Written by a parent, not a doctor. Nothing here is medical advice.

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New York program

Child Health Plus: children's insurance above the Medicaid line

Child Health Plus is New York's health insurance for children under 19 who cannot get Medicaid.

What it is

Child Health Plus is New York's health insurance for children under 19 who cannot get Medicaid.

Child Health Plus covers children whose household income is above the Medicaid line. Premiums depend on household income, and immigration status does not block coverage. Your child cannot also be enrolled in another health plan.

Eligibility rules
  • Your child must be under 19, uninsured and ineligible for Medicaid.
  • Coverage is available regardless of immigration status when the other conditions are met.
  • Being offered a work plan is not the same as being enrolled in one; an offer alone does not block Child Health Plus. An enrollment assister can confirm this and check any public-employer rule before you decide whether to join the work plan.
What you get
  • Coverage is free or has an income-based premium.
  • Subsidized premiums range from $15 to $60 per child each month.
  • Hospital care, cancer treatment and other covered children's health care.
What the help includes
  • Family monthly premium caps for the four paid bands are $45, $90, $135 and $180.
  • For four people, 400% of poverty is $11,000 monthly in 2026. Above that, the plan charges its full premium.
If you decide to apply
  1. Ask a NY State of Health enrollment assister to compare Child Health Plus plans with you.
  2. Have current household income and any insurance information ready.
  3. Ask the hospital which exact plans cover your child's oncology team before choosing one.

NY State of Health: 855-355-5777; Child Health Plus: 1-800-698-4KIDS · Official page ↗

After you ask
  • The enrollment notice gives the coverage start date and any first premium due.
  • Children generally have a 12-month continuous-coverage period. The enrollment office can confirm the child’s renewal date and how the change to the former birth-to-six extension affects an existing period of coverage.
Good to know

Child Health Plus does not cover months before its start date. Earlier bills need a separate discussion with hospital billing.

Other details
  • Medicaid and Child Health Plus can have different specialist networks even when the insurer's name is the same.
  • Hospital financial assistance or the Excess Income Program may help with earlier bills.

Federal background: CHIP.

Official sources
Ask your social worker

“Would Child Health Plus cover our child's treatment team, and how would its premium compare with our other options? If it fits, could you help us with the application and start date?”

Why I’m asking: We need an affordable plan that covers our child's cancer care when Medicaid does not fit.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Apply, report this month's income and any insurance, pay the first premium if the tier has one, and choose a plan the oncology group takes.

Your social worker

The social worker or enrollment assister files with you and checks the plan network.

The care team

Records and letters when the application asks for them.

Who decides
NY State of Health decides the tier; the Child Health Plus plan runs the coverage.
Ask your social worker
“Our child is over the Medicaid line: can you help us apply for Child Health Plus through NY State of Health and check which plan has our oncology group?”

How to apply

First step: Apply at nystateofhealth.ny.gov or call 855-355-5777 and ask about Child Health Plus. Medicaid is tested first on the same application.

  1. Apply through NY State of Health; Medicaid is tested first and Child Health Plus second.
  2. Pay the first premium promptly if the tier has one.
  3. Check the plan's network for the oncology group before choosing.

Official application / program page ↗

Where it starts: Apply at nystateofhealth.ny.gov or call 855-355-5777 (or 1-800-698-4KIDS) and ask about Child Health Plus.

What to gather

  • This month's income for the tax household
  • Proof the child has no other insurance
  • Child's birth certificate or ID

How long: NY State of Health decides the tier; coverage starts once the first premium (if any) is paid. No back coverage.

What a yes looks like

A notice naming the tier and premium and a plan choice. 12 months of continuous coverage follows.

What a no looks like, and the next move

"Has other insurance" or "Medicaid instead". Both are answers: keep the work plan and add Medicaid behind it, or take the Medicaid enrollment.

Watch out

  • No other health insurance: a child enrolled in a work plan cannot have Child Health Plus. Whether an offer alone bars it was not found; ask NY State of Health.
  • No back coverage: it pays nothing for months before it starts. Unpaid earlier bills go to the hospital financial-assistance law and the Excess Income Program.
  • Over 400% of the poverty line ($11,000 a month for four) the family pays the plan's full premium. The price varies by plan and was not found, so ask each plan.
  • Child Health Plus is available regardless of immigration status when the child meets its other conditions. Ask about the premium for the specific plan and household.

Dates that change this

2026-01-01: Tier tops and premiums are the January 2026 HRA chart.

2026-07-01: From July 1, 2026 Child Health Plus continuous eligibility beyond 12 months no longer applies to children from birth through age six (issuer notice; a NYSDOH handbook clause was not found). (not yet confirmed against the final rule)

2025-06-03: No CHIP waiting period is lawful anywhere after June 3, 2025.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 10, 2026.

What it is worth

Full children's coverage. Free up to 222% of the poverty line ($6,105 a month for four). Then $15 / $30 / $45 / $60 a child a month (family caps $45 / $90 / $135 / $180) up to 400% ($11,000 for four). Full premium above that.

  • $6,105/month — Free tier top, family of 4 (222% FPL)
  • $15/month — Premium per child, 223% to 250% FPL
  • $45/month — Family cap, 223% to 250% FPL
  • $30/month — Premium per child, 251% to 300% FPL
  • $45/month — Premium per child, 301% to 350% FPL
  • $60/month — Premium per child, 351% to 400% FPL
  • $180/month — Family cap, 351% to 400% FPL
  • $11,000/month — Top of the $60 tier, family of 4 (400% FPL)
  • $19 — Age limit
  • $12 (from July 1, 2026 the birth-to-six extension no longer applies) — Continuous coverage once enrolled

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Dental and vision

What it costs the family: Nothing up to 222% of the poverty line. Then $15, $30, $45 or $60 a child a month (capped at three children's worth per family) up to 400%. Above 400% you pay the plan's full premium (the price varies by plan and was not found).

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income tiers
free through 222% FPL; $15 (223-250%); $30 (251-300%); $45 (301-350%); $60 (351-400%); full premium above 400%
Insurance status condition
must have no other health insurance (NYSDOH directory, older page); the employer-offer-only rule and its public-employer exceptions were NOT FOUND
Waiting period
none lawful after 2025-06-03 (CMS); the current handbook wording was not found
Continuous eligibility
12 months; the birth-to-six extension ended 2026-07-01 (issuer notice)
Network
identical Medicaid/CHP specialist networks NOT VERIFIED

Decisions this site cannot make: NY State of Health eligibility and tier

Expect friction on: Premium due monthly · Plan network check

The trap: Child Health Plus pays nothing for months before it starts and requires no other insurance. Do not drop a work plan expecting it to pick up old bills.

Where I read this

← Back to your options