For more than a decade, states have provided low-income children with health insurance coverage through the Children's Health Insurance Program (CHIP). CHIP—a state-federal partnership—was created as part of the Balanced Budget Act of 1997 to bridge the safety net gap for low-income children who do not qualify for Medicaid but whose families cannot afford insurance. In February 2009, the Children’s Health Insurance Program Reauthorization Act (CHIPRA) extended the program, and it was extended again by the Affordable Care Act through September 2015. Despite current state budget challenges, ensuring children’s access to health care remains a priority in a number of states. In recent years, most states have maintained or increased eligibility levels under CHIP and improved their eligibility process. In addition, many states have focused on outreach efforts to enroll eligible children.