CHIP and Other Programs
Beyond Medicaid and Social Security, several other government programs provide health coverage to specific populations. These include CHIP for children, TRICARE for military families, VA healthcare for veterans, and Indian Health Service for Native Americans.
Children's Health Insurance Program (CHIP)
CHIP Overview
| Feature | Details |
|---|
| Created | 1997 (as part of Balanced Budget Act) |
| Purpose | Cover uninsured children in families above Medicaid limits |
| Administration | Joint federal-state program |
| Flexibility | States design within federal guidelines |
CHIP Eligibility
| Requirement | Details |
|---|
| Age | Under 19 |
| Income | Too high for Medicaid, too low for private coverage |
| Income range | Typically 170-400% FPL (varies by state) |
| Citizenship | U.S. citizens or qualified immigrants |
| Residency | State resident |
| Other coverage | Cannot have access to affordable employer coverage |
2025 CHIP Income Limits (Examples)
| State | Income Limit |
|---|
| Highest states | Up to 400% FPL |
| Most states | 200-300% FPL |
| Minimum required | 200% FPL |
CHIP vs. Medicaid for Children
| Feature | Medicaid | CHIP |
|---|
| Income level | Lower income | Higher income |
| Cost-sharing | None or minimal | May have premiums/copays |
| Federal match | Standard FMAP | Enhanced FMAP |
| Benefit package | Comprehensive (EPSDT) | State-designed |
2025 CHIP Updates
| Change | Details |
|---|
| Continuous coverage | Required for 12 months |
| Incarcerated children | States cannot terminate, only suspend |
| Pregnancy coverage | Many states cover through CHIP |
Key Point: CHIP serves as a "bridge" between Medicaid and private insurance, covering children whose families earn too much for Medicaid but cannot afford private coverage.
TRICARE (Military Health)
TRICARE Overview
| Feature | Details |
|---|
| Administered by | Defense Health Agency |
| Serves | Active duty, retirees, and families |
| Eligibility | Registered in DEERS database |
| Coverage | Comprehensive health benefits |
TRICARE Plans
| Plan | Who's Eligible | Network |
|---|
| TRICARE Prime | Active duty (required), others optional | HMO-style, assigned PCM |
| TRICARE Select | Active duty families, retirees | PPO-style, self-referred |
| TRICARE For Life | Medicare-eligible retirees | Medicare supplement |
| TRICARE Young Adult | Dependents 21-26 | Extension coverage |
| TRICARE Reserve Select | Guard/Reserve members | Comprehensive coverage |
TRICARE and Other Coverage
| Situation | TRICARE Role |
|---|
| With employer coverage | TRICARE pays secondary |
| With Medicare | TRICARE For Life supplements Medicare |
| With Medicaid | TRICARE pays before Medicaid |
| With VA benefits | Can use both (different services) |
Active Duty Service Members
| Feature | Details |
|---|
| Cost | No premiums, no cost-sharing |
| Access | Military treatment facilities first |
| Enrollment | Automatic in TRICARE Prime |
| Family coverage | Dependents eligible for TRICARE |
Exam Tip: TRICARE is secondary to all health benefits except Medicaid, Indian Health Service, and other government programs. When a beneficiary has employer coverage, that coverage pays first.
Veterans Administration (VA) Healthcare
VA Healthcare System
| Feature | Details |
|---|
| Operates | VA hospitals and clinics nationwide |
| Eligibility | Veterans with qualifying service |
| Cost | Based on priority groups |
| Scope | Comprehensive medical care |
VA Priority Groups
| Group | Who Qualifies |
|---|
| 1 | Service-connected disability 50%+ |
| 2 | Service-connected disability 30-40% |
| 3 | Former POWs, Purple Heart, severely disabled |
| 4 | Aid and Attendance/Housebound |
| 5 | Low-income veterans |
| 6 | Certain wartime service, specific conditions |
| 7-8 | Higher income, non-service connected |
VA vs. Private Insurance
| Aspect | Details |
|---|
| ACA compliance | VA coverage counts as minimum essential coverage |
| Coordination | VA can coordinate with other coverage |
| Dependent coverage | CHAMPVA for eligible dependents |
| Not insurance | VA provides care, not insurance payments |
CHAMPVA (Civilian Health and Medical Program of the VA)
| Feature | Details |
|---|
| For | Spouses/children of veterans with 100% disability |
| Also for | Survivors of veterans who died from service-connected condition |
| Not for | Those eligible for TRICARE |
| Coverage | Shares costs with beneficiaries |
Indian Health Service (IHS)
IHS Overview
| Feature | Details |
|---|
| Agency | Within HHS |
| Serves | American Indians and Alaska Natives |
| Basis | Treaty and trust responsibilities |
| Facilities | Hospitals, clinics, health stations |
IHS Eligibility
| Requirement | Details |
|---|
| Tribal membership | Member of federally recognized tribe |
| Descendant | Of tribal member (varies) |
| Residency | On or near reservation (for some services) |
| No income test | Based on identity, not income |
IHS and Other Coverage
| Situation | IHS Role |
|---|
| With Medicare | Medicare pays first |
| With Medicaid | Medicaid pays first |
| With private insurance | Private pays first |
| Without other coverage | IHS provides care directly |
Purchased/Referred Care (PRC)
| Feature | Details |
|---|
| Purpose | Care from non-IHS providers |
| When used | Services unavailable at IHS facilities |
| Prior authorization | Usually required |
| Funding | Limited (may have waiting lists) |
Key Point: IHS is the payer of last resort—any other coverage (Medicare, Medicaid, private insurance) pays before IHS. This helps preserve limited IHS funding.
Program Comparison Summary
Quick Reference
| Program | Population | Funding | Payer Priority |
|---|
| Medicaid | Low-income | Federal + State | Last (for dual eligibles) |
| CHIP | Uninsured children | Federal + State | Primary |
| TRICARE | Military families | Defense budget | Secondary to most |
| VA | Veterans | Federal | Can coordinate |
| IHS | Native Americans | Federal | Last resort |
Exam Tip: Understanding payer order is critical—know which program pays first when a person has multiple coverages.