 Children's Health Insurance Program (CHIP)
The Children's Health Insurance Program (CHIP, formerly the State Children's Health Insurance Program (SCHIP)) was created by the Balanced Budget Act of 1997, enacted Title XXI of the Social Security Act, and has allocated about $20 billion over 10 years to help states insure low-income children who are ineligible for Medicaid but cannot afford private insurance. States receive an enhanced federal match (greater than the state's Medicaid match) to provide for this coverage. In 2007, after President Bush and Congress could not agree on CHIP reauthorization details, the program was extended through March 2009. In February 2009, the Children's Health Insurance Program Reauthorization Act of 2009 was approved by Congress and signed by President Obama. In concert with the signing, President Obama sent a memorandum to CMS requesting that they immediately withdraw the August 17, 2007 Directive sent to state health officials which imposed conditions on states and limited their options to provide coverage to uninsured children. He requested that they implement CHIP from this time forward without these requirements.
Federal Health Reform
President Obama signed the Patient Protection and Affordable Care Act, H.R. 3590, on March 23rd and the Reconciliation Act of 2010, H.R. 4872, on March 30, 2010. (See the combined full text of Public Laws 111-148 and 111-152 here.) Among many provisions, the laws extend the authorization of the federal CHIP program for an additional two years, through September 30, 2015. The laws require states, upon enactment, to maintain current income eligibility levels for CHIP through September 30, 2019. States are prohibited from implementing eligibility standards, methodologies or procedures that are more restrictive than those in place as of March 23, 2010, with the exception of waiting lists for enrolling children in CHIP.
Additional provisions in the health reform package related to CHIP are summarized in the following resources:
NCSL Federal Health Reform Resources
Federal Health Reform webpage
Health Reform and Women, Children and Adolescents: Medicaid and Children's Health Insurance Program (CHIP) Provisions
Health Reform Fact Sheet--Key Provisions That Take Effect Immediately
State Legislative Tracking Database on Health Reform
Additional Federal Health Reform and CHIP Resources
Key Medicaid, CHIP and Low-Income Provisions in the Health Care Reform Package
Center for Children and Families, Georgetown University Health Policy Institute, March 24, 2010
Holding the Line on Medicaid and CHIP: Key Questions and Answers About Health Care Reform's Maintenance-of-Effort Requirements
Center for Children and Families, Georgetown University Health Policy Institute, March 25, 2010
NCSL CHIP Resources
The Children's Health Insurance Program: A Primer for State Legislatures
National Conference of State Legislatures, April 2009
Covering Kids
This State Legislatures magazine article focuses on outreach and enrollment efforts in the states to cover kids.
National Conference of State Legislatures, June 2009
Express Lanes, Premium Assistance and Contingency Funds: The New Provisions in CHIPRA
State Health Notes, National Conference of State Legislatures, June 22, 2009
CHIP Gets Renewed
State Legislatures magazine, National Conference of State Legislatures, April 2009
Children's Health Reform Laws
National Conference of State Legislatures webpage
News and Additional CHIP Resources
Two Year Anniversary of Children's Health Insurance Law Sees Millions of Newly Insured Children, Families
U.S. Department of Health & Human Services, Press Release, February 3, 2011
Arizona Restores its Children’s Health Insurance Program, KidsCare
On March 16, 2010 the Legislature completed its 7th Special Session to address the severe budget shortfall for Fiscal Year 2010. On March 18, 2010, Governor Jan Brewer signed a budget package (including House Bill 2010/Senate Bill 1010) that eliminated the state’s CHIP program, KidsCare, effective June 15, 2010. KidsCare covers children whose families have income between 100 percent and 200 percent of the federal poverty guideline. Enrollment in the program was frozen, effective January 1, 2010 due to insufficient funds.
