CHIPRA Notice Template

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Employers that maintain a group health plan in a State that provides premium assistance under Medicaid or CHIP must notify all employees annually of potential opportunities for premium assistance in the State in which the employee resides.

In prior years, we’ve been asked if the Health Care Authority (HCA) will distribute the Employer CHIP Notice on behalf of SEBB Organizations. Employers are required to provide the Employer CHIP Notice to all school employees, not just to those school employees who are eligible and enrolled in the employer’s group health plan. Since the HCA does not have information for all of your employees, the HCA will not distribute this notice on your behalf for 2022.

A model Employer CHIP Notice is available on the EBSA Website at The model notice includes State contact information for States that provide Medicaid or CHIP premium assistance programs. This contact information will be updated periodically; therefore, be sure to check the EBSA Website for the most recent version.

We have also drafted a memo for your use in notifying your school employees they may qualify for health care coverage through the Washington Apple Health (Medicaid) program.

If you need assistance or have questions, you can contact EBSA electronically or call toll free to speak to a benefits administrator at 1-866-444-3272.