search our office locations online.
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Q: I have received my son's Medicaid ID card, but I don't know which doctors I can take him to. How do I find a doctor that takes Medicaid?

A: You can use our provider look-up feature where you can put in your child's Medicaid health plan (if your child is enrolled in one) and your ZIP Code or county and the search engine will show all the doctors in your area that accept Medicaid.

Reporting changes

Q: We just moved. How can I make sure Medicaid has my new address?

A: You will need to fill out a Report of Change form (H1019) and deliver it to your nearest HHSC benefits office. You can take it yourself, fax it, or mail it in. You can find the nearest office by dialing 2-1-1 or search our office locations.

Q: We just moved. How can I make sure CHIP has my new address?

A: You can call the CHIP/Children's Medicaid Hotline and tell a customer care representative what your new address is. That toll-free number is 1-877-KIDS-NOW (1-877-543-7669). The hotline is open from 8 a.m. to 8 p.m. Monday through Friday, except for federal holidays.

You will also need to call your child's CHIP health plan to make sure their files have your new address.

Information for providers

Q: How do I become a provider for CHIP?

A: CHIP services in each area of Texas are delivered by private health plans. Each health plan develops and maintains its own network of providers. A complete list of CHIP health plans, including contact information, appears at the bottom of the “Quick Answers” page of the HHSC website. You can also see the CHIP health plans and the areas they serve at: http://www.hhsc.state.tx.us/chip/CountyServiceAreaMap.pdf.

Q: How do I become a provider for Medicaid?

A: If you are interested in becoming a Medicaid provider (STAR, PCCM or STAR+PLUS), please contact our contractor, the Texas Medicaid & Healthcare Partnership (TMHP). A good place to start is the provider page of the TMHP website.

Q: I'm a CHIP provider and I need to check the eligibility of a client. How can I do that?

A: You can call the CHIP provider eligibility hotline at 1-800-645-7164, Monday through Friday between 8 a.m. and 5 p.m. Central Time. Providers who call the hotline can speak with a customer service representative to confirm whether a child is a currently enrolled CHIP member, or receive an automated response if the provider has a CHIP member ID number. You can also call the health plan to confirm eligibility if you have the child's CHIP ID card.

Other

Q: Why does my 4 year-old daughter have Medicaid but my 7 year-old son has CHIP?

A: The income limits for Medicaid are higher for children younger than 5 years-old, so your 4 year-old daughter might qualify for Medicaid while your older 7 year-old boy does not.

Q: My ex-wife has custody of our daughter, but I need to know if she's got health coverage through the CHIP program. Can you tell me if she is enrolled?

A: Federal law protects people's health information. We are not allowed to share a child's CHIP case information with anyone other than the person who filed the application on behalf of the child and any authorized representatives named in the application or listed in the child's case file. If you are one of those people – the person who filed the application or an authorized representative – we will be able to share information with you but if you are not, we will not be able to answer your question.

Q: I need a letter showing when my child was covered by CHIP. Can you send me that?

A: The document you need is called a certificate of credible coverage. Your child's CHIP health plan can give you this certificate.

If you don't know your child's health plan, you can call the CHIP/Children's Medicaid hotline toll-free at 1-877-KIDS-NOW (1-877-543-7669). That hotline is open Monday through Friday from 8 a.m. to 8 p.m., except federal holidays.

Another option is to search for your child's health plan by visiting the Find a CHIP Health Plan page of this website.

Q: I know someone on CHIP, but I'm sure the family makes way more than the CHIP income limit. Who can check into that?

A: If you suspect fraud of the CHIP or Children's Medicaid programs, please call the HHSC Office of the Inspector General toll-free at 1-800-436-6184. You can also report waste, fraud, or abuse online on the HHSC Office of Inspector General website.

Q: I call the 877-KIDS-NOW phone number and get the Louisiana CHIP call center. How can I get the Texas CHIP call center?

A: The 877-KIDS-NOW phone number is a national number. It rings to the CHIP call center for the state in which the call originates. If you are near the Louisiana, Arkansas, Oklahoma, or New Mexico border, you may get that state's CHIP call center instead of Texas. You can call the Texas CHIP call center from anywhere in the U.S. by calling 1-800-647-6558.

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