On March 25, 2010 the Arizona Health Care Cost Containment System (AHCCCS) released a letter to Governor Brewer regarding the impact of federal health reform on the elimination of KidsCare. The letter recognizes that as a result of the maintenance of effort provision in federal health reform, the state will need to restore, at a minimum, the KidsCare program with a freeze on enrollment. The letter specifies that the projected general fund cost to restore KidsCare with an enrollment freeze is $38 million from July 1, 2010 through September 30, 2019. In addition, the Centers for Medicare and Medicaid Services (CMS) notified the state that the elimination of the KidsCare program would be in violation of the federal maintenance of effort provisions and would result in the loss of an estimated $7.8 billion in federal Medicaid funds per year. On May 6, 2010, Governor Brewer signed Senate Bill 1043, restoring the KidsCare program. On May 12, 2010, AHCCCS submitted a letter to CMS to withdrawal the March 18th request to terminate KidsCare. CMS also provided clarification to the state that the continuation of the KidsCare enrollment freeze would not trigger a maintenance of effort violation.
More information:
Arizona Health Care Cost Containment System News and Updates Webpage
Arizona Drops Children’s Health Program, New York Times, March 18, 2010
Governor signs Arizona budget-balancing bills, Business Week, March 18, 2010
Children's Health Insurance Program Reauthorization Act: One Year Later Connecting Kids to Coverage
U.S. Department of Health & Human Services
Sebelius, Vilsack Celebrate One Year Anniversary of Children’s Health Insurance Law, Highlight Campaign to Cover Kids
U.S. Department of Health & Human Services, Press Release, February 4, 2010
States make deep cuts to health
Although states are facing their worst fiscal crisis since the Great Depression, 14 found the dollars this year to increase health coverage for about 250,000 children.
Stateline.org, August 5, 2009
Defying Slump, 13 States Insure More Children
New York Times, July 18, 2009
An Overview of the CHIPRA Outreach and Enrollment Grants
Center for Children and Families, Georgetown University Health Policy Institute, July 2009
$10 Million in Grants Aimed at Enrolling American Indiana, Alaska Native Kids in Health Care to be Awarded
U.S. Department of Health & Human Services, Press Release, November 19, 2009
Secretary Sebelius Awards $40 Million to States to Find, Enroll Children in CHIP, Medicaid
Press Release, U.S. Department of Health and Human Services, September 30, 2009
HHS Secretary Sebelius Announces Availability of $40 Million in Grants to Help Insure More Children
U.S. Department of Health & Human Services, Press Release, July 6, 2009
Additional information: Grants.gov, Full announcement
HHS Secretary Sebelius Announces Release of $6 Billion in New CHIP Funds to Insure Children
U.S. Department of Health & Human Services, Press Release, June 19, 2009
FY 2009 CHIPRA Allotments
- State Health Official Letter, April 17, 2009
- Statement Related to Premium Assistance Provision in CHIPRA Section 311
- State Health Officials Letter, May 11, 2009 Pregnant Women Coverage Option
Pregnant Women Coverage Option Attachment
- State Health Official Letter, August 31, 2009: Medicaid Managed Care Requirements Applied to CHIP Managed Care Delivery Systems
- State Health Official Letter, August 31, 2009: Further Guidance on the Eligibility of Deemed Newborns
- State Health Official Letter, September 3, 2009: Further guidance on CMS policies regarding options for coverage of pregnant women under CHIP
- State Health Official Letter, October 7, 2009: Dental Coverage in CHIP
- State Health Official Letter, October 21, 2009: Guidance on the application of section 1932(c) of the Act (Quality Assurance Standards) to State CHIP managed care programs
- State Health Official Letter, November 4, 2009: Guidance on implementation of section 502 of CHIPRA, the mental health and substance use disorder parity requirements
- State Health Official Letter, December 16, 2009: CHIPRA Performance Bonus Payments
Federal Fiscal Year 2009 State Bonus Payment Awards, Release December 16, 2009
- State Health Official Letter, January 22, 2010: Guidance on CHIPRA Premium Grace Period
- State Health Official Letter, February 2, 2010: Premium Assistance Option
- State Health Official Letter, February 4, 2010: Express Lane Eligibility Option
- State Health Official Letter, February 4, 2010: Prospective Payment System for Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs)
CHIP Tips
A series of implementation briefs called “CHIP Tips” examines new opportunities for covering children following the reauthorization and expansion of CHIP.
The Kaiser Commission on Medicaid and the Uninsured
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Updated May 2010
This site is made possible by project, UC4MC21528, from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, U.S. Department of Health and Human Services.
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