Medicaid CHIP Notice

The Medicaid and CHIP (CHIPRA) notice tells employees about possible state premium assistance for their health coverage and where to find state-specific help. Required annually, with an updated DOL model notice each year.

See the Step-by-Step ProcessView Model Notice
What A notice informing employees that some states offer Medicaid/CHIP premium assistance that may help pay for employer-sponsored coverage, and how to contact those programs.
Who Employers that maintain a group health plan and have employees in any state that offers Medicaid/CHIP premium assistance. Provide to all employees, enrolled or not.
When At new hire and at least annually (most employers include it with Open Enrollment materials).
Risk Up to $145 per employee per day for failure to provide the notice (2026 rate, adjusted annually for inflation under ERISA civil monetary penalty rules). Keep the state contact list current; using an outdated model notice version is a common compliance gap.
Hire
New hire / eligibility

At or before the enrollment opportunity, in your new-hire benefits packet.

Annual
Annual reminder

At least once each plan year, best bundled with Open Enrollment materials.

60
Special enrollment

Employees have up to 60 days to enroll after a Medicaid/CHIP loss or premium-assistance event.

Trigger Due Date / Window Notes
New hire / initial eligibility At or before enrollment opportunity Include in your new-hire benefits packet.
Annual reminder At least once each plan year Best practice: bundle with Open Enrollment materials.
Medicaid/CHIP special enrollment Employee has up to 60 days to enroll in the group plan Triggered when an employee or dependent loses Medicaid/CHIP coverage or becomes eligible for premium assistance. Spell out how to request enrollment (form, portal, or email).
Trigger: New hire / initial eligibility
Window: At or before enrollment opportunity
Notes: Include in your new-hire benefits packet.
Trigger: Annual reminder
Window: At least once each plan year
Notes: Best practice: bundle with Open Enrollment materials.
Trigger: Medicaid/CHIP special enrollment
Window: Up to 60 days to enroll in the group plan
Notes: Triggered by loss of Medicaid/CHIP or premium-assistance eligibility. Spell out how to request enrollment.
  • Model notice: See the Model Notice section below, the DOL's ready-to-use Word template with all state contacts pre-filled.
  • Employer details: Your plan administrator name and contact, plus your process for submitting special enrollment requests (email address, portal link, or form name).
  • Employee locations: The states where your employees reside, so you know which state contacts are most relevant, though distributing the full national list is also acceptable.
  • Languages: English is required; the DOL CHIPRA resource page includes Spanish-language versions of the model notice if your workforce needs them.
1
Download the model noticeGet the current DOL CHIPRA model notice (Word version) from the Model Notice section below. Check the version date; the DOL updates it periodically as state contacts change.
2
CustomizeInsert your plan administrator contact information and your process for requesting special enrollment. Employees have 60 days from a qualifying Medicaid/CHIP event to enroll in your group plan.
3
Verify state contactsThe model notice covers all states; no editing required unless you want to trim the list to only the states where your employees reside.
4
DistributeAdd to your new-hire benefits packet and send annually to all employees (paper or compliant e-delivery, enrolled or not).
5
File itSave the exact version used with a date stamp and retain your distribution proof (see Proof & Recordkeeping).
  • Audience: All employees, regardless of health plan eligibility or enrollment status.
  • Method: Paper mail or electronic delivery. If using email or a benefits portal, follow ERISA's e-disclosure safe harbor rules (employees must have consented or meet the electronic access criteria).
  • Format: Written in a manner calculated to be understood by the average employee. Use the current version of the model notice and make the special enrollment request path clear and easy to act on.
  • Notice versionA copy of the exact notice version distributed, including the state contacts page (date-stamped).
  • New-hire logEmployee name, date notice provided, delivery method.
  • Annual distribution recordsMailing list, date sent, and delivery method. For paper mailings, retain a Certificate of Mailing (USPS Form 3817) as proof of dispatch; certified mail is not required.
  • E-delivery recordsPortal access timestamps or email delivery confirmations.
  • Returned-mail logAnd re-mail dates for any undeliverable notices.

Common traps

Sending only to enrolled employees: All employees must receive the notice, regardless of whether they participate in the health plan.
Using an outdated model notice: The DOL updates the state contact list periodically; check the version date each year before distributing.
Not explaining special enrollment: Not telling employees how to request special enrollment or what the 60-day window means defeats the purpose of the notice.

FAQs

Who should receive the CHIP Notice?
All employees, whether or not they're enrolled in your health plan.

When should it be distributed?
At hire and at least annually. Most employers include it with Open Enrollment materials, which satisfies the annual requirement.

Do we have to customize it state by state?
No. The DOL model notice includes contacts for all states; you only need to add your plan administrator contact and your special enrollment request process. You can trim the state list to just your employees' states, but distributing the full list is also acceptable.

What's the penalty for not providing it?
Up to $145 per employee per day under ERISA civil monetary penalty enforcement (2026 rate, adjusted annually for inflation). The practical risk is low if you're distributing it consistently, but it's a real penalty, not a theoretical one.

  • Multi-state workforce: The DOL model notice includes all states, so distributing the full list to all employees is the simplest approach; no need to segment by state.
  • Language access: Add translations for languages common in your workforce. The DOL CHIPRA resource page includes Spanish-language versions of the model notice.
  • Self-funded vs. insured: The notice requirement applies regardless of funding arrangement. If you use a TPA or carrier, confirm they are not separately distributing the notice on your behalf to avoid gaps or duplicates.

The DOL provides a ready-to-use model notice with all state contacts already included: download, fill in two fields, and distribute.

  • DOL Model CHIPRA Notice, Word (recommended): Download model-notice.doc. Open in Word, insert your plan administrator contact information and special enrollment request process, then print or email to all employees.
  • DOL Model CHIPRA Notice, PDF (reference): Download model-notice.pdf. Use this to review the required language and current state contacts before customizing the Word version.

What to fill in: The state contacts and program descriptions are pre-filled by the DOL. You only need to add (1) your plan administrator name and contact information, and (2) how employees should submit a special enrollment request: email address, portal link, or form name.

Re-download annually: The DOL updates state contacts each year. Re-download a fresh copy before each annual distribution rather than reusing a saved version.