California CHIP: children's health coverage through Medi-Cal

Last verified: June 2026

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

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.

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:

• 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 (confirmed: National Academy for State Health Policy)
• No disqualification for having employer-sponsored insurance available, in most cases

Bay Area exception: Children in San Francisco, San Mateo, and Santa Clara counties are eligible up to 317% FPL — well above the statewide 266% ceiling — through the County Children's Health Initiative Program (CCHIP). A small monthly premium applies in those counties: $13 per child per month, up to $39 per family.

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:

Source: NASHP California CHIP Fact Sheet; Covered California cost schedule. 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. Per Covered California and federal EPSDT requirements, children's coverage includes:

• 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.

CHIP background: what it 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.

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.

For free application help, call BenefitsCal support at (844) 859-2100 or visit your county social services office.