Medicaid Office

Ohio CHIP: Children's Health Insurance Program

Updated August 2026

Ohio's Children's Health Insurance Program (CHIP) operates under the name "Healthy Start." It covers children who don't qualify for Ohio Medicaid because their family income is above the Medicaid limit — but still can't afford private insurance. Apply through Ohio Benefits; the same application determines whether a child qualifies for Medicaid or Healthy Start.

156–206% FPL

Healthy Start income range

Under 19

Age group covered

Ohio Benefits

One application for both programs

Apply for Healthy Start and Medicaid on the same form

Apply for Healthy Start at benefits.ohio.gov — the same Ohio Benefits application used for all Medicaid programs. The system determines whether a child qualifies for Ohio Medicaid or Healthy Start based on income. You don't need to know in advance which program applies. Year-round enrollment is available; there is no open enrollment window for CHIP.

What Healthy Start is and who it serves

Healthy Start is Ohio's implementation of Title XXI of the Social Security Act, enacted in 1997 to extend coverage to children in families that earn too much for Medicaid but too little to realistically buy private health insurance. Ohio operates Healthy Start as a Medicaid expansion CHIP — rather than a standalone program — which means Healthy Start uses Medicaid's rules and delivery infrastructure, with federal CHIP matching funds covering the additional cost.

Children qualify for Healthy Start when their family's income falls between the Ohio Medicaid limit for children (156% FPL) and 206% FPL, and they are not already covered by creditable employer-sponsored insurance. Children at or below 156% FPL qualify for Ohio Medicaid itself, not Healthy Start. The distinction matters primarily for administrative tracking — from a child's perspective, covered benefits are similar in either program. Source: Ohio Medicaid's official "Children, Families, and Pregnant Women" eligibility page (medicaid.ohio.gov). Note: KFF's national CHIP eligibility tracker (as of January 2026) cites a slightly different combined children's upper limit of 211% FPL for Ohio — verify the current threshold directly with Ohio Medicaid before relying on either figure.

Healthy Start covers children through age 18. Age 19 is the cutoff — young adults who previously enrolled in CHIP as teenagers transition to Ohio Medicaid (if they remain income-eligible) or seek marketplace coverage.

EPSDT: why children's coverage is broader than adults'

Children enrolled in Ohio Medicaid receive the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, a federal mandate under 42 U.S.C. § 1396d(r). EPSDT requires Ohio to provide all medically necessary services for enrollees under 21 — not just services that Ohio has chosen to include in its adult benefit package. Dental, vision, hearing, mental health, and developmental services are all covered to the extent they are medically necessary for the child.

EPSDT also includes well-child visits on a schedule aligned with the American Academy of Pediatrics' Bright Futures guidelines — visits at birth, 2 weeks, and then at ages 1, 2, 4, 6, 9, 12, 15, 18, and 24 months, then annually. Providers are expected to screen for developmental delays, vision and hearing problems, and behavioral health conditions at each visit.

When a well-child screening identifies a problem, EPSDT requires treatment — not just a referral. That distinction is significant. An adult on Ohio Medicaid might face coverage limitations for a given service; under EPSDT, a child cannot.

Who qualifies for Healthy Start in Ohio

The Ohio Benefits portal determines the correct program automatically based on the income information you provide; you don't have to figure out which program to apply for separately. Children at or below 156% FPL qualify for full Ohio Medicaid — typically with more generous cost-sharing rules than Healthy Start.

  • Child under age 19
  • Ohio resident
  • Family income above 156% FPL and at or below 206% FPL
  • Not already enrolled in employer-sponsored insurance that meets minimum value standards
  • U.S. citizen or qualified immigrant (lawfully present)

Cost sharing for Healthy Start families

Healthy Start has no premium for most enrolled children — a significant difference from many private plans and even some other states' CHIP programs. Some families at higher income levels within the Healthy Start range may pay small co-pays for certain services; these are capped by federal rules under Title XXI, which prohibits cost sharing that exceeds 5% of a family's gross income for the year.

Preventive services for children — well-child visits, immunizations, developmental screenings — are provided without cost sharing under federal rules. If a Healthy Start provider charges a co-pay for a well-child visit, that's an error; contact your MCO or ODM at 1-800-324-8680.

What Healthy Start covers

Because Ohio operates Healthy Start as a Medicaid expansion CHIP (not a standalone program), Healthy Start enrollees receive the same benefits package as Ohio Medicaid enrollees. Benefits are delivered through the same five managed care organizations.

  • Well-child visits and preventive care
  • Primary care, specialist, and hospital visits
  • Prescription medications
  • Dental care through DentaQuest
  • Vision care — eye exams and eyeglasses
  • Mental health and substance use treatment
  • Emergency and urgent care
  • Physical, occupational, and speech therapy (when medically necessary)
  • EPSDT — all medically necessary services for children under 21

Ohio Healthy Start vs CHIP in neighboring states

Upper income limit

Ohio Healthy Start
206% FPL
Pennsylvania CHIP
317% FPL
North Carolina Health Choice
210% FPL

Program type

Ohio Healthy Start
Medicaid expansion CHIP
Pennsylvania CHIP
Separate CHIP program
North Carolina Health Choice
Separate CHIP program

Monthly premium

Ohio Healthy Start
$0 (no premium)
Pennsylvania CHIP
$0–$115/child
North Carolina Health Choice
Small (income-based)

Dental included

Ohio Healthy Start
Yes (DentaQuest)
Pennsylvania CHIP
Yes (full)
North Carolina Health Choice
Yes

Ohio Medicaid

  • Ohio Benefits application portal: benefits.ohio.gov
  • Ohio Department of Medicaid (ODM): 1-800-324-8680
Visit the official Ohio Medicaid website

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