The Children’s Health Insurance Program (CHIP), Title XXI of the Social Security Act, was initially passed in 1997 as part of the Budget Balance Act. The program’s main goal is to provide health insurance for uninsured, low-income children in households which make too much to qualify for Medicaid. CHIP has been extended in 2 and 6 year increments throughout the past two decades, and is currently set to expire in 2027. CHIP’s funding requires periodical reappropriation by Congress because legislation has not passed to fund it indefinitely. According to a report by Georgetown University Health Policy Institute, CHIP provides health coverage to 6.8 million people each month, mostly children. For the past decades, the CHIP program along with Medicaid have helped reduce the number of uninsured children by more than 60%.

About CHIP

CHIP is administered by states and jointly funded by the federal government. Each state receives an enhanced federal match for CHIP which is about 15% more than the federal match for Medicaid funding. 

States can design the program based on one of the following program designs: separate CHIP, Medicaid expansion CHIP, or combination CHIP. States with separate CHIP programs can choose among four benefit options: benchmark coverage, benchmark-equivalent coverage, the benefit package used by Florida, New York, and Pennsylvania before the enactment of SCHIP, and secretary-approved coverage. Forty-four states expanded Medicaid/CHIP up to 200% of the federal poverty line or above, and 12 of those states expanded eligibility to at least 300% of the federal poverty line. Besides uninsured children, states have the option to provide coverage for pregnant women through the CHIP program at various stages of pregnancy. States are required to cover dental coverage for children enrolled in the program. States with the Medicaid expansion programs are required to provide the full Medicaid benefit package, including EPS-DT (Early and Periodic Screening, Diagnostic, and Treatment). 

Strengths of the Program

• Receives bipartisan support and support from the public
• Increases coverage gain for children and access to children’s healthcare around the US, especially for children from near-poor family
• Improves the utilization of primary and preventive care as well as the health status of applicants after the enrollment in the program
• Incorporates a core set of quality child health measurement standards, monitoring capabilities, and reporting requirements for states
• Affords states flexibility with respect to implementation as well as encourages new developments in healthcare management for children. 

Weaknesses of the Program

• Federal CHIP funding is capped and not permanent. This financial uncertainty prevents states from making improvements.
• Limits access to children’s hospitals and certain subspecialists due to network restrictions following the enactment of ACA
• Lower retention rates and enrollments rates than expected due to lack of outreach and uncertain funding possibility
• Children are left uninsured for a period of time due to waiting periods and lock-outs in some states.
• Higher cost-sharing requirements and high charges of premiums by separate CHIP programs can diminish access to healthcare.