Texas CHIP 2025: Eligibility, Benefits & How to Apply

Quick Answer: Texas CHIP gives health insurance to kids under 19 whose families earn too much for Medicaid but can’t pay for private insurance. If you make up to $64,752 a year for a family of four, your kids can get coverage for just $0-$75 a month.

What You Get:

• Doctor visits, hospital stays, and emergency care
• All medicines your child needs
• Dental checkups, fillings, and braces
• Eye exams and glasses
• Mental health care and therapy
• All shots (vaccines) for free
• No yearly limits on care

How to Start: Apply any time at YourTexasBenefits.com or call 2-1-1, or you can apply for CHIP online.

You’ll need pay stubs and IDs. Most families get approved in 45 days or less. Nearly 1 million Texas kids use CHIP right now, and your children could be next.

This guide shows you exactly how CHIP works, who qualifies, what it costs, and how it’s different from standard Texas Medicaid. Let’s get your kids the healthcare they deserve.

What is CHIP vs. Medicaid

CHIP Texas helps families who make too much money for Medicaid but still can’t buy expensive private insurance. Think of it this way: Medicaid is for families with very low income, and CHIP picks up where Medicaid stops.

Medicaid covers the poorest families—kids, adults, seniors, and people with disabilities. It’s usually free with no fees at all. Kids ages 1 to 18 qualify if their family makes up to 138% of the federal poverty level.

CHIP is different. It covers kids only (not parents) whose families make between 139% and 201% of poverty level.

You pay small monthly fees based on what you earn, but it’s way cheaper than buying insurance yourself. Texas gets federal money to run CHIP, so it’s solid and reliable.

Both programs focus on keeping kids healthy with free checkups to catch problems early. CHIP works great for working families where mom and dad both have jobs but the boss doesn’t offer insurance.

If you want to see all the differences, compare with standard Texas Medicaid using our Texas Medicaid overview to find what fits your family best.

CHIP Eligibility for Children

Getting into CHIP Texas is simple if you know the rules. Here’s what your child needs:

Basic Requirements:

• Under 19 years old
• Lives in Texas
• U.S. citizen, national, or legal immigrant
• Family income between 139% and 201% of poverty level

Who Can’t Get CHIP: Undocumented kids don’t qualify. But if you have a mixed family, your citizen kids can still get coverage even if parents can’t.

Good News: There’s no check on what you own—no asset test. CHIP only looks at your family size and monthly income. Pregnant teens under 19 can join too, and coverage continues after the baby is born.

You can apply any time during the year. There’s no waiting period, even if your child has health problems like asthma or diabetes. If you already have insurance from your job, CHIP can work as backup coverage to help pay what your main insurance doesn’t cover.

Important: Check your eligibility every year because your income might change. If your pay goes down, your kids might qualify for children’s Medicaid eligibility instead, which has no fees at all.

Right now, about 600,000 Texas kids use CHIP, but experts say many more families could qualify. Don’t wait—if you’re unsure, just apply. The worst they can say is no.

The 2025 federal shutdown slowed down some applications, but HHS workers are catching up fast.

If your income dropped recently, definitely look into children’s Medicaid eligibility since it might be completely free for your family.

Income Limits for CHIP

Texas CHIP uses 201% of the federal poverty level as the cutoff. This number changes every year to match inflation. For 2025 (through March 31), here’s what you can earn and still qualify:

2025 CHIP Income Limits:

What Counts as Income:

• Wages from jobs
• Child support payments
• Unemployment benefits
• Social Security payments

What You Can Subtract:

• Childcare costs (if you pay someone to watch kids while you work)
• Some disability expenses

These limits are higher than Children’s Medicaid, which stops at 138% of poverty for kids ages 1 to 18. CHIP is the bridge for working parents who earn too much for Medicaid but still struggle to pay for healthcare.

If You Make Too Much: Families over 201% can look at marketplace insurance with tax credits to help pay. Use the HHS calculator at YourTexasBenefits.com to see your exact number after deductions count.

CHIP Perinatal Program

If you’re pregnant and earn too much for regular Medicaid, CHIP Perinatal can help. This special program covers your unborn baby from the start of pregnancy all the way through birth, plus two checkups in the 60 days after delivery.

What Perinatal Covers:

• Up to 20 prenatal visits with your doctor
• All ultrasounds and medical tests
• Medicines you need during pregnancy
• Labor and delivery at the hospital
• Two postpartum checkups for mom

Who Qualifies: Pregnant women up to 202% of the federal poverty level. For example, a mom with one other family member can make up to $3,561 a month and still qualify.

