California CHIP: Children's Health Insurance Program

Updated August 2026

California's CHIP program is a Medicaid expansion, funded by federal Title XXI (CHIP) dollars but administered entirely within Medi-Cal. Children enrolled through this route are full Medi-Cal members — they receive the same benefits, use the same managed care plans, and follow the same application process as all other Medi-Cal enrollees.

266% FPL

Statewide Medi-Cal (CHIP) income limit

OTLICP

California's CHIP program name

322% FPL

Bay Area (CCHIP) income limit

California does not have a separate CHIP application

California folded its separate CHIP program (Healthy Families) into Medi-Cal in 2013. Children who would qualify for CHIP in other states are enrolled directly in Medi-Cal in California, through a program called the Optional Targeted Low-Income Children's Program (OTLICP). The benefits and application process are the same as standard Medi-Cal.

How California covers children: Medi-Cal as a CHIP expansion

Approximately 1.4 million California children are enrolled in Medi-Cal through the CHIP-funded category at any given time; over 2 million children and pregnant individuals are served over the course of a year, per the Children's Defense Fund. In federal fiscal year 2018, California's OTLICP had 1,896,403 enrolled children, per the National Academy for State Health Policy — making it the largest state CHIP program in the country by enrollment.

When a family applies through BenefitsCal or Covered California, the eligibility system automatically determines which program applies based on income. Families do not need to know whether a child qualifies for the MAGI-based Medi-Cal category or the CHIP-funded category — the system routes them correctly.

Who qualifies for Medi-Cal (CHIP) in California

Children in California qualify for Medi-Cal if they meet these requirements. Children in San Francisco, San Mateo, and Santa Clara counties are eligible up to 322% FPL — well above the statewide 266% ceiling — through the County Children's Health Initiative Program (CCHIP), with a small monthly premium in those counties.

Age: under 19 (up to but not including the 19th birthday)
California resident
Household income at or below 266% of the Federal Poverty Level — approximately $87,780/year for a family of four (2026)
All income-eligible children qualify regardless of immigration status — California covers undocumented children using state-only funds
No disqualification for having employer-sponsored insurance available, in most cases

Premiums and copays for Medi-Cal children

Most children enrolled in Medi-Cal pay no premium and no copays. For children in the CHIP-funded income range (above the base Medi-Cal threshold), California charges small monthly premiums at higher income levels.

Income range	Monthly premium	Copays
0–160% FPL	None	None
160%–266% FPL	$13–$39/family	None (no office visit, Rx, or inpatient copays)
266%–322% FPL (CCHIP counties only)	$21–$63/family	None

0–160% FPL

Monthly premium: None
Copays: None

160%–266% FPL

Monthly premium: $13–$39/family
Copays: None (no office visit, Rx, or inpatient copays)

266%–322% FPL (CCHIP counties only)

Monthly premium: $21–$63/family
Copays: None

Infants under age 1 in households up to 261% FPL pay no premium. Premiums are per family, not per child. Emergency services cannot be denied due to unpaid premiums.

What Medi-Cal covers for children

Children enrolled in Medi-Cal receive coverage under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) mandate, which requires all medically necessary services to be covered for enrollees under 21. This is a significantly broader standard than adult Medi-Cal.

Well-child checkups at all federally recommended intervals
Sick visits and specialist referrals
Inpatient and outpatient hospital care
Emergency room and urgent care
Prescription drugs covered by the Medi-Cal formulary
Mental health and substance use disorder services
Dental care through Medi-Cal Dental (Denti-Cal) — comprehensive coverage with no annual cap, including orthodontia for qualifying children
Vision care — eye exams, glasses, and contact lenses when medically necessary
Physical, occupational, and speech therapy when medically necessary
Durable medical equipment and medical supplies

Express Lane Eligibility: auto-enrollment from CalFresh

California uses Express Lane Eligibility (ELE). Families already receiving CalFresh (SNAP) benefits can have their children automatically enrolled in or renewed for Medi-Cal without a full separate application. The CalFresh eligibility data is used directly to determine Medi-Cal eligibility.

If your family receives CalFresh and you have children who are not yet enrolled in Medi-Cal, contact BenefitsCal or your county social services office to check whether your children qualify through ELE. The process is typically faster than a standard application.

What CHIP is nationally

CHIP — the Children's Health Insurance Program — was created by Congress in 1997 under Title XXI of the Social Security Act. It was designed to cover children in families whose income is too high for Medicaid but too low to afford private insurance. CHIP is jointly funded by the federal government and each state.

States can run CHIP as a standalone program, as a Medicaid expansion, or as a combination. California chose the Medicaid expansion model in 2013 when it merged its standalone Healthy Families program into Medi-Cal. Children who would qualify for CHIP in other states are enrolled in Medi-Cal in California — same benefits, same managed care plans, same application process.

How to apply

Apply once at BenefitsCal.com or through Covered California. The eligibility system determines which program each household member qualifies for. There is no separate CHIP application in California. A single application evaluates every household member for all applicable programs — Medi-Cal, CHIP (OTLICP), CalFresh, and others.

If your child is denied coverage

A denial must state the reason and explain your right to appeal. You have 90 days from the denial date to request a State Fair Hearing. Common denial reasons include income documentation not received, residency verification missing, or a household size question unresolved.

If your child was denied but you believe they qualify, reapply with complete documentation before pursuing a hearing — many denials are resolved faster this way.

Medi-Cal

BenefitsCal (apply): benefitscal.com
Covered California: coveredca.com
BenefitsCal support line: (844) 859-2100

Visit the official California Medicaid website