Pennsylvania CHIP Apply Grandchild Without Custody

A child living in your home needs health insurance, and you don't have a court order saying the child is yours. In Pennsylvania, you don't need one. Grandparents and other relatives can apply for CHIP or Medical Assistance for a child in their care without legal custody. Eligibility uses the program's household and income rules; it is not based on the child's income alone.

CHIP vs. Medical Assistance: which one applies

Medical Assistance (MA/Medicaid) covers children in the lowest income brackets. Since most children in informal kinship care have little or no income of their own, many qualify. Medical Assistance provides comprehensive coverage: doctor visits, dental, mental health, prescriptions, hospital care, and more.

CHIP (Children's Health Insurance Program) covers children under 19 who are not eligible for Medical Assistance and don't have other insurance. CHIP comes in three tiers based on household income, ranging from free to low-cost premiums. For kinship families, CHIP catches children who fall above the Medical Assistance threshold but below the CHIP income ceiling.

When you apply through COMPASS, the system evaluates both programs automatically and places the child in whichever they qualify for. You don't need to figure out the right program in advance.

How to apply

Online: Pennsylvania's COMPASS portal (compass.state.pa.us) accepts applications for Medical Assistance, CHIP, SNAP, and TANF. You can apply for the child's health coverage separately from any benefits for yourself.

In person: Visit your local County Assistance Office (CAO). Bring the child's birth certificate, your ID, and proof of the child's living situation (the Section 1302 Sworn Statement you used for school enrollment works well as supporting documentation, though it's not required).

By phone: Call the CHIP hotline at 1-800-986-KIDS (1-800-986-5437) for CHIP-specific applications and questions.

What the application asks about household income

The application asks for household information and before-tax income. The household used for eligibility depends on the program's rules and the child's circumstances, so do not assume that only the child's income counts.

This is different from SNAP, where the child is included in your household's food stamp budget and your income counts. For health insurance, the child is evaluated on their own.

Answer the questions the application asks about household members and income. Do not assume a caregiver's income or other requested household information can be omitted because the child is applying.

Custody is not required

Neither CHIP nor Medical Assistance requires you to have legal custody, guardianship, or any court order. The application asks who the child lives with, and a relative caregiver providing for the child is sufficient to establish the application.

The CAO may ask for proof that the child lives with you. A utility bill with your name and address, the child's enrollment records from the local school, or a Section 1302 Sworn Statement can serve as supporting evidence. If the CAO pushes for a custody order, escalate to the supervisor and reference that informal kinship caregivers are explicitly eligible to apply on behalf of children in their care.

Health coverage while the application processes

CHIP applications generally take four to six weeks to process. During that time, the child may need medical care. Keep the consent and coverage questions separate:

1. Emergency consent is limited by statute. Under Pennsylvania law (35 P.S. § 10104), a physician may provide medical, dental, or health services to a minor without a parent's consent when, in the physician's judgment, trying to obtain consent would delay treatment and increase risk to the minor's life or health. This rule does not guarantee insurance coverage or that care will be free.

2. Retroactive coverage. Medical Assistance can provide coverage for up to three months before the month of application under current rules. Starting January 1, 2027, the limit will be two months for non-expansion recipients, including children. If the child received medical care during an eligible retroactive period, those bills may be covered once the application is approved.

If the child has an immediate medical need that isn't an emergency — a prescription refill, a dental appointment, a therapy session — ask the provider about sliding-scale fees or payment plans while the insurance application is pending. Community health centers that accept uninsured patients are listed through the PA Department of Health.

CHIP and the gratis requirement for school enrollment

Some caregivers worry that receiving CHIP or Medical Assistance for the child might affect the "gratis" requirement under Section 1302 for school enrollment. It doesn't. Public benefits paid for the child's health coverage are not compensation to you for providing room and board. The gratis requirement is about whether someone is paying you to house the child — health insurance for the child is an entirely separate matter.

Next steps after coverage is approved

Once the child has health insurance, you still need a Medical Consent Act authorization (11 P.S. § 2513) from a parent to actually consent to the child's medical care. Having insurance gets the bill paid, but the Medical Consent Act authorization is what gives you the legal authority to approve treatment.

The Pennsylvania School and Medical Consent Guide covers both the insurance application process and the Medical Consent Act authorization — so you can get the child insured and authorized for care in the same push.

See more Pennsylvania guides →