Special Help: The baby doesn’t need citizenship documents to qualify. This helps undocumented moms get prenatal care, which keeps both mom and baby healthier. After birth, your newborn automatically gets 12 months of CHIP or Medicaid coverage.

Why It Matters: Texas has some of the highest maternal death rates in the country. CHIP Perinatal focuses on preventive care to catch problems early and save lives. Most applications get approved in just 15 days—much faster than regular CHIP—so you can start getting care quickly when you need it most.

Covered Benefits for Children

CHIP Texas gives kids complete healthcare coverage, just like expensive private insurance but way cheaper. Here’s everything your child gets:

Medical Care:

• Unlimited doctor visits (no limit on how many times)
• Emergency room visits
• Hospital stays
• Surgery if needed
• X-rays, lab tests, and scans
• Home healthcare for sick kids
• Medical equipment like wheelchairs or nebulizers

Mental Health:

• Therapy and counseling
• Treatment for ADHD, anxiety, depression
• Inpatient mental health care if needed

Prescriptions:

• All medicines your child needs
• Generic and brand-name drugs
• No yearly limit on prescriptions
• Coverage for long-term conditions like asthma or diabetes

Therapies:

• Physical therapy
• Occupational therapy
• Speech therapy
• Allergy shots

Other Services:

• Ambulance rides
• Medical transportation to appointments
• Interpreter services
• Hospice care (in rare cases)

2025 Updates: Telehealth has expanded a lot, especially for rural families. Your child can now see specialists through video visits, making care easier when you live far from big hospitals.

CHIP follows EPSDT rules (Early and Periodic Screening, Diagnostic, and Treatment). This means if your child needs it medically, CHIP covers it—no arguments. For the complete list of what kids get, see covered pediatric services.

Cost-Sharing (Premiums, Copays)

CHIP keeps costs very low compared to private insurance. What you pay depends on how much your family earns. Here’s the breakdown:

Monthly Premiums (Per Child):

Good News: If you have three or more kids, you only pay for two. Native American families pay nothing at all.

Copays (When You Visit the Doctor):

Protection: Your total copays can never go over 5% of your yearly income. If you hit that limit, everything else is free for the rest of the year.

Dental and Vision: Small copays of $10 to $25 for dental work and glasses.

No Deductibles: Unlike private insurance, CHIP has no big deductibles (the thousands of dollars you pay before insurance kicks in). You just pay the small fees listed above.

2025 Help: Because of the federal shutdown and hard economic times, Texas is offering waivers to help families who can’t afford premiums. Ask when you apply.

Application Process

Applying for CHIP is easy. Here’s exactly how to do it:

Three Ways to Apply:

• Online (Fastest): Go to YourTexasBenefits.com and fill out the application. You can upload documents right there or follow our step-by-step guide to apply for CHIP online.
• By Phone: Call 2-1-1 or 877-541-7905. Workers speak English and Spanish and will help you fill out everything.
• In Person: Visit your local HHS office or community health center. Bring your documents with you.

What You Need:

• Pay stubs from the last month
• IDs for everyone (driver’s license, birth certificate)
• Social Security numbers for all family members
• Proof of where you live (utility bill, lease)

How Long It Takes: Most families get an answer in 45 days or less. Pregnant women in the Perinatal program often get approved in just 15 days.

Pick Your Plan: Texas CHIP works through managed care plans like Superior HealthPlan, Community First, or Molina. You’ll choose one when you apply. They all cover the same services, so pick whichever has doctors near you.

After Approval: Your coverage usually starts the first day of the next month. You’ll get a member ID card in the mail within 10 days.

Renewals: You must renew every year. Texas will send you a letter when it’s time. Report any changes to your income or address right away—you can do this online or by phone.

2025 Shutdown Delays: The federal shutdown slowed down some applications. If you haven’t heard back in 45 days, call to follow up. Don’t give up—they’re working through the backlog.

For step-by-step help, see how to apply for children’s coverage with pictures and videos to guide you.

CHIP vs. Children’s Medicaid Comparison

Both programs protect Texas kids, but they work differently. Here’s how to know which one your family needs:

Side-by-Side Comparison:

The Main Difference: Children’s Medicaid is for families with lower income and is completely free. CHIP is for families earning a bit more and has small fees.

What If Your Income Changes? If your pay goes down, you can switch from CHIP to Medicaid easily—no gaps in coverage. If you get a raise and make too much for CHIP, you can look at marketplace insurance.

2025 Changes: After the pandemic, Texas reviewed everyone’s Medicaid eligibility (called “unwinding”). Many families moved from Medicaid to CHIP because their income went up slightly. The good news: No kid loses coverage—they just switch programs.

