Child Health Plus (CHP) FAQ

In New York State, if you are employed, your employer may offer health care insurance for your children. 

If not, you can qualify for coverage under Children's Medicaid or Child Health Plus. For more information, see below or call New York State at this toll-free number: 800-698-4KIDS (1-800-698-4543), and ask about Child Health Plus and Children's Medicaid. 

You can also call Fidelis Care directly at 1-888-343-3547.

To be eligible for Child Health Plus, children must be under the age of 19 and be residents of New York State if they don't already have health insurance and are not eligible for coverage under the public employees' state health benefits plan.

For CHP, there is no monthly premium for families whose income is less than 2.2 times the poverty level. 

• That's about $1065 a week for a three-person family, about $1283 a week for a family of four. 
• Families with somewhat higher incomes pay a monthly premium of $15, $30, $45, or $60 per child per month, depending on their income and family size. 
• For larger families, the monthly fee is capped at three children.
• If the family's income is more than four times the poverty level, they pay the full monthly premium charged by the health plan. 
• There are no co-payments for services under Child Health Plus, so you don't have to pay anything when your child receives care through these plans.

Child Health Plus is a New York State program that is administered by a range of health insurance companies, including Fidelis Care. 

• Complete the Contact Form to speak with a qualified Health Representative
• Contact Fidelis Care directly to sign up, at 1-888-343-3547.
  • Our representatives are happy to answer your questions and walk you through the process.

After your child is enrolled in Child Health Plus, you will be given a list of providers near you. The provider may be a single doctor, group practice of several doctors, or community health center. If it is a group practice, you will be asked to choose a doctor for your child.

• Well-child care.
• Immunizations.
• Treatment for illness or injury.
• Inpatient hospital medical or surgical care.
• Short-term physical therapy; occupational therapy.
• Radiation therapy.
• Therapeutic outpatient services (chemotherapy, hemodialysis).
• Inpatient and outpatient treatment for alcoholism and substance abuse, and mental health.
• Prescription and non-prescription drugs if ordered by a physician.
• Emergency care.
• Emergency ground transportation.
• Emergency, preventative and routine dental care. Limited orthodontic services are available for children with a severe medical condition such as cleft lip or cleft palate.
• Preventive and routine vision care (including eyeglasses).
• Speech and hearing services (with limits).
• Durable medical equipment.
• Hospice services.

• To learn about supplemental health services for children, visit the NYS Division of Child Care Services.

• A few examples of such conditions include cerebral palsy, muscular dystrophy, asthma, sickle cell anemia, diabetes, heart conditions, depression, developmental disability, conduct disorder, and autism. 
• For more information, contact Fidelis Care at 1-888-343-3547.

Yes.  If a child marries, they may continue to be covered by their parents' health insurance until they turn 26. If preferred, the child may also be included in a spouse's work-based insurance plan.  According to the Affordable Care Act (ACA), all children under the age of 26 must be covered under family insurance.  Marriage will not alter these rulings.

A court in New York must decide who is responsible forpaying the child's health insurance payments and uninsured medical bills, aswell as who is responsible for providing the child with health insurancebenefits. For more on HealthInsurance Coverage of Minor Child of Divorced Parents

• The parent with the insurance is responsible for paying the premium directly, but the other parent will reimburse that parent for a portion of that amount on whatever terms they choose.
• According to their income, the parents contribute to their health insurance.
• Moreover, health insurance for the child is typically deemed reasonable if it costs less than 5% of the parent's gross income, with the 5% representing the price difference between the individual plan for the parent only and the plan's price when the child is included.

For more information, please visit, Income Withholding for Dependent Health Insurance (Medical Support) - NYSDOH

Income Requirements for NYS CCAP 

Here are the highest incomes a family can make and still be eligible, per NYS DOCCS. Although this information may be useful, families should contact local LSSD to see if they are eligible. Income is simply one consideration for eligibility for child care assistance in the state of New York. Depending on their unique needs, other families might also be eligible.

• Annual Income Limit numbers are 300% Federal Poverty Level (FPL), effective 08/01/22 - 06/01/23.
• For more information, visit New York State's Division of Child Care Services

In early 2021, the online Medicaid Provider Directory for Private Duty Nurses for Medically Fragile Children was made public by the New York State Department of Health.

With the use of the new online tool, family members and caregivers can find nurses in their region who have experience and training in providing care to children and young adults up to age 23 who have medically fragile conditions.

Filters for the Directory include name, license type, and county. It includes a list of private duty nurses and nursing organizations that provide Medicaid participants up to the age of 23 who need ongoing skilled nursing care at home. Children who are medically fragile run the risk of being hospitalized or institutionalized, but they can still be cared for at home with the right home care services. Currently, Medicaid-covered private duty nursing services are provided to 650+ medically fragile children.

Registered nurses (RNs) and licensed practical nurses (LPNs), among other independent providers, who have agreed, subject to their availability, to serve medically fragile children enrolled in fee-for-service Medicaid are eligible providers for the Directory. These providers include Licensed Home Care Services Agencies (LHCSAs) and independent providers.  Participants in the Directory who accept patients will be reimbursed for Medicaid at a higher rate.

• You can see the Directory and learn more about the Private Duty Nursing Program for Medically Fragile Children here.

• For more information on Eligibility and Cost, please visit the New York State Department of Health

• For more on the Transition of Dental and Orthodontia coverage criteria, visit the New York State Department of Health.