Both programs cover the same health services for kids: checkups, vaccines, medicines, dental, vision, and mental health. Your child gets great care either way. For a broader picture of how these fit together, you can also review our Texas Medicaid overview.

Dental and Vision Services

CHIP knows that teeth and eyes are super important for kids. Here’s what’s covered:

Dental Coverage:

• Two cleanings per year
• Checkups with the dentist
• X-rays of teeth
• Fillings for cavities
• Sealants to prevent cavities
• Tooth extractions if needed
• Braces for serious bite problems
• Emergency dental care

No Yearly Limit: Unlike some insurance, CHIP dental has no cap. If your child needs a lot of dental work, it’s all covered.

Copays: $10 to $25 per visit depending on your income.

Vision Coverage:

• One eye exam per year
• Glasses or contact lenses if needed
• Frames up to $150
• Repairs if glasses break

2025 Improvements: Texas added more dental and vision providers in rural areas. Now it’s easier to find a dentist or eye doctor near you, even if you don’t live in a big city.

Connected to Checkups: Dental and vision screenings happen during regular well-child visits. This catches problems early, like cavities or vision issues that affect learning at school. For more details, see our full guide to pediatric dental and vision coverage.

Well-Child Visits

Texas Health Steps requires free checkups for all CHIP kids. These visits follow the Bright Futures schedule—a plan recommended by doctors across America.

Checkup Schedule:

What Happens at Checkups:

• Height, weight, and head size (for babies)
• Vision and hearing tests
• Blood tests (like lead screening)
• Developmental checks (is your child meeting milestones?)
• BMI calculation (healthy weight check)
• Parent education (nutrition, safety, sleep tips)
• Vaccines (if due)

Mental Health Screening: Starting around age 11, doctors ask about feelings, stress, and relationships. This helps catch depression or anxiety early.

All Free: Well-child visits have no copays, even for families who pay premiums. Texas wants every kid getting preventive care.

2025 Bonus: Some counties give $10 gift cards to families who bring kids to all scheduled checkups. It’s a small thank-you for keeping kids healthy.

Immunizations

CHIP covers every vaccine the CDC recommends for kids, from birth through age 18. All shots are completely free—no copays ever.

Vaccines Your Child Gets:

• Hepatitis B (birth)
• Rotavirus (2, 4, 6 months)
• DTaP (diphtheria, tetanus, whooping cough)
• Hib (meningitis prevention)
• Pneumococcal (lung infections)
• Polio
• MMR (measles, mumps, rubella)
• Chickenpox
• Hepatitis A
• HPV (prevents cancer, ages 11–12)
• Meningitis (preteens and teens)
• Flu shot (every year)
• COVID-19 (if recommended)

Catch-Up Shots: If your child missed vaccines, CHIP pays to catch them up on the schedule. No judgment—just get them done.

Where to Get Shots:

• During well-child visits
• At community health clinics
• Local health departments
• Some pharmacies (for older kids)

Reminders: Texas sends text messages or app notifications when your child is due for shots. This helps you stay on schedule.

Why It Matters: Vaccines stop dangerous diseases and prevent outbreaks at schools. They keep your child safe and healthy so they don’t miss school days.

Conclusion

Texas CHIP is a lifeline for working families who earn too much for Medicaid but can’t afford expensive private insurance. With nearly 1 million children enrolled and income limits reaching up to $64,752 yearly for a family of four, this program ensures kids get the healthcare they need without breaking the family budget.

What Makes CHIP Special:

• Comprehensive coverage including doctor visits, medicines, dental, vision, and mental health
• Low monthly premiums ($0-$75) based on what you earn
• Copays that never exceed 5% of your yearly income
• No deductibles or yearly limits on care
• Free vaccines and well-child checkups
• Year-round enrollment with no waiting periods

The program works because it’s simple: apply at YourTexasBenefits.com or call 2-1-1, provide income documents, and get approved within 45 days. Even with 2025’s federal shutdown causing temporary delays, HHS continues processing applications and enrolling eligible children.

Don’t Wait: If your family income falls between 139% and 201% of the federal poverty level, your children likely qualify. If you’re unsure whether CHIP or Medicaid is right for your family, check the CHIP income thresholds or review children’s Medicaid eligibility.

Your children deserve access to doctors, dentists, and medicines without financial stress. CHIP delivers exactly that—comprehensive care that keeps kids healthy, catches problems early, and helps them thrive at school and home. With free support available through 2-1-1 and local navigators, you’re not alone in this process.

Take action today. Apply for CHIP, get your kids covered, and give them the healthy future they deserve. Nearly 400,000 more Texas children could qualify but aren’t enrolled yet. Make sure your family isn’t missing out on this valuable benefit.

Frequently Asked Questions: Texas CHIP 2025